title: Treatment of moderate-to-severe atopic eczema in adults within the U.K.: results of a national survey of dermatologists.
abstract: BACKGROUND
  Little is known about U.K. dermatologists' treatment approaches towards adult patients with recalcitrant moderate-to-severe atopic eczema.
  
  
  OBJECTIVE
  We wanted to learn about (i) treatment approaches used for this disease in the U.K.; (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 U.K.
  
  
  RESULTS
  Sixty-one respondents from over 30 centres reported on management of moderate-to-severe atopic eczema in adults, outwith the context of an acute flare. Phototherapy or psoralen-ultraviolet A was the most common therapeutic modality chosen first line (46%), and this was usually narrowband ultraviolet B. Systemic therapy was chosen as a first-line approach by 36% of dermatologists. Azathioprine was the commonest drug reported being used as first line followed by oral corticosteroids, ciclosporin and methotrexate. Methotrexate was the most common second-line treatment of respondents. The key factors that influenced decision making on the use of phototherapy and systemic agents were the 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, we found that phototherapy, in particular narrowband ultraviolet B, 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.
authors.affiliation: Policy, Ethics and Life Sciences Research Centre, Newcastle University, Newcastle upon Tyne, U.K.
authors.forename: K
authors.initials: K
authors.lastname: Taylor
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, U.K.
authors.forename: D J
authors.initials: DJ
authors.lastname: Swan
authors.affiliation: Newcastle University Business School, Newcastle upon Tyne, U.K.
authors.forename: A
authors.initials: A
authors.lastname: Affleck
authors.affiliation: Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' Hospital NHS Foundation Trust and King's College, London, U.K.
authors.forename: C
authors.initials: C
authors.lastname: Flohr
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, U.K.|Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, U.K.
authors.forename: N J
authors.initials: NJ
authors.lastname: Reynolds
mesh_terms: D000328:Adult; D000066491:Clinical Decision-Making; D003253:Consultants; D003876:Dermatitis, Atopic / Q000628:therapy*; D003879:Dermatologic Agents / Q000627:therapeutic use; D000072085:Dermatologists; D005544:Forecasting; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D020380:Needs Assessment; D010778:Photochemotherapy / Q000379:methods; D017319:Photosensitizing Agents / Q000627:therapeutic use; D010818:Practice Patterns, Physicians'; D014467:Ultraviolet Therapy / Q000379:methods; D006113:United Kingdom
chemical_list: D003879:Dermatologic Agents; D017319:Photosensitizing Agents