Strengths and limitations of evidence-based dermatology

Abstract

The need for understanding and reflecting on evidence-based dermatology (EBD) has never been greater given the exponential growth of new external evidence to inform clinical practice. Like any other branch of medicine, dermatologists need to acquire new skills in constructing answerable questions, efficiently searching electronic bibliographic databases, and critically appraising different types of studies. Secondary summaries of evidence in the form of systematic reviews (SR), that is, reviews that are conducted in a systematic, unbiased and explicit manner, reside at the top of the evidence hierarchy, because they are less prone to bias than traditional expert reviews. In addition to providing summaries of the best external evidence, systematic reviews and randomized controlled trials (RCTs) are also powerful ways of identifying research gaps and ultimately setting the agenda of future clinical research in dermatology. But like any paradigm, EBD can have its limitations. Wrong application, misuse and overuse of EBD can have serious consequences. For example, mindless pooling together of data from dissimilar studies in a meta-analysis may render it a form of reductionism that does not make any sense. Similarly, even highly protocolised study designs such as SRs and RCTs are still susceptible to some degree of dishonesty and bias. Over-reliance on randomized controlled trials (RCT) may be inappropriate, as RCTs are not a good source for picking up rare but important adverse effects such as lupus syndrome with minocycline. A common criticism leveled against SRs is that these frequently conclude that there is lack of sufficient evidence to inform current clinical practice, but arguably, such a perception is grounded more on the interpretation of the SRs than anything else. The apparent absence of evidence should not paralyze the dermatologist to adopt a state of therapeutic nihilism. Poor primary data and an SR based on evidence that is not up-to-date are also limitations that can only improve with better primary studies and updated reviews such as those done by the Cochrane Collaboration. Most dermatologists are interested in integrating the best external evidence with the care of individual patients and have been practicing good EBD without realizing it.

A Systematic Scoping Literature Review of Publications Supporting Treatment Guidelines for Pediatric Atopic Dermatitis in Contrast to Clinical Practice Patterns

“…This may be related to the fact that clinical practice patterns are often not completely evidence-based, but driven by medical training, individual experience, and institutional “norms”. This makes change difficult and also delays and interferes with introduction of innovative treatments into guidelines and practice [ 293 ]. Finally, standardized data are needed to support the treatments that are actually used in clinical practice, especially those used in younger children and for long-term treatment and severe disease.…”

Using Implementation Science to Optimize the Uptake of Evidence-Based Medicine into Dermatology Practice

“…Barriers to conducting implementation or deimplementation studies in dermatology include a lack of understanding of the utility and methods for conducting this type of research, the misconception that simply generating evidence is enough to change clinical practice, and the need for a more robust evidence-base within the field grounded in randomized controlled trials and comparative effectiveness studies that can better define the gap between evidence and current care (Romero-Pérez et al, 2016;Williams, 2014Williams, , 2013Williams and Dellavalle, 2012). Based on published literature and the coauthors' experiences in the research field, our goal in this article is to provide a broad overview of implementation science for dermatologists, review key methods and frameworks, and highlight resources and funding opportunities with the goal of paving the path for future implementation studies in dermatology.…”

The Assessment of Dermatology Clinical Research in Saudi Arabia

“…In dermatology practice, reliance on research is essential as it is a rapidly growing medical science. Evidence-based dermatology aids in being systematic and explicit, keeping up to date with increasing precision and minimizing bias [ 2 ].…”