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Lookup NU author(s): Dr Kenneth Taylor, Dr David Swan, Dr Arthur Affleck, Professor Nick ReynoldsORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2017 British Association of Dermatologists. Background: Little is known about U.K. dermatologists' treatment approaches towards adult patients with recalcitrant moderate-to-severe atopic eczema. Objectives: We wanted to learn about (i) treatment approaches used for this disease in the U.K.; (ii) factors that influence treatment decisions and (iii) perceived gaps in evidence on treatment safety and efficacy, and priorities for future trials. Methods: We conducted an online survey of consultant-level dermatologists in the U.K. Results: Sixty-one respondents from over 30 centres reported on management of moderate-to-severe atopic eczema in adults, outwith the context of an acute flare. Phototherapy or psoralen-ultraviolet A was the most common therapeutic modality chosen first line (46%), and this was usually narrowband ultraviolet B. Systemic therapy was chosen as a first-line approach by 36% of dermatologists. Azathioprine was the commonest drug reported being used as first line followed by oral corticosteroids, ciclosporin and methotrexate. Methotrexate was the most common second-line treatment of respondents. The key factors that influenced decision making on the use of phototherapy and systemic agents were the respondent's clinical experience, results of baseline tests (systemic agents) and knowledge of both efficacy and acute and chronic side-effect profiles. The most important evidence gaps identified were the relative effectiveness of treatments, the alternatives to current approaches and the safety of long-term maintenance treatment. With regard to future trials, respondents suggested that priority should be given to studies involving methotrexate. Conclusions: While survey study designs have limitations, we found that phototherapy, in particular narrowband ultraviolet B, was respondents' preferred first-line treatment for adults with recalcitrant moderate-to-severe atopic eczema, perhaps reflecting access to, and clinical experience of, this approach. Azathioprine is widely used as a longer-term maintenance treatment.
Author(s): Taylor K, Swan DJ, Affleck A, Flohr C, Reynolds NJ
Publication type: Article
Publication status: Published
Journal: British Journal of Dermatology
Year: 2017
Volume: 176
Issue: 6
Pages: 1617-1623
Print publication date: 01/06/2017
Online publication date: 11/12/2016
Acceptance date: 01/12/2016
Date deposited: 03/05/2017
ISSN (print): 0007-0963
ISSN (electronic): 1365-2133
Publisher: John Wiley & Sons Ltd
URL: https://doi.org/10.1111/bjd.15235
DOI: 10.1111/bjd.15235
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