Clinical impact in the real life of guidelines recommendations for atopic dermatitis in a tropical population (TECCEMA cohort)

Rev Alerg Mex. Jul-Sep 2017;64(3):260-269. doi: 10.29262/ram.v64i3.244.

Abstract

Background: Real-life impact of guidelines for the management of atopic dermatitis has been poorly studied.

Objective: To assess atopic dermatitis clinical control in residents of a tropical area managed according to international consensuses.

Methods: Prospective study with a 24-month follow-up. Clinical response was assessed with SCORAD, DLQI and a subjective scale (SS) on severity perception by the patient.

Results: Two-hundred and thirty-three patients were stratified according to SCORAD: 53 had mild severity (22%), 116 moderate (49%) and 64 severe (27%). Baseline SCORAD mean was 33 (15-41), for DLQI, it was 14 (11-20), and for the subjective scale, 85% (67-99). At 6 months, there was significant reduction (p < 0.5): SCORAD 29 (14-41), DLQI 12 (8-16) and subjective scale 62% (45-80). At 2 years, SCORAD was 21 (9-34), DLQI 7 (4-10) and subjective scale 41% (27-56); only 33% achieved complete control (SCORAD < 15%, DLQI < 5, subjective scale < 20%).

Conclusions: Following international guidelines' recommendations reduces eczema severity and improves quality of life, although only 33% achieved complete control after 2 years.

Antecedentes: Se ha estudiado poco el impacto en la vida real de las guías de manejo de la dermatitis atópica. Objetivo: Evaluar el control clínico de la dermatitis atópica en residentes de un área tropical manejados conforme a los consensos internacionales. Métodos: Estudio prospectivo con seguimiento por 24 meses. La respuesta clínica fue evaluada mediante SCORAD, DLQI y una escala subjetiva (SS) de la percepción de severidad del paciente. Resultados: 233 pacientes fueron estratificados conforme el SCORAD: gravedad leve 53 (22 %), moderada 116 (49 %) y severa 64 (27 %). La media inicial del SCORAD fue de 33 (15-41), del DLQI de 14 (11-20) y de la escala subjetiva de 85 % (67-99). A los 6 meses existió reducción significativa (p < 0.5): SCORAD 29 (14-41), DLQI 12 (8-16) y escala subjetiva 62 % (45-80). A los 2 años, SCORAD (21, 9-34), DLQI (7, 4-10) y escala subjetiva (41 %, 27-56); solo 33 % consiguió control completo (SCORAD < 15 %, DLQI < 5, escala subjetiva < 20 %). Conclusiones: El apego a las guías internacionales reduce la gravedad del eccema y mejora de forma importante la calidad de vida de los pacientes con dermatitis. Sin embargo, solo 33 % de los pacientes alcanza un control completo a los 2 años de seguir las recomendaciones.

Keywords: Atopic; Dermatitis; Eczema; Guidelines; Pharmacotherapy; Quality of life.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Cohort Studies
  • Colombia
  • Dermatitis, Atopic / therapy*
  • Dermatologic Agents / therapeutic use
  • Environmental Exposure
  • Female
  • Follow-Up Studies
  • Histamine Antagonists / therapeutic use
  • Humans
  • Hygroscopic Agents / therapeutic use
  • Immunosuppressive Agents / therapeutic use
  • Male
  • Practice Guidelines as Topic*
  • Prospective Studies
  • Quality of Life
  • Severity of Illness Index
  • Treatment Outcome
  • Tropical Climate
  • Young Adult

Substances

  • Dermatologic Agents
  • Histamine Antagonists
  • Hygroscopic Agents
  • Immunosuppressive Agents