Updates to International Recommendations for Eczema, with Jonathan Silverberg, MD, PhD

A newly-released set of recommendations were created by an international cohort of experts in the field of dermatology, designed to provide guidance to clinicians regarding atopic dermatitis management.¹

These recommendations include findings drawn from a global patient study, with 87 expert dermatologists from 44 countries having been included and recommendations being made using a modified eDelphi voting process. The Aiming High in Eczema/Atopic Dermatitis (AHEAD) recommendations, as they were titled, worked to incorporate shared decision-making and formulate a novel approach to management of atopic dermatitis.

Jonathan I. Silverberg, MD, PhD, AHEAD investigator and director of clinical research at the George Washington University School of Medicine and Health Sciences, spoke with the HCPLive editorial team about these recommendation updates and what they mean for clinicians and patients.

“We've started to see the emergence of this idea of treat-to-target guidelines showing up in dermatology,” Silverberg explained. “But there were some questions around whether or not the targets that were set really reflected all the (atopic dermatitis) patients out there, and whether or not they were even the right sort of thresholds or endpoints that we should be aiming for given the growing toolbox of options that we have now. So this exercise really sought to revamp or enhance and develop a more optimal treat to target approach.”²

Silverberg noted that when the new notion of treat-to-target guidelines emerged, dermatologists had been lacking any patient feedback regarding their views on the updates. He explained that the perspectives of patients were captured in this global, qualitative patient research, with the investigators considering these views in their initial drafting of the AHEAD recommendations.

“What became very clear from the patients in that research study was that they felt it was absolutely imperative to have both an assessment of the overall lesional severity by the dermatologist as well as the symptoms,” Silverberg said. “And to understand their experience with the disease, recognizing that each patient is going to have a different experience.”

Silverberg highlighted the fact that different patients face high levels of itch, whereas others seek relief from pain or from other elements of their disease.

For additional information on the AHEAD recommendations, view the interview clip above.

The quotes contained in this summary were edited for the purposes of clarity. Relevant disclosures for Silverberg include his work as an investigator for AbbVie, Bristol Myers Squibb, Eli Lilly, GlaxoSmithKline, Incyte, Kiniksa Pharmaceuticals, LEO Pharma, and others.

References

1. ^{Silverberg JI, Gooderham M, Wollenberg A. Combining treat-to-target principles and shared decision-making: International expert consensus-based recommendations with a novel concept for minimal disease activity criteria in atopic dermatitis. J Eur Acad Dermatol Venereol. 2024 Jul 11. doi: 10.1111/jdv.20229. Epub ahead of print. PMID: 38989857.}
2. ^{Thyssen JP, Vestergaard C, Deleuran M, de Bruin-Weller MS, Bieber T, Taieb A, et al. European task force on atopic dermatitis (ETFAD): treatment targets and treatable traits in atopic dermatitis. J Eur Acad Dermatol Venereol. 2020; 34(12): e839–e842.}