Atopic dermatitis usually develops in childhood, but can occur in adults. Management involves drug and non-drug treatments to clear the skin. Not all patients with atopic dermatitis have allergies. Most patients have trigger factors that can be avoided. All patients should use soap substitutes and bath oils. Moisturisers are important for improving the condition of the skin. Topical corticosteroids are the main drug treatment. The choice of corticosteroid depends largely on the site of the atopic dermatitis. Topical calcineurin inhibitors can be considered for sensitive sites such as the face where potent topical corticosteroids are potentially harmful. Adjunctive treatments given during flares of dermatitis include bleach baths and wet dressings. Antihistamines may help to relieve itch. Phototherapy may be considered by a specialist for adults if there is inadequate response to treatment. Severe cases of atopic dermatitis may require systemic treatment. Immunosuppressants, such as ciclosporin, have been used and now dupilumab and upadacitinib are available for severe chronic atopic dermatitis.

SUMMARYNucleic acid amplification tests (NAATs), including polymerase chain reaction (PCR) assays, are more sensitive for the detection of SARS-CoV-2 than rapid antigen tests (RATS), and are the gold standard for diagnosis of acute COVID-19. However NAATs can remain positive for weeks following infection due to low-level shedding of non-viable viral fragments.RATs (in particular self-testing) are the mainstay of COVID-19 diagnosis due to their convenience, speed and high specificity. The sensitivity of RATs is highest within seven days of symptom onset. A negative RAT result may warrant a NAAT or repeat RAT for confirmation.The presence of spike antibodies is consistent with either vaccination or infection. Nucleocapsid antibodies suggest a previous infection. Serological tests measuring neutralising antibodies that infer immunity are not readily available.

SUMMARYObesity is a major public health issue with significant health and financial costs. Almost one in three Australian adults are living with obesityBariatric surgery can have a role in the management of obesity. There is evidence for its effectiveness in preventing or reversing chronic health conditionsThe type of bariatric surgery can significantly impact the absorption, distribution, metabolism or elimination of orally administered drugs. Some changes can be predicted from pharmacokinetic and physiological effects, but management should be individualisedThe effect of weight loss itself after bariatric surgery may require drug doses to be alteredA review of the patient’s medicines and ongoing follow-up are important before and after surgery to ensure optimal outcomes

SomatrogonApproved indication: growth hormone deficiency Ngenla (Pfizer) pre-filled pens containing 24 mg/1.2mL or 60 mg/1.2mL

We do not believe the article 'Medicines for long-term obesity management' 1 is consistent with the NPS MedicineWise philosophy, to provide independent and evidence-based advice to health professionals.

SUMMARYHormonal contraception is known to precipitate or perpetuate depression in some patients. The link between oral contraceptive pills and depression relates to the amount and type of progestogen contained in these pills.Many of the older oral contraceptive pills, which contain ethinylestradiol, are linked to severe mood problems. Newer oral contraceptive pills containing physiological forms of oestrogen may be better tolerated with a purported weaker link to mood problems.Clinicians should consider the temporal relationship between the use of hormonal contraception and development of new or worsened depression or mood changes.

SUMMARYSevere cutaneous adverse drug reactions include Stevens-Johnson syndrome, toxic epidermal necrolysis and acute generalised exanthematous pustulosis. These eruptions are a type of delayed hypersensitivity reaction and can be life-threatening.The assessment of a severe cutaneous drug reaction requires a detailed clinical history and examination to identify the culprit drug and evaluate the allergy. Allopurinol, antibiotics and anticonvulsants are often implicated.Patch testing and delayed intradermal testing can assist in determining if the reaction was allergic, however there is limited evidence about the sensitivity and specificity of skin testing in severe cutaneous adverse drug reactions. If the testing is non-conclusive or negative, it is recommended to avoid the suspected culprit drug and any structurally similar drug in future.Any decision to reintroduce a drug should be made after considering the harm–benefit ratio. Caution is also needed if considering a possibly cross-reactive drug in a patient with a history of severe cutaneous adverse drug reactions.