Consensus on the Clinical Approach to Moderate-to-Severe Atopic Dermatitis in Spain : A Delphi Survey
Sastre, Joaquin (Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz)
Serra-Baldrich, E (Institut d'Investigació Biomèdica Sant Pau)
Armario Hita, José Carlos (Hospital Universitario Puerto Real (Cadis))
Herráez, L. (Hospital Universitario 12 de Octubre (Madrid))
Jáuregui, Ignacio (Hospital Universitario de Cruces (Barakaldo, País Basc))
Martín-Santiago, Ana (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Ortiz de Frutos, Javier (Hospital Universitario 12 de Octubre (Madrid))
Silvestre, Juan Francisco (Hospital General Universitario de Alicante (Alacant, País Valencià))
Valero, Antonio (Hospital Clínic i Provincial de Barcelona)
Universitat Autònoma de Barcelona

Data:	2020
Resum:	The purpose of this study was to gather information on the current assessment and management of patients with moderate-to-severe AD in routine daily practice. A cross-sectional two-round Delphi survey with the participation of dermatologists and allergologists throughout Spain was conducted. They completed a 46-item questionnaire, and consensus was defined when responses of ≥80% of participants coincided in the categories of a 5-point Likert scale for that item. A total of 105 specialists (aged 40-59 years) completed the two rounds. Participants agreed regarding the consideration of AD as a multifaceted disease and the differences in clinical presentation of AD according to the patient's age. It is recommendable to perform a skin biopsy to exclude early stage T-cell cutaneous lymphoma, psoriasis, or dermatitis herpetiformis, among others (99. 1%). Also, consensus was reached regarding the use of the SCORAD index to quantify the severity of the disease (86. 7%), the use of wet wraps to increase the effect of topical corticosteroids (90. 4%), the usefulness of proactive treatment during follow-up (85. 6%) and tacrolimus ointment (91. 2%) to reduce new flares, and the fact that crisaborole is not the treatment of choice for severe AD (92. 4%). AD was not considered a contraindication for immunotherapy in patients with allergic respiratory diseases (92. 4%). In patients with severe AD, the use of immune response modifier drugs (97. 6%) or phototherapy (92. 8%) does not sufficiently cover their treatment needs. Consensus was also obtained regarding the role of the new biologic drugs (93. 6%) targeting cytokines involved in the Th2 inflammatory pathway (92. 0%) and the potential role of dupilumab as first-line treatment (90. 4%) in moderate-to-severe AD patients. This study contributes a reference framework to the care of AD patients. There is no diagnostic test or biomarkers to direct treatment or to assess the severity of the disease, and many therapeutic challenges remain.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	Dermatology Research and Practice, Vol. 2020 (april 2020) , ISSN 1687-6113

DOI: 10.1155/2020/1524293
PMID: 32318104

10 p, 486.6 KB

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Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut de Recerca Sant Pau
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