Dr. Mohammad Fatani

Dr Mohammad Fatani is the head of Dermatology unit in : Hera General Hospital in Makkah. He is a consultant dermatologist 1 and also a board member of Saudi Society of Dermatology and I Dermatologic Surgery

Barriers to the Management of Atopic dermatitis

Atopic dermatitis (AD) is one of the most common skin diseases in the Middle East, especially in Saudi Arabia. Unfortunately, there is no study about the prevalence of atopic dermatitis in our area. Our aim is to provide our AD patients with a holistic approach to help manage their disease. We have numerous challenging issues in AD management. One is the absence of any unified definition of AD severity, along with the lack of any assessment tool to measure that severity in our country. Based on our personal experience, one acceptable tool is SCORAD. However, we are subjected to the time restraints of a busy clinic, so we now use the EASI (Eczema Area and Severity Index) score, pruritus numerical rating scale, and sleep lost score
Another critical issue is how to define an AD flare-up, which is not clear to the dermatologists. I think a vital strategy for AD is a national guideline to help unify our treatment protocol, measure the key performance indicator for medication used, and record the percentage of treatment failure.
The most significant barrier to AD management is patient education about the disease, especially in busy clinical practices. AD is very common among children, so we need so set more time aside to educate parents about the disease, provide information to help eliminate exacerbating factors, discuss good skin care practices (e.g., different dressing methods), and offer an information about how to deal with this disease in the long term. Also, we must explain to the patient and the parent(s) about the correct application of emollient, ointment, and cream to avoid any complications with topical treatments. The psychological effect of AD on both the child and the parents is well recognized, particularly with regard to sleep disturbance at night. So, lack of treatment education and treatment compliance are two important reasons for treatment failure. An educational program for AD is challenging because it involves many health care providers, patients, parents, and family members. Many countries have patient support groups that provide useful supplementary material to the patient and family, but that is severely lacking in our area. Other useful tools like simple infographic brochures and detailed AD websites to help guide patients to prevent a flare-up and to keep the disease under control could be created at the corporate level, among various institutions that are willing to help.
We face a problem of limited medications to treat both moderate and severe types of AD. Currently, we have traditional systemic immunosuppressive medication and one approved biological treatment; so we need more treatment options to cover unmet medication demand.
Categories: Dermatology

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