Treatment of moderate-to-severe atopic eczema in adults within the UK: results of a national survey of dermatologists

Abstract

Background

Little is known about UK dermatologists' treatment approaches towards adult patients with recalcitrant moderate-to-severe atopic eczema.

Objectives

We wanted to learn about the i) treatment approaches used for this disease in the UK; ii) factors that influence treatment decisions; and iii) perceived gaps in evidence on treatment safety and efficacy and priorities for future trials.

Methods

We conducted an online survey of consultant-level dermatologists in the UK.

Results

61 respondents from at least 35 centres reported on management of moderate-to-severe atopic eczema in adults, outwith the context of an acute flare. Phototherapy/PUVA was the most common therapeutic modality chosen as first-line (46%), and this was usually narrowband UVB. Systemic therapy was chosen as a first-line approach by 36% of dermatologists, with most using azathioprine (46%), followed by oral corticosteroids (43%), ciclosporin (37%) and methotrexate (25%). Methotrexate was the most common second-line treatment, chosen by 49% of respondents. The key factors that influenced decision-making on the use of phototherapy and systemic agents were: respondent's clinical experience, results of baseline tests (systemic agents), and knowledge of both efficacy and acute and chronic side-effect profiles. The most important evidence gaps identified were: the relative effectiveness of treatments, the alternatives to current approaches and the safety of long-term maintenance treatment. With regard to future trials, respondents suggested that priority should be given to studies involving methotrexate.

Conclusions

While survey study designs have limitations, including the possibility of selection and recall bias, we found that phototherapy, in particular narrow-band UVB, was respondents' preferred first-line treatment for adults with recalcitrant moderate-to-severe atopic eczema, perhaps reflecting access to, and clinical experience of, this approach. Azathioprine is widely used as a longer-term maintenance treatment.

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