Systematic review and thematic synthesis: exploring pharmacist knowledge on atopic dermatitis therapy and their recommendations on the management of the condition
Authors: Cayci A B , Rathbone A , Lindsey L 
Published: November 2022

Abstract

Introduction
Atopic Dermatitis also known as atopic eczema, is a chronic condition that can present at early age and remain long term.1 This disease is identified by regular eczematous lesions particularly localised to the curving surfaces of the patient’s body, redness of the skin, extreme itchy rash and disturbance.2,3 Although Atopic Dermatitis is a long-term condition, it can be treated successfully. To get successful results, it requires personalised therapy management. Community pharmacists are the first line health professionals to help patients manage their conditions.

Aim
This systematic review aimed to identify the knowledge of community pharmacists in management and treatment of Atopic Dermatitis as well as their recommendations in coping with the condition.

Methods
A systematic literature search was conducted using five databases, including Medline, Embase, CINAHL, PsycINFO, and PubMed. The literature search was conducted between January and February 2022 by one author (ABC) and validated by two others (APR, LL). Papers were screened against the eligibility criteria and included if they were full-text primary research in any language published in peer reviewed journals and investigated the role of community pharmacists in the management of Atopic Dermatitis. Data was extracted using a standard data extraction form. Data included any information in the published literature including text, graphics and diagrams. Data was transposed to NVivo and synthesised thematically to determine 1) characteristics of studies, 2) descriptive findings, and 3) analytical findings.

Results
Twenty-three studies published between 1995 and 2021 were included, two used qualitative methods, 18 used quantitative methods, and two used mixed methods. Descriptive findings indicate that 20 studies were from high-income countries, and three were from low-middle income countries. Seven descriptive themes were identified from included studies and the most used theme was “knowledge about corticosteroids”. Analytical findings showed that overall community pharmacists had a knowledge gap about categorising corticosteroids and the strength of them. Also, most of them appeared not to have a positive approach to corticosteroids, leading to corticophobia in patients and ultimately resulting in unsuccessful treatment. Additionally, pharmacists seemed to give patients recommendations about using emollients, without assessing the severity or condition of the skin. Recommendation on lifestyle, probiotics, and complementary-alternative medicine was limited.

Discussion/Conclusion
The results suggest that community pharmacists have limited knowledge about corticosteroids in use for Atopic Dermatitis and this may exacerbate corticophobia in patients. A limitation of the study is that it was not clear in some studies if ‘pharmacy staff’ comprises pharmacists. Additionally, studies mostly focused on topical corticosteroid use, rather than other treatments of Atopic Dermatitis. Furthermore, most of studies were from high-income countries, so the findings may not be applicable to low-middle income countries.

References
1. Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, et al. Guidelines of care for the management of atopic dermatitis. J. Am. Acad. Dermatol. 2014;70(2):338–51.
2. Bieber T. Atopic Dermatitis. N. Engl. J. Med. 2008;358(14):1483–94.
3. Berke R, Singh A, Guralnick M. Atopic dermatitis: an overview. Am Fam Physician. 2012;86(1):35–42.