Volume 61, Issue 1 pp. 23-32
Original Research

Atopic dermatitis in adults: An Australian management consensus

Saxon Smith

Corresponding Author

Saxon Smith

Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia

Department of Dermatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia

Correspondence: Saxon Smith, Dermatologist, The Dermatology and Skin Cancer Centre, University of Sydney, Gosford, NSW, Australia. Email: [email protected]Search for more papers by this author
Christopher Baker

Christopher Baker

Department of Dermatology, St Vincent's Hospital, Melbourne, Victoria, Australia

The University of Melbourne, Melbourne, Victoria, Australia

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Kurt Gebauer

Kurt Gebauer

Fremantle Dermatology, Fremantle, Western Australia, Australia

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Diana Rubel

Diana Rubel

Woden Dermatology, Canberra, Australian Capital Territory, Australia

The Canberra Hospital, Canberra, Australian Capital Territory, Australia

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Brad Frankum

Brad Frankum

Campbelltown Hospital, School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia

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H. Peter Soyer

H. Peter Soyer

Dermatology Research Centre, Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia

Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia

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Warren Weightman

Warren Weightman

Department of Dermatology, Queen Elizabeth Hospital, Adelaide, South Australia, Australia

Dermatology on Ward, North Adelaide, South Australia, Australia

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Michael Sladden

Michael Sladden

Department of Dermatology, University of Tasmania, Launceston, Tasmania, Australia

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Morton Rawlin

Morton Rawlin

Macdeon Medical Centre, Lower Templestowe, Victoria, Australia

Sydney University, Sydney, New South Wales, Australia

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Alexander P. Headley

Alexander P. Headley

Department of Clinical Immunology/Allergy, Concord Repatriation General Hospital, Sydney, New South Wales, Australia

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Colin Somerville

Colin Somerville

The Allergy West Clinic, Perth, Western Australia, Australia

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Julie Beuth

Julie Beuth

YourGP@Crace Medical Centre, Crace, Australian Capital Territory, Australia

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Nick Logan

Nick Logan

Nick Logan Pharmacist Advice, Artarmon, New South Wales, Australia

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Erin Mewton

Erin Mewton

Department of Dermatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia

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Peter Foley

Peter Foley

Department of Dermatology, St Vincent's Hospital, Melbourne, Victoria, Australia

The University of Melbourne, Melbourne, Victoria, Australia

Skin and Cancer Foundation Inc, Melbourne, Victoria, Australia

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First published: 01 August 2019
Citations: 17
Saxon Smith, FACD. Christopher Baker, FACD. Kurt Gebauer, FACD. Diana Rubel, FACD. Brad Frankum, FRACP. H. Peter Soyer, FACD. Warren Weightman, FACD. Michael Sladden, FACD. Morton Rawlin, FRACGP. Alexander P. Headley, FRACP, FRCPA. Colin Somerville, FRACP. Julie Beuth, FRACGP. Nick Logan, BPharm. Erin Mewton, CNC. Peter Foley, FACD.
Conflict of Interest: SS, PF, CB, KG, DR and BF received an honorarium from Sanofi Genzyme Australia Pty Ltd for their involvement in an initial working group to determine the parameters of this research project. The authors were responsible for all content, interpretation of the data and the decision to publish the results; they received no honoraria related to the development of this manuscript. The authors confirm independence from the sponsor. Sanofi Genzyme Australia Pty Ltd markets dupilumab (Dupixent®). The sponsor was given the opportunity to review the manuscript prior to submission, but has not influenced the content of the article. SS, KG, DR, AH, PF and EM have received honoraria from Sanofi Genzyme (Australia) for advisory board participation. CB, DR, KG and PF have received research support and funding from Sanofi Genzyme (Australia). AH has received speaker fees from Sanofi Genzyme (Australia). MS has received sponsorship from Sanofi Genzyme (Australia) to attend a conference. All other authors declare that they have no conflict of interest. SS has received honoraria from Pfizer (Australia) for advisory board participation and has been a Principal Investigator for clinical trials with AbbVie. PF and KG have received honoraria from AbbVie, Leo Pharma, Lilly, Novartis and Pfizer (Australia) for advisory board participation. PF has received research support and funding from AbbVie, Leo Pharma, Lilly, Novartis and Pfizer. DR has received research support and provided consultation services for AbbVie, Botanix, Leo Pharma, Lilly, Novartis and Pfizer. WW has received honoraria from AbbVie, Leo Pharma, Novartis, Lilly, Pfizer and Mayne Pharma for advisory board participation. BF, NL, MR, CS, JB, MS, HPS and WW report having no conflicts to declare.
A/Prof Saxon Smith accepts full responsibility for this work, had access to the data and controlled the decision to publish.

Abstract

Background/Objectives

Atopic dermatitis (AD) has significant negative impact on health-related quality of life, mood, sleep, work productivity and everyday activities. Research into the use of new drugs in the management of AD continues to develop, and international updates and recommendations have been published. However, questions remain in the Australian setting. This consensus aims to provide evidence-based insights and practical advice on the management of adult AD in Australia.

Methods

A panel (five dermatologists and one clinical immunologist) met to review the literature, critically examine clinical questions of relevance to Australian healthcare practitioners and develop a series of recommendation statements. A consensus panel, comprising the initial panel plus nine additional members, used a 2-round Delphi voting process to determine a set of final guidance statements. Consensus: ≥75% agreement in the range 7–9.

Results

Round 1 voting comprised 66 guidance statements. Of these, consensus was reached on 26, which were retained, and five were removed. The remainder (35) were modified and one new guidance statement was added for inclusion in round 2 voting. After round 2, consensus was reached on 35, which were retained, and one was removed (considered redundant). The 61 guidance statements upon which consensus was reached were then used to support a series of core consensus recommendations and a management flow chart.

Conclusions

Expert consensus recommendations providing practical guidance of clinical relevance to specialists and primary care physicians in Australia have been developed. Dissemination of this guidance and evaluation of its impact on patient outcomes remain to be undertaken.

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