Patient Journey in Atopic Dermatitis: The Real-World Scenario

Abstract

Introduction:The diagnosis and management of atopic dermatitis (AD) is extensively addressed in detailed clinical guidelines. However, the high heterogeneity regarding presentation and progression and the increasingly broad therapeutic landscape suggest a complex real-world scenario, leading to multiple trajectories of AD patients. Methods: Using a Delphi methodology for assessing the degree of consensus, we explored the views of a panel of dermatologists regarding the patients' trajectory through the diagnosis (block 1), treatment (block 2), and long-term management (block 3) of AD. Based on a systematic search of the literature, a scientific committee prepared a questionnaire of relevant items that were rated on a 10-point scale (from ''totally agree'' to ''totally disagree'') by a panel of dermatologists attending patients with AD in the hospital setting. Consensus was established based on predefined rules. Results: The final questionnaire included 58 items and was answered by 17 dermatologists. Overall, consensus was reached on 22 items (37.9%), each of which was a consensus for agreement. The consensus rates in blocks 1, 2, and 3 were 22.7%, 19.0%, and 86%, respectively. Conclusions: Our analysis revealed a remarkable lack of consensus on various aspects of the routine diagnosis and treatment of AD. These findings suggest the presence of unmet needs or limited implementation of guidelines for the management of AD and encourage further research to explore the causes of this low consensus on the management of AD in the realworld setting.

The journey of patients with skin diseases from the first consultation to the diagnosis in a representative sample of the European general population from the EADV burden of skin diseases study

“…18,19 Patient journey in acne has been recently explored in The Netherlands, 20 where 58 different pathways through the healthcare system were described, showing that standardized patient pathways across different levels of care and specialisms are lacking. An analysis of the patient journey in atopic dermatitis 21 reported a lack of consensus on patients' trajectory through diagnosis, treatment, and long-term management. In some particular diseases, the pathway may be treacherous, as, for example, in hidradenitis suppurativa, 8 where diagnostic delay is often protracted and treatment complex.…”

A Multidisciplinary Approach Is Beneficial in Atopic Dermatitis

“…In the case of AD, the multidisciplinary teams must be coordinated by a dermatologist, as only specialists from this clinical speciality have the skills needed to diagnose AD, which is a skin condition, and define the patient's treatment targets [3,41]. The work of a multidisciplinary team has to result in an agreed treatment plan, avoid contradictory advice and lead to better control of AD and its co-morbidities.…”

“…Scaling, fissuring and lichenification occur in the chronic phase [1]. The heterogeneity of the disease leads to the co-existence of multiple trajectories of disease presentation and history [3]. The AD severity can range from minimal flexural eczema (e.g.…”

Dermatologists' perspectives on healthcare of patients with atopic dermatitis: A cross‐sectional study in Germany

“…To improve healthcare of affected individuals, it is necessary to gain a comprehensive overview of people's usage of medical services. Although patients consult a variety of physicians, the majority is treated by dermatologists 11,12 . Therefore, the study aimed to assess the healthcare of patients with AD in Germany from the perspective of practice‐based dermatologists.…”

“…Although patients consult a variety of physicians, the majority is treated by dermatologists. 11,12 Therefore, the study aimed to assess the healthcare of patients with AD in Germany from the perspective of practice-based dermatologists.…”