[Mexican consensus on the diagnosis and treatment of atopic dermatitis in adolescents and adults]

Rev Alerg Mex. 2018;65 Suppl 2:s8-s88. doi: 10.29262/ram.v65i6.526.
[Article in Spanish]

Abstract
in En , Spanish

Background: The diagnostic approaches and therapeutic strategies of atopic dermatitis (AD) are generally inconsistent among physicians and health institutions.

Objective: To develop a consensus statement among experts to reduce the variations in practice regarding the diagnosis and treatment of patients ≥ 12 years with AD to improve their care.

Methods: Systematic literature search in PubMed and GREAT. With methodological support and using the Delphi method, a formal consensus was developed among 16 experts in Dermatology and Allergology, based on the current evidence and its applicability in the Mexican context. Apart from intense electronic communication, several issues of disagreement were discussed in two face-to-face meetings.

Results: The clinical experts reached consensus on 46 statements related to the definition, classification, diagnostic strategies and treatment of AD. For the diagnosis we suggest the Williams criteria and for severity scoring the SCORAD (by the doctor) and POEM (by the patient). In addition to general care and treatment education (workshops), we suggest four steps for treatment, depending on severity: 1. Topical treatment with anti-inflammatory agents (and systemic: antihistamines/antileukotrienes -low level evidence-) 2. Phototherapy, 3. Cyclosporin A and 4. Dupilumab, with the possibility of managing this biological earlier on if a fast effect is needed. In extrinsic AD we suggest evaluating the addition of allergen immunotherapy or an elimination diet, if there is an IgE-mediated respiratory or food allergy, respectively.

Conclusion: The panel of experts reached consensus on relevant aspects of AD with a focus on the transcultural adaptation of recent evidence.

Antecedentes: Los abordajes diagnósticos y las estrategias terapéuticas de la dermatitis atópica generalmente son inconsistentes entre los médicos y entre las instituciones de salud. Objetivo: Consensar las opiniones de expertos para reducir las variaciones en la práctica respecto al diagnóstico y tratamiento de pacientes ≥ 12 años con dermatitis atópica para mejorar su cuidado. Métodos: Búsqueda sistemática de la literatura en PubMed y GREAT. Con apoyo metodológico y utilizando el método Delphi se desarrolló un consenso formal entre 16 expertos en dermatología y alergología, basándose en la evidencia actual y su aplicabilidad en el contexto mexicano. A parte de una comunicación electrónica intensa, se discutieron los puntos en desacuerdo en dos reuniones presenciales. Resultados: Los expertos clínicos alcanzaron consenso en 46 declaraciones relacionadas con la definición, clasificación, estrategias de diagnóstico y tratamiento de la dermatitis atópica. Para el diagnóstico sugerimos se usan los criterios de Williams y el SCORAD (por parte del médico) y POEM (por parte del paciente) para definir la gravedad. Aunado a cuidados generales y educación terapéutica, sugerimos cuatro pasos para tratamiento, según gravedad: 1. Manejo tópico con antiinflamatorio (y sistémico: antihistamínico/antileucotrieno —evidencia reducida—) 2. Fototerapia, 3. Ciclosporina A y 4. Dupilumab, con la posibilidad de manejarlo antes si se necesita efecto rápido. En la dermatitis atópica extrínseca sugerimos agregar inmunoterapia con alérgenos o una dieta de eliminación si existe una alergia IgE-mediada, inhalatoria o alimentaria, respectivamente. Conclusión: El panel de expertos realizó consenso en aspectos relevantes de la dermatitis atópica con enfoque en la adaptación transcultural de evidencia reciente.

Keywords: Atopic dermatitis; Atopic dermatitis treatment; Biological treatment; Consensus; Cyclosporin A; Dupilumab; Omalizumab.

Publication types

  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Biological Products / therapeutic use
  • Combined Modality Therapy
  • Comorbidity
  • Dermatitis, Atopic* / diagnosis
  • Dermatitis, Atopic* / psychology
  • Dermatitis, Atopic* / therapy
  • Dermatologic Agents / classification
  • Dermatologic Agents / therapeutic use
  • Dermatology / methods
  • Diagnosis, Differential
  • Disease Management
  • Female
  • Humans
  • Immunotherapy / methods
  • Lactation
  • Male
  • Mexico
  • Phototherapy / methods
  • Practice Guidelines as Topic*
  • Pregnancy
  • Pregnancy Complications / therapy
  • Randomized Controlled Trials as Topic
  • Severity of Illness Index
  • Skin Diseases, Infectious / complications
  • Surveys and Questionnaires
  • Therapeutic Irrigation
  • Transition to Adult Care

Substances

  • Biological Products
  • Dermatologic Agents