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1 Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, DK-2900 Hellerup, Denmark. E-mail: jacob.pontoppidan.thyssen@regionh.dk.
1 Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, DK-2900 Hellerup, Denmark. E-mail: jacob.pontoppidan.thyssen@regionh.dk.
There is a need for unified guidance on the management of ocular manifestations of atopic dermatitis and ocular manifestations associated with dupilumab in the Nordic region (Denmark, Finland, Norway and Sweden). This initiative gathered Nordic dermatologists and ophthalmologists to identify consensus in this area using a modified Delphi process. The initiative was led by a Nordic expert panel who developed a questionnaire that was circulated to a wider group. The results informed an agenda consisting of 24 statements to be voted on using a 5-point Likert scale at a meeting in Copenhagen on 24 April 2019. A facilitator moderated discussion and revised statements according to expert feedback for a second vote when required to reach consensus. Consensus was reached for 23 statements regarding the diagnosis, treatment and referral of these patients, which we hope will improve patient management in the Nordic region.
Conflicts of interest: JPT has been an advisor/speaker/investigator for Abbvie, Pfizer, Regeneron, Sanofi-Genzyme, Eli Lilly and LEO Pharma. SH reports personal fees from Sanofi during the conduct of the study. LI reports no conflicts of interest. AR received compensation for clinical studies from Regeneron/Sanofi, Lily and Novartis, and personal fees for lectures from Leo Pharma. TA reports grants, personal fees and non-financial support from Sanofi. Md B-W reports grants and personal fees from Regeneron/Sanofi-Genzyme during the conduct of the study; personal fees from AbbVie for consultancy and PI multicentre studies, personal fees from Pfizer for consultancy and PI multicentre studies, personal fees from Leo Pharma for consultancy and PI multicentre studies, personal fees from UCB for consultancy and from Galderma for consultancy outside the submitted work. All fees are paid to the University Medical Center Utrecht, the Netherlands. TH-N reports personal fees and non-financial support from Sanofi Norway for lecturing during the conduct of the study and personal fees from Sanofi Norway for travel and stay outside the submitted work. LK reports non-financial support from Sanofi Genzyme during the conduct of the study and non-financial support from Abbvie, personal fees and non-financial support from Novartis, personal fees from Orion, personal fees, non-financial support and other from Sanofi Genzyme outside the submitted work. LUI reports financial support from Sanofi Genzyme for lecturing outside the submitted work. PL reports personal fees from Sanofi Genzyme for consultancy and non-financial support from Sanofi Genzyme for travel during the conduct of the study. JM reports non-financial support from Sanofi Genzyme during the conduct of the study and personal fees from Sanofi Genzyme for consultation, personal fees from Orion Pharma for lecturing, non-financial support from Medac for travel outside the submitted work. TS reports no conflicts of interest. TS has received refund for travel expenses as well as personal fees for consulting from Sanofi. ES reports personal fees from Sanofi Genzyme for consultancy during the conduct of the study. SFT reports personal fees from Sanofi for an advisory board during the conduct of the study and grants from Sanofi for research support outside the submitted work. TT reports personal fees from Sanofi Genyzme for an advisory board during the conduct of the study. CV reports travel grants from Sanofi during the conduct of the study, as well as grants and personal fees from Sanofi outside the submitted work. LvK reports grants and participation in advisory boards. MB has received grants funding from Sanofi-Genzyme, speaker honoraria from Novartis, AstraZeneca, AbbVie, Leo Pharma and Celgene and has attended advisory boards for Sanofi-Genzyme, Novartis, Lilly, AbbVie and Leo Pharma.
Figures
Fig. 1
Modified Delphi process. AD: atopic…
Fig. 1
Modified Delphi process. AD: atopic dermatitis.
Fig. 1
Modified Delphi process. AD: atopic dermatitis.
Fig. 2
Three typical patients with ocular…
Fig. 2
Three typical patients with ocular manifestations of atopic dermatitis that should be referred…
Fig. 2
Three typical patients with ocular manifestations of atopic dermatitis that should be referred to an ophthalmologist. Patient one: (a) moderate conjunctivitis in the right eye, and (b) a more severe conjunctivitis in the left eye. Patient two: (c) a keratoconus due to atopic dermatitis, a herpes simplex keratitis as well as Staphylococcus aureus keratitis prior to uveitis with secondary glaucoma. The greyness paracentrally on the cornea was the stromal opacification due to the deep keratitis as well as temporary vessel ingrowth and conjunctival injection. Patient three: (d) severe conjunctivitis with signs of symblepharon development.
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