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      Position Statement on Atopic Dermatitis in Sub‐Saharan Africa: current status and roadmap

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          Abstract

          Background

          The first International Society of Atopic Dermatitis ( ISAD) global meeting dedicated to atopic dermatitis ( AD) in Sub‐Saharan Africa ( SSA) was held in Geneva, Switzerland in April 2019. A total of 30 participants were present at the meeting, including those from 17 SSA countries, representatives of the World Health Organization ( WHO), the International Foundation for Dermatology ( IFD) (a committee of the International League of Dermatological Societies, ILDS http://www.ilds.org), the Fondation pour la Dermatite Atopique, as well as specialists in telemedicine, artificial intelligence and therapeutic patient education ( TPE).

          Results

          AD is one of the most prevalent chronic inflammatory skin diseases in SSA. Besides neglected tropical diseases ( NTDs) with a dermatological presentation, AD requires closer attention from the WHO and national Departments of Health.

          Conclusions

          A roadmap has been defined with top priorities such as access to essential medicines and devices for AD care, in particular emollients, better education of primary healthcare workers for adequate triage (e.g. better educational materials for skin diseases in pigmented skin generally and AD in particular, especially targeted to Africa), involvement of traditional healers and to a certain extent also patient education, bearing in mind the barriers to effective healthcare faced in SSA countries such as travel distances to health facilities, limited resources and the lack of dermatological expertise. In addition, several initiatives concerning AD research in SSA were discussed and should be implemented in close collaboration with the WHO and assessed at follow‐up meetings, in particular, at the next ISAD meeting in Seoul, South Korea and African Society of Dermatology and Venereology ( ASDV) meeting in Nairobi, Kenya, both in 2020.

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          Most cited references38

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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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            High levels of butyrate and propionate in early life are associated with protection against atopy

            Dietary changes are suggested to play a role in the increasing prevalence of allergic diseases and asthma. Short-chain fatty acids (SCFAs) are metabolites present in certain foods and are produced by microbes in the gut following fermentation of fibers. SCFAs have been shown to have anti-inflammatory properties in animal models. Our objective was to investigate the potential role of SCFAs in the prevention of allergy and asthma.
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                Author and article information

                Contributors
                alain.taieb@u-bordeaux.fr
                Journal
                J Eur Acad Dermatol Venereol
                J Eur Acad Dermatol Venereol
                10.1111/(ISSN)1468-3083
                JDV
                Journal of the European Academy of Dermatology and Venereology
                John Wiley and Sons Inc. (Hoboken )
                0926-9959
                1468-3083
                12 November 2019
                November 2019
                : 33
                : 11 ( doiID: 10.1111/jdv.v33.11 )
                : 2019-2028
                Affiliations
                [ 1 ] Allergy Unit Department of Dermatology University Hospital Zurich Switzerland
                [ 2 ] Department of Dermatology University of São Paulo Medical School São Paulo Brazil
                [ 3 ] Département de médecine et Spécialités Médicales Dermatologie et Vénérologie CHU Treichville Université Félix Houphouët‐Boigny UFR Sciences Médicales Abidjan Côte d'Ivoire
                [ 4 ] College of Health Science Ayder Comprehensive Specialized Teaching Hospital Mekelle University Mekelle Ethiopia
                [ 5 ] Skin Research Group School of Medicine Ninewells Hospital & Medical School University of Dundee Dundee UK
                [ 6 ] Division of Therapeutic Education for Chronic Diseases WHO Collaborating Center Department of First Aid Medecine Geneva University Hospitals Geneva Switzerland
                [ 7 ] Department of Dermatology Hospital Cuf Descobertas and Hospital Cuf Torres Vedras Torres Vedras Portugal
                [ 8 ] Department of Dermatology Faculty of Health Sciences National and Teaching Hospital HKM of Cotonou University of Abomey‐Calavi Cotonou Benin
                [ 9 ] Department of Adult and Pediatric Dermatology CHU Bordeaux Bordeaux France
                [ 10 ] INSERM U 1035 University of Bordeaux Bordeaux France
                [ 11 ] Department of Dermatology Faculty of Medicine CNAM Bamako Mali
                [ 12 ] Chair of International Foundation for Dermatology Chelsea and Westminster Hospital London UK
                [ 13 ] Department of Dermatology Teledermatology and AI University Hospital of Basel Basel Switzerland
                [ 14 ] Kigali Dermatology Center University of Rwanda Kigali Rwanda
                [ 15 ] University of Cape Town Cape Town South Africa
                [ 16 ] Université Cheikh Anta Diop Dakar Senegal
                [ 17 ] Service de Dermatologie‐Vénéréologie CHU Sylvanus Olympio Lomé Togo
                [ 18 ] Department of Dermatology Ministry of Health Hospital Central de Maputo Maputo Mozambique
                [ 19 ] Hôpital Amitié Nouakchott Mauritanie
                [ 20 ] Regional Dermatology Training Center Kilimanjaro Christian Medical University College Moshi Tanzania
                [ 21 ] Clinique Bondeko Kinshasa‐Limete Democratic Republic of the Congo
                [ 22 ] University Hospital Yalgado Ouedraogo of Ouagadougou University Ouaga I Pr Joseph Ki‐Zerbo Ouagadougou Ouagadougou Burkina Faso
                [ 23 ] Department of Dermatology University Hospital Joseph Raseta Befelatanana Antananarivo Madagascar
                [ 24 ] Department of Paediatrics Murdoch Children's Research Institute Royal Children's Hospital The University of Melbourne Parkville Victoria Australia
                [ 25 ] Service dermatologie et IST CHU Sylvanus Olympio Université de Lomé Lomé Togo
                [ 26 ] Department of Medicine University of Cape Town Cape Town South Africa
                Author notes
                [*] [* ]Correspondence: Alain Taïeb. E‐mail: alain.taieb@ 123456u-bordeaux.fr
                Article
                JDV15972
                10.1111/jdv.15972
                6899619
                31713914
                f69b33cb-9bab-4a11-860d-65c8cd94410f
                © 2019 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 06 June 2019
                : 05 September 2019
                Page count
                Figures: 3, Tables: 1, Pages: 10, Words: 6434
                Categories
                Position Statement
                Guidelines and Position Statements
                Custom metadata
                2.0
                November 2019
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.2 mode:remove_FC converted:05.12.2019

                Dermatology
                Dermatology

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