All aboard the <i> <scp>BJD</scp> </i> for global dissemination of high‐quality dermatology clinical practice guidelines
Authors: Z.Z.N. Yiu, C.‐C. Chi, C. Flohr
Journal: British Journal of Dermatology (2020)

Linked Article: Yiu et al. Br J Dermatol 2020; 183:188–189. The year 2020 is an exciting time for dermatology. The last decade ushered in an era exploding with knowledge about causes of diseases, holistic standards of patient care, cutting edge technologies to diagnose and screen for disease, and new treatments for dermatological conditions lacking effective treatment previously. The developments have given hope to millions of patients worldwide. However, new knowledge is also accompanied by an avalanche of supporting evidence and journal articles with over 3800 new publications on PubMed per day. No individual clinician can be expected to keep up with the rapidly generated evidence, not to mention the need to critically appraise and assimilate this data for use in the clinic. Therefore, clinical practice guidelines (CPGs) play a critical role in helping to translate evidence into recommendations, improving treatment outcomes and the lives of patients with skin disease: a key aim of the BJD. One of the reasons for establishing the BJD's Evidence-Based Dermatology Section in late 2016 was to ensure a focus on treatment guidelines.1 The BJD encourages submission of national, regional and international guidelines from any location, not only those produced by the British Association of Dermatologists (BAD). The scope of the guidelines can cover any aspect of dermatological practice, provided a rigorous and transparent methodology is used. Recently, the author guidelines for CPGs have been updated to draw attention to the standards required by the BJD to permit publication (https://onlinelibrary.wiley.com/page/journal/13652133/homepage/forauthors.html). This includes rigour of development, using a framework such as GRADE to convert evidence to strength of recommendation. We also mandate consultation of the AGREE II instrument to ensure high standards of reporting when developing and writing the guideline. In areas of dermatology where evidence is not suited to the GRADE approach, the BJD also welcomes consensus guidelines that are produced in a transparent manner.1 The process of evidence search and synthesis for a CPG, typically equivalent to performing several systematic reviews at the same time, is onerous, costly and time consuming. Moreover, the evidence base for many dermatological diseases is derived from a limited set of international multicentre randomized controlled trials. Despite this, multiple guideline development groups (GDGs) across the world duplicate their efforts to produce local guidelines from the same evidence for the same disease. Conversely, jobbing clinicians do not have time to wade through lots of evidence to get to the recommendations. Therefore, we suggest to GDGs to submit the systematic review(s) as a separate paper to the BJD so that we can publish the review alongside the main guideline paper. The CPG publication itself then acts as an accessible summary of the recommendations as well as including any implementation toolkits. Alternatively, GDGs can publish the detailed evidence and conversion from evidence to recommendation sections as a supplementary file. Arguably, publication of the evidence and the recommendations from a CPG is only the first leg of the journey. We performed a survey of the BJD readership to better understand end users’ attitudes regarding CPGs and how CPGs can be improved. Results from the survey are published in this issue of the BJD.2 The survey found that although attitudes towards CPGs are broadly positive, the readership would like guidelines to be more accessible, concise, and regularly updated. Survey respondents also requested greater provision of implementation toolkits that are prominently accessible. Given the rapidly changing evidence landscape for an increasing number of skin diseases, we recognize that timely publication and regular updates to guidelines are important considerations. We encourage GDGs to contact the BJD editorial office at the time of the stakeholder review to coordinate the external peer review process to minimize any delays to publication. We also have the infrastructure within the BJD to support ‘living’ systematic reviews and ‘living’ guidelines to facilitate regular and timely updates, allowing new evidence to be reflected in revised treatment recommendations.3 We encourage all GDGs to consider and discuss writing ‘living’ guidelines with the BJD editorial team prior to undertaking the project. It is clear that we are moving into a new era of speed and robustness in translating evidence to recommendations, and we invite all of you to join the BJD on this journey. As always, the goal is to improve care of patients with skin disease in this next innovative decade and beyond. The authors would like to thank Dr Zarif Jabbar-Lopez for his contribution to the Guidelines section during his term as an associate editor of the BJD; Professor Catherine Smith and Dr M. Firouz Mohd Mustapa for their suggestions with the strategy for this section of the BJD; and Dr John Ingram for his critical review and suggestions for this editorial.