The articles in this issue of CME reflect the views of a number of individuals who developed the guideline for the management of atopic dermatitis (AD) to improve the outcome of its treatment in South Africa (SA). AD has a major impact on the quality of life of sufferers and it is hoped that the articles and the guidelines they embody, if implemented, play a role in achieving these outcomes. Not only is AD the most common skin disease in children, but it causes tremendous morbidity. Engaging with many of these suffering children and their parents daily, is emotionally draining and energy sapping. No other skin condition places such demands on resources, time and the human spirit.
It is therefore essential that the management of AD should be optimal, with a thorough understanding of the pathogenesis, approaching it in a multi-professional manner. Understanding the disease will also contribute towards eliminating unnecessary investigations, unnecessary and inappropriate interventions and unsubstantiated treatment modalities. The simplistic way of approaching AD as ‘an allergy’ is long outdated, as the complexity of the condition becomes increasingly apparent with the publication of new information. All healthcare workers involved in the management of AD should take note of these guiding principles and try to implement them in clinical practice whenever possible.
The basis of each topic was developed through general consensus by a panel of four dermatologists and five paediatricians (including three allergists) from SA, based on evidence from an extensive literature review. Draft documents were made available for comment via the internet. All input, where appropriate, was then incorporated into the guideline.
This issue of CME consists of six full-length articles, covering the following topics: aetiopathogenesis,1 epidemiology,2 diagnosis,3 patient education and specialist referral,4 non-pharmacological treatment5 and pharmacological treatment.6 Summaries of the general approach to and guideline for the management of AD are also provided (available online only).7
A disclaimer has to be added: these guidelines do not represent all possible methods of management applicable to all patients, do not exclude any other reasonable methods, and will not ensure successful treatment in every situation. The responsible physician should take the unique circumstances of each patient into consideration regarding decisions about a specific therapy.
The pharmaceutical companies Astellas Pharma and Galderma generously co-sponsored the meeting of the work group and all costs generated by the meeting.
We trust that all who read this issue will find it stimulating, informative and helpful in daily practice to improve the condition of these suffering children and adults.
Department of Dermatology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
Robin J Green
Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa
1. Jordaan HF, Todd G, Sinclair W, Green RJ. Aetiopathogenesis of atopic dermatitis. S Afr Med J 2014;104(10):706-709. [http://dx.doi.org/10.7196/SAMJ.8840]
2. Todd G. Epidemiology of atopic dermatitis. S Afr Med J 2014;104(10):710. [http://dx.doi.org/10.7196/SAMJ.8843]
3. Sinclair W, Aboobaker J, Green RJ, Levin ME. Diagnosis of atopic dermatitis: From bedside to laboratory. S Afr Med J 2014;104(10):711. [http://dx.doi.org/10.7196/SAMJ.8850]
4. Green RJ, Pentz A, Jordaan HF. Education and specialist referral of patients with atopic dermatitis. S Afr Med J 2014;104(10):712. [http://dx.doi.org/10.7196/SAMJ.8857]
5. Todd G, Manjra A, Sinclair W, Levin M, Green RJ. Non-pharmacological treatment modalities for atopic dermatitis. S Afr Med J 2014;104(10):713. [http://dx.doi.org/10.7196/SAMJ.8860]
6. Puterman A, Lewis H, Sinclair W, Green RJ. Topical and systemic pharmacological treatment of atopic dermatitis. S Afr Med J 2014;104(10):714. [http://dx.doi.org/10.7196/SAMJ.8870]
7. Green RJ, Sinclair W. General approach to and summary of the guideline for the management of atopic dermatitis. S Afr Med J 2014;104(10). [http://dx.doi.org/10.7196/SAMJ.8876]
S Afr Med J 2014;104(10):705. DOI:10.7196/SAMJ.8865
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