Case Studies:Werner Sinclair *, Jamila Aboobaker, Francois Jordaan, Deepak Modi and Gail Todd Objective The guidelines for the management of atopic dermatitis in patients older than 18 years have been developed in an attempt to improve the outcomes of treatment of this condition in South Africa. This condition has a major impact on the quality of life of sufferers and it is expected that these guidelines, if implemented, will play a role in achieving this. Recommendations All health care workers involved in the management of atopic dermatitis should take note of these guidelines and try and implement them in clinical practice as far as possible. All treatment methods and procedures not substantiated by evidence from the literature should be discontinued and avoided to decrease the financial burden of dermatitis treatment. Validation These guidelines were developed through general consensus by a group of five South African dermatologists, from evidence based on extensive literature review. Draft documents were made available for comment to the dermatology community as a whole, via the official web site of the Dermatological Society of South Africa. A series of discussions were held in the six largest centres in the country, attended by the majority of South African dermatologists. All input from these sources, where appropriate, were then incorporated into these guidelines. Guidelines sponsor Novartis initiated the project and sponsored the meetings of the work group and all costs generated by these meetings. Disclaimer These guidelines do not represent all the 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 unique circumstances of each patient should be taken into account by the responsible physician regarding decisions on any specific therapy. (*Chair of Work Group) Introduction and MethodsAtopic dermatitis (AD) is a very common, chronic, inflammatory eczematous skin disease in children, affecting up to 20 percent of children in Western Europe and Australia. The morbidity and impact on quality of life of these patients can be very severe . Women seem to be more severely affected than men and the psychological distress suffered correlates well with the severity of the dermatitis .There is considerable confusion about uniform criteria for the diagnosis of AD in adults and management if often arbitrary and emperical, with poor outcomes in general. There is therefore a need for standardized guidelines on diagnosing and managing this condition. A work group of dermatologists, the current full time heads of Dermatology departments / divisions of five of the medical schools in South Africa, were convened on instruction from the executive committee of the Dermatological Society of South Africa and tasked with publishing these guidelines. The work group used an evidence-based module, evidence obtained through a thorough literature search on the topic over the last 15 years. Evidence was graded according to the SIGN grading system and all recommendations and statements in the text are marked according to these levels of evidence to denote the strength of evidence and therefore the validity and weight of recommendation: Levels of evidence:
Grades of recommendation:
ScopeThese guidelines were developed to address the diagnosis and management of adult patients, at the ages of 13 years and above, who suffers from atopic dermatitis.
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