Consensus on the Clinical Approach to Moderate-to-Severe Atopic Dermatitis in Spain: A Delphi Survey.

Joaquín Sastre,Javier Ortiz De Frutos,José Carlos Armario Hita,Ignacio Jáuregui,Antonio Valero,Esther Serra Baldrich,Ana Martín-Santiago,Juan Francisco Silvestre,L Herráez

doi:10.1155/2020/1524293

Abstract

Background 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. Methods 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. Results 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. Conclusion 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.

Highlights

Atopic dermatitis (AD) is a chronic, pruritic, relapsing inflammatory skin condition, commonly affecting children and, to a lesser extent, adults
Of the 105 participants, 59 (56.2%) were dermatologists and 46 (43.8%) allergologists. e general profile of participants included a mean age between 40 and 59 years, 5 or more than 5 years of experience in the care of patients with AD with at least 10 patients with AD visiting per month, and 46.7% working in public hospitals, with all of them having available biologic drugs in the workplace
AD is diagnosed clinically (97.6%) using the criteria of Hanifin and Rajka (94.3%), with the clinical presentation depending on the patient’s age (92.8%), and currently lacking validated biomarkers that can help in the diagnosis of AD (83.2%). ere were discrepancies in the usefulness of the classification of intrinsic and extrinsic AD as the basis of specific avoidance strategies (60%) and eosinophil count as a biomarker of AD (37.1%)

Summary

Introduction

Atopic dermatitis (AD) is a chronic, pruritic, relapsing inflammatory skin condition, commonly affecting children and, to a lesser extent, adults. Depression and anxiety have been reported to be more common in adults with AD, with these psychiatric symptoms being influenced by AD disease severity and the degree of impairment of quality of life [6]. A number of cytokines and mediators involved in 2, 22, 17, and 1 pathways appear to be important in AD pathogenesis, and there is currently an increasing interest in developing targeted therapies, especially for patients with moderate-to-severe forms of the disease not responding to conventional treatments [10,11,12]. The disease is frequently associated with other comorbid skin conditions and extracutaneous diseases [13, 14]. e causative mechanisms underlying these associations are poorly understood, but treating physicians should be aware of these associations while seeking to alleviate the burden for patients with AD [15]

Methods

Results

Conclusion