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      Prevalence, incidence and management of atopic dermatitis in Australian general practice using routinely collected data from MedicineInsight

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          Abstract

          Background/Objectives

          The prevalence of atopic dermatitis (AD) has increased significantly in industrialised countries in recent decades but data about the incidence or prevalence of AD in Australia are sparse. We aimed to determine the prevalence and incidence of AD among patients seen in Australian general practice and the use of specified medicines.

          Methods

          This was a cross‐sectional study of 2.1 million patients attending 494 general practices in the MedicineInsight program from 1 January 2017 to 31 December 2018. We assessed the prevalence (lifetime and current), incidence, management and severity of AD.

          Results

          The lifetime (ever diagnosed) prevalence of AD in this general practice population was 16.4% and was greater in females (17.3%) than males (15.3%). One in five patients with AD were classified as having moderate‐to‐severe disease. Prevalence over the last two years was 6.3%. The incidence of AD in 2018 was 2.0% and was greater in females (2.2%) and for patients aged 0–4 years (3.9%). Patients with AD had an increased risk of insomnia, anxiety and depression, compared to those with no recorded AD. For AD patients, topical corticosteroids were the most commonly prescribed AD medication (36.5%) and topical calcineurin inhibitors the least (0.1%), with systemic corticosteroids (15.6%) more commonly prescribed than other immunosuppressants (0.9%).

          Conclusions

          Our findings provide important insights into the epidemiology of AD and its management in Australian general practice. This information is likely to be useful in planning effective interventions to support GPs in the optimal management of patients with AD.

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          Most cited references17

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          Atopic Dermatitis: Global Epidemiology and Risk Factors

          Atopic dermatitis (AD) is a chronic inflammatory skin disease posing a significant burden on health-care resources and patients' quality of life. It is a complex disease with a wide spectrum of clinical presentations and combinations of symptoms. AD affects up to 20% of children and up to 3% of adults; recent data show that its prevalence is still increasing, especially in low-income countries. First manifestations of AD usually appear early in life and often precede other allergic diseases such as asthma or allergic rhinitis. Individuals affected by AD usually have genetically determined risk factors affecting the skin barrier function or the immune system. However, genetic mutations alone might not be enough to cause clinical manifestations of AD, and it is merely the interaction of a dysfunctional epidermal barrier in genetically predisposed individuals with harmful effects of environmental agents which leads to the development of the disease. AD has been described as an allergic skin disease, but today, the contribution of allergic reactions to the initiation of AD is challenged, and it is proposed that allergy is rather a consequence of AD in subjects with a concomitant underlying atopic constitution. Treatment at best achieves symptom control rather than cure; there is thus a strong need to identify alternatives for disease prevention.
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            Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I

            This guideline was developed as a joint interdisciplinary European project, including physicians from all relevant disciplines as well as patients. It is a consensus-based guideline, taking available evidence from other guidelines, systematic reviews and published studies into account. This first part of the guideline covers methods, patient perspective, general measures and avoidance strategies, basic emollient treatment and bathing, dietary intervention, topical anti-inflammatory therapy, phototherapy and antipruritic therapy, whereas the second part covers antimicrobial therapy, systemic treatment, allergen-specific immunotherapy, complementary medicine, psychosomatic counselling and educational interventions. Management of AE must consider the individual clinical variability of the disease; highly standardized treatment rules are not recommended. Basic therapy is focused on treatment of disturbed barrier function by hydrating and lubricating topical treatment, besides further avoidance of specific and unspecific provocation factors. Topical anti-inflammatory treatment based on glucocorticosteroids and calcineurin inhibitors is used for flare management and for proactive therapy for long-term control. Topical corticosteroids remain the mainstay of therapy, whereas tacrolimus and pimecrolimus are preferred in sensitive skin areas and for long-term use. Topical phosphodiesterase inhibitors may be a treatment alternative when available. Adjuvant therapy includes UV irradiation, preferably with UVB 311 nm or UVA1. Pruritus is targeted with the majority of the recommended therapies, but some patients may need additional antipruritic therapy. Antimicrobial therapy, systemic anti-inflammatory treatment, immunotherapy, complementary medicine and educational intervention will be addressed in part II of the guideline.
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              • Article: not found

              Mental health comorbidity in patients with atopic dermatitis.

              Recent data, primarily from Europe, suggest that children with atopic dermatitis (AD) might be at increased risk of mental health disorders.
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                Author and article information

                Contributors
                dbusingye@nps.org.au
                Journal
                Australas J Dermatol
                Australas. J. Dermatol
                10.1111/(ISSN)1440-0960
                AJD
                The Australasian Journal of Dermatology
                John Wiley and Sons Inc. (Hoboken )
                0004-8380
                1440-0960
                15 March 2020
                August 2020
                : 61
                : 3 ( doiID: 10.1111/ajd.v61.3 )
                : e319-e327
                Affiliations
                [ 1 ] NPS MedicineWise Sydney New South Wales Australia
                [ 2 ] Australian National University Canberra Australian Capital Territory Australia
                [ 3 ] Woden Dermatology Canberra Australian Capital Territory Australia
                [ 4 ] The Canberra Hospital Canberra Australian Capital Territory Australia
                [ 5 ] Northern Clinical School Sydney Medical School University of Sydney Sydney New South Wales Australia
                [ 6 ] The Dermatology and Skin Cancer Centre St Leonards New South Wales Australia
                [ 7 ] Department of Dermatology Royal North Shore Hospital St Leonards New South Wales Australia
                Author notes
                [*] [* ] Correspondence: Doreen Busingye, NPS MedicineWise, Sydney, New South Wales, Australia. Email: dbusingye@ 123456nps.org.au

                Author information
                https://orcid.org/0000-0003-4901-4182
                https://orcid.org/0000-0002-4744-9070
                https://orcid.org/0000-0003-0995-4372
                Article
                AJD13268
                10.1111/ajd.13268
                7496939
                32173859
                d940ffaa-ef12-45e2-92d6-9078c3267fdb
                © 2020 The Authors. Australasian Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Australasian College of Dermatologists

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 08 December 2019
                : 10 February 2020
                Page count
                Figures: 2, Tables: 4, Pages: 9, Words: 6844
                Funding
                Funded by: Pfizer , open-funder-registry 10.13039/100010793;
                Award ID: This study was supported by an unrestricted grant
                Categories
                Original Research
                Original Research
                Custom metadata
                2.0
                August 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.0 mode:remove_FC converted:11.09.2020

                atopic dermatitis,australia,eczema,general practice,incidence,management,medicineinsight,prevalence,therapies

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