Jemma Weidinger’s scientific contributions

Atopic dermatitis (AD) is a chronic disease that is increasing in prevalence, particularly in children and people with skin of colour. Current management involves topical treatments, phototherapy and immunosuppressants, as well as newer therapies like dupilumab. Health professionals should also be aware of the specific management considerations for AD in people with skin of colour. This systematic review was conducted to examine global guidelines for the management of AD in children, compare management recommendations, examine specific recommendations for children with skin of colour, and assess the quality of the guidelines. The databases Medline, Embase, CINAHL, Scopus, Guidelines International Network, and Emcare Nursing and Allied Health were searched to identify guidelines or articles relating to the management of AD in children from 1990 to 2023. A grey literature search was also undertaken. The recommendations from the guidelines were extracted and compared, and the quality of the guidelines was assessed using the Appraisal Guidelines for Research and Evaluation (AGREE) II tool. A total of 1644 articles were identified from the initial search. Title and abstract screening, full text screening, and reference checking yielded 28 guidelines for the final appraisal and data extraction. The main variations in management recommendations were the timing of emollients, bleach baths, bath additives, oral antihistamines, and the age cut-offs for topical calcineurin inhibitors. Many guidelines were not updated to reflect newer therapies like dupilumab and topical phosphodiesterase-4 (PDE4) inhibitors. There were minimal recommendations regarding management of skin of colour. Only 12/28 guidelines met the satisfactory cut-off score for the AGREE II appraisal, largely due to a lack of well-documented methodology. This review showed that the recommendations for AD management in skin of colour were consistently lacking. Despite generally consistent management strategies over the last 5 years, less than half of the guidelines met high-quality criteria, emphasising the importance of using tools like AGREE II in future guideline development.

Background: It is important to be able to manage patients regardless of ethnicities. The understanding of skin diseases, including atopic dermatitis, in patients with skin of colour (SOC) is lagging compared with that in patients with lighter skin and has been identified as an educational gap among medical practitioners. Objective: This paper synthesises the latest literature on the diagnosis, assessment, treatment outcomes and cultural considerations for managing atopic dermatitis in children with SOC in the general practice setting. Discussion: Atopic dermatitis in children with SOC can vary from traditional descriptions and appear psoriasiform, lichenoid, scaly, papular, hypopigmented or violaceous. It can be misdiagnosed and its severity underestimated. Complications from atopic dermatitis, as well as the treatments provided, might result in inadequate treatment unless the treating doctor is aware of specific nuances in children with SOC.

Atopic diseases, such as eczema and food allergy, have increased in prevalence in Australia during the past few decades and pose a significant health burden on patients, their families and the healthcare system. Eczema is also referred to as atopic dermatitis or atopic eczema. For the purpose of this chapter, the term eczema will be used.With eczema increasing in Australia and being the leading cause of the global burden from skin disease as well as long specialist waiting times, there was a pressing need to address timely access to care for infants and children with eczema in Western Australia (WA). Recent research shows the altered skin barrier in people with eczema has a key role in the development of food allergy and suggests sensitisation to allergenic foods may occur through this impaired skin barrier. Therefore, an urgency also exists to effectively manage eczema to reduce the risk of food allergy development.Funding was sought to develop and implement a multidisciplinary eczema shared care model involving consumers to optimise eczema management and improve timely access to care for children with eczema. The model was piloted in WA, and engagement with national partner organisations was undertaken to promote consistent evidence-based eczema information state-wide and Australia-wide. Potential national roll-out of the model was also proposed.KeywordsEczemaAtopic dermatitisPaediatricChildShared care modelNurse practitioner