Publication Type(s): Journal: Conference Abstract
Author(s): Johnston G.; Slack J.; Exton L.; Mohd Mustapa M.F.; Coulson I.; English J.; Bourke J.
Abstract:The Grading of Recommendations Assessment, Development and Evaluation (GRADE) process is now the gold-standard methodology for developing systematic reviews and clinical guidelines. The British Association of Dermatologists contact dermatitis Guidelines Development Group (GDG) is the first to adopt the GRADE methodology for the assessment of the investigation and treatment of contact dermatitis. The process commenced by establishing clinical questions, in three categories and relevant to the scope of the guideline, which asked the following questions in patients with contact dermatitis. (i) Diagnosis. Which allergens and how much should be used in tests? When should tests be carried out? Does increasing the number of allergens tested improve diagnosis? (ii) Prevention. Does education improve or prevent hand dermatitis? Do barrier creams improve hand dermatitis? (iii) Treatment. Does topical treatment work? Does systemic treatment work? Do soap substitutes improve contact dermatitis? Does education as a treatment work? Does phototherapy work?
The GDG also established a set of outcome measures of importance to patients (prevention and treatment), graded from 1 (least important) to 9 (most important) according to the GRADE methodology, data on which were extracted from included studies. These measures are (i) return to/remain in work (9), (ii) improvement of quality of life (8), (iii) improvement or clearance of dermatitis (8), (iv) treatment tolerability (5), (v) prevention of dermatitis (5) and (vi) side-effects of interventions (4). The following recommendations were agreed by the GDG and patient representatives. (i) Diagnosis. Offer patients with contact dermatitis a patch-test technique based on the availability of resources. In identifying allergens in patients with contact dermatitis, consider testing for additional series dependent on allergen exposure. Consider additional readings at day 6 or 7 if the results are unexpectedly negative at day 4. (ii) Prevention. Consider skin-care and skin-protection creams in preventing occupational dermatitis. (iii) Treatment. Offer topical tacrolimus to patients with contact dermatitis where topical steroids are unsuitable. Offer alitretinoin to patients with moderate-to-severe chronic hand eczema. Consider psoralen-ultraviolet A therapy for treating patients with chronic hand eczema. Consider patient education in occupational contact dermatitis. There was insufficient evidence to determine the efficacy of systemic immunosuppressive treatment specifically for contact dermatitis. 'Offer' was used where evidence was of good quality and 'consider' was used where evidence was of lower quality. As a result of the GRADE process the GDG also recommended that reporting of results of future patch-test studies should be standardized and that high-quality studies are needed to address the efficacy of interventions for contact dermatitis.