Consenso de tratamiento de la dermatitis atópica en atención primaria: resolviendo mitos y leyendas a partir de la evidencia
PDF

Palabras clave

Alergia
Médico de atención primaria
Atopia
Dermatitis atópica
Consenso
Latinoamérica
Tratamiento
Recomendaciones basadas en evidencia

Resumen

Para la dermatitis atópica existen múltiples pautas de tratamiento basadas en evidencia científica, pero generalmente están dirigidas a brindar recomendaciones a los especialistas en el área. El objetivo de este estudio fue: elaborar un consenso para los médicos de atención primaria, con la finalidad de ofrecer recomendaciones prácticas basadas en la evidencia y brindar atención oportuna a los pacientes con dermatitis atópica. Como fuente central de información se utilizaron las recomendaciones de múltiples guías para el tratamiento de la dermatitis atópica. Se convocó a delegados de diferentes sociedades médicas para identificar las barreras en la atención y posibles soluciones para la correcta aplicación de las recomendaciones en atención primaria. Posteriormente se realizó una segunda evaluación de su aplicabilidad, invitando a una revisión externa por médicos de diferentes países de Latinoamérica. Se identificaron las principales dudas y barreras de los médicos de atención primaria para la aplicación de las recomendaciones propuestas por las guías, de acuerdo con los criterios diagnósticos, tratamientos no farmacológicos y farmacológicos, tratamiento en condiciones especiales y pautas para envío de pacientes al especialista. Se propusieron soluciones de consenso para cada interrogante identificada.

Palabras clave: Alergia; Médico de atención primaria; Atopia; Dermatitis atópica; Consenso; Latinoamérica; Tratamiento; Recomendaciones basadas en evidencia.

PDF

Referencias

Borzutzky A, Larco JI, Luna PC, McElwee E, et al. Atopic Dermatitis in Latin America: A Roadmap to Address Data Collection, Knowledge Gaps, and Challenges. Dermatitis. 2022; 33 (6S): S83-S91.

Sánchez J, Ale IS, Angles MV, Fogelbach GG, et al. Healthcare Disparities in Atopic Dermatitis in Latin America: A Narrative Review. Dermatol Ther (Heidelb). 2022: 1-18.

Sanchez J, Cherrez-Ojeda I, Galvan C, Garcia E, et al. The Unmet Needs in Atopic Dermatitis Control in Latin America: A Multidisciplinary Expert Perspective. Dermatol Ther (Heidelb). 2021; 11 (5): 1521-40.

Sacotte R, Silverberg JI. Epidemiology of adult atopic dermatitis. Clin Dermatol. 2018; 36 (5): 595-605.

Wollenberg A, Kinberger M, Arents B, Aszodi N, et al. European guideline (EuroGuiDerm) on atopic eczema - part II: non-systemic treatments and treatment recommendations for special AE patient populations. J Eur Acad Dermatol Venereol. 2022; 36 (11): 1904-26.

Wollenberg A, Kinberger M, Arents B, Aszodi N, et al. European guideline (EuroGuiDerm) on atopic eczema: part I - systemic therapy. J Eur Acad Dermatol Venereol. 2022; 36 (9): 1409-31.

Larenas-Linnemann D, Rincón-Pérez C, Luna-Pech JA, Macías-Weinmann A, et al. [Guidelines on atopic dermatitis for Mexico (GUIDAMEX): using the ADAPTE methodology]. Gac Med Mex 2023; 158 (Suplement 2): 1-116.

Sidbury R, Alikhan A, Bercovitch L, Cohen DE, et al. Guidelines of care for the management of atopic dermatitis in adults with topical therapies. J Am Acad Dermatol. 2023; 89 (1): e1-e20.

Katoh N, Ohya Y, Ikeda M, Ebihara T, Katayama I, Saeki H, et al. Japanese guidelines for atopic dermatitis 2020. Allergol Int. 2020; 69 (3): 356-69.

Ardusso L, Castro CC, De Gennaro M, Hermida D, et al. Guías para el Diagnóstico y Tratamiento de la Dermatitis Atópica 2019. Archivos de Alergia e Inmunología Clínica. 2020; 51: 1-76.

Sánchez J, Toro Y, Cardona R. Clinical impact in the real life of guidelines recommendations for atopic dermatitis in a tropical population (TECCEMA cohort). Rev Alerg Mex. 2017; 64 (3): 260-9.

Sánchez J, Páez B, Macías-Weinmann A, De Falco A. [Key points for the management of dermatitis in Latin America. The SLAAI Consensus]. Rev Alerg Mex. 2015; 62 (3): 226-33.

Sánchez J, Páez B, Macías A, Olmos C, et al. Atopic dermatitis guideline. Position paper from the Latin American Society of Allergy, Asthma and Immunology. Rev Alerg Mex. 2014; 61 (3): 178-211.

Chu DK, Schneider L, Asiniwasis RN, Boguniewicz M, et al. Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations. Ann Allergy Asthma Immunol. 2023.

Okoli C, D. Pawlowski S. The Delphi method as a research tool: an example, design considerations and applications. IM 2004; 42 (1): 15-29.

Chang A, Robison R, Cai M, Singh AM. Natural History of Food-Triggered Atopic Dermatitis and Development of Immediate Reactions in Children. J Allergy Clin Immunol Pract. 2016; 4 (2): 229-36.e1.

Carlsten C, Dimich-Ward H, Ferguson A, Watson W, et al. Atopic dermatitis in a high-risk cohort: natural history, associated allergic outcomes, and risk factors. Ann Allergy Asthma Immunol. 2013; 110 (1): 24-8.

Ricci G, Patrizi A, Baldi E, Menna G, et al. Long-term follow-up of atopic dermatitis: retrospective analysis of related risk factors and association with concomitant allergic diseases. J Am Acad Dermatol. 2006; 55 (5): 765-71.

Kim JP, Chao LX, Simpson EL, Silverberg JI. Persistence of atopic dermatitis (AD): A systematic review and meta-analysis. J Am Acad Dermatol. 2016; 75 (4): 681-7.e11.

Arruda LK, Campos Yang A, Aoki V, Fachini Jardim Criado R, et al. Clinical features and disease management of adult patients with atopic dermatitis receiving care at reference hospitals in Brazil: the ADAPT Study. J Investig Allergol Clin Immunol. 2021; 31 (3): 236-245.

Cheng BT, Silverberg NB, Silverberg JI. Association of Childhood Atopic Dermatitis With Atopic and Nonatopic Multimorbidity. Dermatitis. 2021: 32 (4): 214-219.

Silverberg JI. Comorbidities and the impact of atopic dermatitis. Ann Allergy Asthma Immunol. 2019; 123 (2): 144-51.

Sánchez J, Sánchez MR, Macías-Weinmann A, Barreto B, et al. Systematic review about 10 interventions in dermatitis. A document from the Latin American Society of Allergy, Asthma, and Immunology. Rev Alerg Mex. 2019; 66 (4): 426-55.

Sánchez J, Sánchez A, Cardona R. Particular characteristics of atopic eczema in tropical environments. The Tropical Environment Control for Chronic Eczema and Molecular Assessment (TECCEMA) cohort study. An Bras Dermatol. 2017; 92 (2): 177-83.

Amaral AFS, Newson RB, Abramson MJ, Antó JM, et al. Changes in IgE sensitization and total IgE levels over 20 years of follow-up. J Allergy Clin Immunol. 2016; 137 (6): 1788-95.e9.

Caraballo L, Zakzuk J, Lee BW, Acevedo N, et al. Particularities of allergy in the Tropics. World Allergy Organ J. 2016; 9: 20.

Ansotegui IJ, Melioli G, Canonica GW, Caraballo L, et al. IgE allergy diagnostics and other relevant tests in allergy, a World Allergy Organization position paper. World Allergy Organ J. 2020; 13 (2): 100080.

Chalmers JR, Thomas KS, Apfelbacher C, Williams HC, et al. Report from the fifth international consensus meeting to harmonize core outcome measures for atopic eczema/dermatitis clinical trials (HOME initiative). Br J Dermatol. 2018; 178 (5): e332-e41.

Lam M, Spuls PI, Leshem YA, Gerbens LAA, et al. Reporting of Harmonising Outcome Measures for Eczema (HOME) core outcome set instruments in randomized clinical trials for systemic treatments in atopic dermatitis. Br J Dermatol. 2023; 189 (4): 494-6.

Williams HC, Schmitt J, Thomas KS, Spuls PI, et al. The HOME Core outcome set for clinical trials of atopic dermatitis. J Allergy Clin Immunol. 2022; 149 (6): 1899-911.

Restrepo C, Valencia C, Giraldo A, Tamayo S, et al. Instrumentos de evaluación de la calidad de vida en dermatología. Iatreia. 2012; 26 (4): 467-75.

Christensen MO, Barakji YA, Loft N, Khatib CM, et al. Prevalence of and association between atopic dermatitis and food sensitivity, food allergy and challenge-proven food allergy: A systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2023; 37 (5): 984-1003.

Tamagawa-Mineoka R, Katoh N. Atopic Dermatitis: Identification and Management of Complicating Factors. Int J Mol Sci. 2020; 21 (8).

Sala-Cunill A, Lazaro M, Herráez L, Quiñones MD, et al. Basic Skin Care and Topical Therapies for Atopic Dermatitis: Essential Approaches and Beyond. J Investig Allergol Clin Immunol. 2018; 28 (6): 379-91.

Fukuie T, Hirakawa S, Narita M, Nomura I, et al. Potential preventive effects of proactive therapy on sensitization in moderate to severe childhood atopic dermatitis: A randomized, investigator-blinded, controlled study. J Dermatol. 2016; 43 (11): 1283-92.

Sach TH, Lartey ST, Davies C, Chalmers JR, et al. Emollients for preventing atopic eczema: Cost-effectiveness analysis of the BEEP trial. Clin Exp Allergy. 2023; 53 (10): 1011-9.

Kelleher MM, Phillips R, Brown SJ, Cro S, et al. Skin care interventions in infants for preventing eczema and food allergy. Cochrane Database Syst Rev. 2022; 11 (11): CD013534.

Maleki-Yazdi KA, Heen AF, Zhao IX, Guyatt GH, et al. Values and Preferences of Patients and Caregivers Regarding Treatment of Atopic Dermatitis (Eczema): A Systematic Review. JAMA Dermatol. 2023; 159 (3): 320-30.

Kleinman E, Laborada J, Metterle L, Eichenfield LF. What's New in Topicals for Atopic Dermatitis? Am J Clin Dermatol. 2022; 23 (5): 595-603.

Diaz A, Guttman-Yassky E. Topical agents for the treatment of atopic dermatitis. Expert Rev Clin Immunol. 2019; 15 (4): 369-82.

Chovatiya R, Paller AS. JAK inhibitors in the treatment of atopic dermatitis. J Allergy Clin Immunol. 2021; 148 (4): 927-40.

Drucker AM, Morra DE, Prieto-Merino D, Ellis AG, et al. Systemic Immunomodulatory Treatments for Atopic Dermatitis: Update of a Living Systematic Review and Network Meta-analysis. JAMA Dermatol. 2022; 158 (5): 523-32.

Drucker AM, Eyerich K, de Bruin-Weller MS, Thyssen JP, et al. Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement. Br J Dermatol. 2018; 178 (3): 768-75.

Yepes-Nuñez JJ, Guyatt GH, Gómez-Escobar LG, Pérez-Herrera LC, et al. Allergen immunotherapy for atopic dermatitis: Systematic review and meta-analysis of benefits and harms. J Allergy Clin Immunol. 2023; 151 (1): 147-58.

Herrera-Sánchez DA, Hernández-Ojeda M, Vivas-Rosales IJ. [Epidemiological study on atopic dermatitis in Mexico]. Rev Alerg Mex. 2019; 66 (2): 192-204.

Creative Commons License

Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.

Derechos de autor 2024 Revista Alergia México

Descargas

##plugins.themes.healthSciences.displayStats.noStats##