Harmonizing and sharing knowledge in atopic dermatitis

Atopic dermatitis (AD) is a chronic, inflammatory skin disease that affects up until 25% of all children and 10% of adults. A substantial part of these patients have moderate-to-severe AD, but their treatment is not yet optimal. With this thesis we therefore aimed to contribute to the improvement of the treatment of moderate-to-severe AD patients. In part I we worked on the harmonization of outcome measurement instruments used in AD research. We reached consensus on how and when to measure the previously defined domain items of the TREatment of ATopic eczema (TREAT) Registry Taskforce core dataset for research registries. In part II further evidence was gathered on the prescribing practices of European dermatologists caring for adult moderate-to-severe AD patients. This chapter provides insight into different prescribing practices for conventional phototherapy and systemic therapy and shows that off-label therapies are also preferred as first-line choice of systemic therapy. In the next chapter we gathered evidence on the off-label use of methotrexate for 31 skin diseases, including AD. Unfortunately, we found that most of the current available evidence is of (very) low quality. Part III concerns Shared Decision Making (SDM) in AD and psoriasis. In the first chapter we investigated if patients and physicians are experiencing SDM and see a need to apply SDM. We showed that there is room for improvement of SDM in AD and psoriasis, as patients experience a limited extent of SDM. In the last chapter we elaborate on the steps taken to develop decision cards (which are also presented), that can be used for SDM in AD and psoriasis.