Consenso mexicano para el diagnóstico y tratamiento de la dermatitis atópica en adolescentes y adultos

Catalina Rincón-Pérez, Désirée Larenas-Linnemann, Marco Antonio Figueroa-Morales, Jorge Luna-Pech, Linda García-Hidalgo, Alejandra Macías-Weinmann, Javier Gómez-Vera, José Fernando Barba-Gómez, Juan José Juan José Matta-Campos, Esther Guevara-Sangines, Fermín Jurado-Santacruz, Adriana López Tello-Santillán, José Antonio Ortega-Martell, Nancy Pulido-Díaz, Liliana Guadalupe Serrano-Jaén, Mirna Toledo-Bahena, Guadalupe Villanueva-Quintero, José Luis Mayorga-Butrón

Resumen


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


Palabras clave


Dermatitis atópica; Ciclosporina A; Tratamiento biológico; Dupilumab; Omalizumab; Posición de consenso

Texto completo:

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Referencias


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DOI: http://dx.doi.org/10.29262/ram.v65i6.526

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