The ABC Topical Management of Atopic Dermatitis in Philippines: Expert Recommendations
January 2021 | Volume 20 | Issue 1 | Original Article | 84 | Copyright © January 2021
Published online December 24, 2020
Angela M Lavadia MDa, Angela T Cumagun MDb, Lourdes Palmero MDb,c, Noemie Salta Ramos MDd, Cindy Jao Tan MDe
aEast Avenue Medical Center, Quezon City, Manila, Philippines
bUniversity of Santo Tomas, Metro Manila, Philippines
cThe Medical City, Metro Manila, Philippines
dOur Lady of Fatima University, Metro Manila, Philippines
eUniversity of the East - Ramon Magsaysay Memorial Medical Center, Quezon City, Manila, Philippines
Atopic dermatitis (AD) has been shown to have an increasing incidence in Asia, congruous with the trends observed worldwide. The severity of the condition has been associated with challenges in disease control. Moreover, a significant number of patients do not adhere to their physicians’ recommendations correctly and prefer alternative treatments. Better education regarding the nature of the disease and its appropriate management may improve patient compliance and lead to better control. An ABC scheme of AD management entails anti-inflammatory, barrier repair and basic skin care strategies to adequately manage AD. It is an easy-to-follow model which helps lessen distress and improve the quality of life amongst patients. An expert panel composed of specialists in the field of dermatology and pediatric dermatology in the Philippines convened to review current data and management practices in order to provide key treatment recommendations and identify current gaps in the treatment of mild to moderate atopic dermatitis. This scientific expert panel, likewise, seeks to provide guidance for all healthcare professionals involved in the care and management of AD patients.J Drugs Dermatol.
Atopic dermatitis (AD), also referred to as atopic eczema, is a chronic, pruritic, remitting and relapsing inflammatory skin disorder that affects both the epidermal barrier and the immune system.1 AD signs and symptoms can vary widely from person to person and these clinical manifestations include, but are not limited to, pruritus, erythema, inflammation and xerosis.2 Itch or pruritus is a key symptom of AD and is related to inflammation that triggers a vicious cycle of itch and scratching ultimately resulting in chronicity.3 Xerosis, one of its main clinical features, results from deficient skin barrier function leading to increased transepidermal water loss (TEWL) and decreased stratum corneum hydration.4 AD is considered incurable, thus, there is a need for accepted guidelines to manage and reduce the burden that this condition brings.
AD is a common chronic condition, with an estimated global prevalence of nearly 230 million. The prevalence in Asia has been increasing as in the global trend worldwide This trend may be attributed to increasingly Westernized lifestyles, and improved standards of living and education.5
AD affects 15–20% of children and 1–3% of adults worldwide; however, the prevalence varies greatly throughout the world.6 Data from 744,673 dermatological consults in the Philippine Dermatological Society-accredited outpatient institutions in the Philippines from 2007–2011 showed that more than half of the patients (65.1%) were children between 1–12 years old and twenty-four percent (24%) were infants less than one year.7 Young children rely on their parents and caregivers to administer treatments. The control of AD in children, therefore, largely depends on the resources, education, and attitude of parents and caregivers toward taking care of their child’s skin.
A study by Ortiz de Frutos et al showed that despite doctors’ recommendations, a significant number of patients do not correctly apply medications and prefer alternative treatments. Disease control was considered insufficient by 41.6% of adults and 27.6% of pediatric patients and was significantly affected by the severity of AD. Based on the same study, better education may improve treatment compliance and lead to adequate disease control.8 Challenged by the need to lessen distress and improve the quality of life of patients, a group of dermatology experts in Europe composed of Professors Gelmetti, Proksch, and Metz developed an easy-to-follow ABC scheme of AD management, published as an expert panel review entitled “Best Practices in Atopic Dermatitis Management” in June 2014.1 Building on