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“Eczema has been rightly called the keystone of dermatology, and he who fully masters its management is not only skilled in regard to treating one of the most common and distressing of all cutaneous diseases, but has acquired a knowledge of the principles of dermatologic practice which will assist in the treatment of many, if not all, other maladies of the skin.”

-L. Duncan Bulkley1

It is difficult to argue with Bulkley’s words, knowing full well the tremendous impact of atopic dermatitis (AD), not only on patients and their families, but also on those caring for them. Despite fantastic leaps in understanding and treatment, AD remains a complex and multifaceted disease that often requires more from every stakeholder; none but the mildest cases can be easily dismissed with a prescription or two and a pro re nata follow up plan.

The concept of “best practices” is an exciting one, in part because it promises to identify approaches from around the world that are working well and disseminate them widely in a useful, codified format. And that is exactly what KPMG has achieved with the Global Atopic Dermatitis Quality of Care Initiative. Conducting detailed interviews and analyses of 32 centers across the globe, they have distilled their findings into a document and a searchable, interactive website that is free for all to access and learn from.2

This project, commissioned and funded by Sanofi Genzyme & Regeneron but without any input or influence beyond that, was presented at the recent EADV Virtual Summit by Dr. Emma Guttman, Dr. Eric Simpson, and Dr. Mette Deleuran in an engaging session that reviewed and discussed the initiative in detail.3 Using an impressively thorough approach, the team at KPMG reviewed the literature, actually visited each site physically, conducted detailed interviews to document good practices, and then reviewed these findings with AD experts before finalizing their report.

To my knowledge, nothing quite like this has ever been done in AD before, and it stands as a compelling model for other diseases and treatment centers. Moreover, this was not simply focused on patient care and management: the scope of the analysis was larger, encompassing disease awareness and presentation for both patients and primary care providers, diagnosis, and even the referral process.

Remarkable Findings

One of the most remarkable findings was that so many of the challenges identified were shared globally. It is a reflection, perhaps, of the same phenomenon whereby individual patients so often feel alone in their disease, not realizing that there are literally millions of individuals around the world in similar situations. As a clinician, it is often frustrating to see patients feeling isolated when you have just come from a room with another AD patient also feeling like they are the only one. Sometimes, simply acknowledging the fact that there are others can be incredibly powerful. It was this precise sentiment, now more than a decade ago, that prompted me to start an eczema center in the first place. Over the years it has morphed and evolved, but currently we offer live educational programs (at least before the pandemic, that is), online educational resources, a National Eczema Association-affiliated support group, as well as a network of providers who work well together including allergists, dietitians, psychologists, and—as we take an integrative approach—a Traditional Chinese Medicine doctor, acupuncturist, and hypnotherapist.

For clinicians, there is a tremendous range of ideas represented, from things to consider for the solo practitioner who rarely sees AD all the way to ideas for centers of excellence themselves. Starting with relatively easy and low cost ideas, such as simply defining care goals, process, and outcomes, there are also more complex and potentially expensive interventions, such as building infrastructure for patient education and support with a multidisciplinary team.

The Biggest Acheivement

Perhaps more than any individual idea represented here, the biggest achievement may well be the fact that this was done at all. The recognition of the importance and impact of AD as being worthy of such an endeavor vindicates those who have been trying to get the attention of people who may have been dismissive of “this little skin rash” in the past. Aside from the wonderfully rich conclusions about clinical diagnosis and assessment, patient education, and coordinated multidisciplinary teams, the project itself stands as a testament to the state of AD. With luck, the rapid developments in pathophysiology and therapeutics of AD will inspire many more to avail themselves of this great resource in the coming years.

1. Bulkley LD.

2. Improving Quality of Care in Atopic Dermatitis, KPMG. Accessed November 27, 2020.

3. EADVAdmin. New Frontiers in Dermatology and Venereology. Accessed November 27, 2020.

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