Patterns of Clinical Management of Atopic Dermatitis: A Survey of Three Physician Specialties in the Middle East

Abstract

Introduction: Atopic dermatitis (AD) is a complex inflammatory disease of the skin that has a significant impact on the well-being of patients and their families. The prevalence of AD has increased in developing countries and regions, including the Middle East. Despite similarities in the presentation of the disease, there is a lack of consistent management and treatment guidelines for AD. The objective of this survey was to develop further insight into the management patterns of AD from dermatologists, pediatricians, and primary care/family medicine physicians in the Middle Eastern nations of Egypt, Lebanon, the United Arab Emirates, and Saudi Arabia. Methods: The survey was composed of 47 closedended, multiple-choice questions. These questions assessed physician and patient characteristics and treatment familiarity and approach. Results: A total of 400 physicians, including 200 dermatologists, 100 pediatricians, and 100 primary care physicians, participated in the survey. The findings provide insight into the management of AD by physician specialty within the region. A diverse array of management approaches was observed for both referral patterns and treatments for AD in the Middle East. Conclusion:The diversity of management tactics highlights the lack of a standard approach for the management of AD throughout the Middle East.

Burden of Disease and Unmet Needs in the Diagnosis and Management of Atopic Dermatitis in the Arabic Population of the Middle East

“…A study by Ammoury et al evaluated the management strategies of physicians in Egypt, Lebanon, UAE, and Saudi Arabia and found that there is a significant variation in types of treatments used, referral patterns, and treatment familiarity [2]. This study highlights the lack of a standardized approach to AD management in many countries in the Middle East.…”

“…Historically, the prevalence of AD throughout the Arab Middle East has been lower than North America and Europe; however, AD prevalence is increasing in the region due to many factors potentially including increasing urbanization and pollution [2]. Due to the large environmental, socioeconomic, and sociocultural heterogeneity of the Arab Middle East, prevalence varies greatly across and within countries.…”

“…Patients with moderate-to-severe disease requiring targeted therapies may decline treatments due to cost or if insurance coverage is not available. Regional differences in accessibility to specialized dermatologists, care availability, and cost further compound the situation; and in less affluent countries and with patients with lower socioeconomic status, there will be challenges with access and continuity of care and treatment adherence [2,29]. In many regions of the Middle East, healthcare systems are limited and ineffective.…”

“…In the Arab Middle East, there is a lack of consistent diagnostic and management guidelines that consider regional risk factors and differences in climate and environment, socioeconomics, treatment availabilities, diet and lifestyle, and patient skin types, as well as integrating local cultural and treatment practices. Current guidelines derived from European and North American populations may not be suitable for Arab Middle Eastern patients [2]. Biologic medications and other newer therapies referenced in existing AD guidelines may not be approved in the country of interest [6].…”

“…This study highlights the lack of a standardized approach to AD management in many countries in the Middle East. Many of the surveyed physicians were also unfamiliar with many of the newer AD treatments, such as crisaborole, or inadequately utilized treatments [2]. Previous studies have shown that patients with AD in this population often receive ineffective or inappropriate care, such as oral antihistamines, oral corticosteroids, or traditional medicines and remedies.…”