Keywords
Primary care physician
Atopy
Dermatitis
eczema
Consensus
Latin America
Clinical managment
Treatment
Abstract
Atopic dermatitis (AD) is a disease that significantly impacts the quality of life of patients. Although there are multiple evidence-based guidelines, they are usually aimed at providing recommendations to AD specialists rather than primary care physicians (PCPs). The aim of this study was to construct a consensus document for PCPs, with the aim of presenting evidence-based recommendations that allow general practitioners, family physicians, pediatricians, internists and emergency physicians to provide appropriate care to AD patients, facilitating their diagnosis, management, and avoiding delays that can deteriorate patients’ f quality of life. As a central source of information, we used the recommendations of different international AD guidelines. Delegates from distinct medical societies identify barriers to care and possible solutions for the application of recommendations in primary care. Subsequently, a second evaluation for physicians from different Latin American countries was carried out. The main doubts and barriers that PCPs face in applying the recommendations proposed by the guidelines were identified across different areas, diagnostic criteria, non-pharmacological therapies, pharmacological therapies, management in special conditions and guidelines for referral to a specialist. Consensus solutions were proposed for each identified issue. In conclusion, this consensus contains recommendations regarding the management and treatment of AD in children and adults, which clarify doubts and provide tools to primary care physicians to offer effective treatment for patients and their families.
Keywords: Allergy; Primary care physicians; Atopy; Atopic dermatitis; Consensus; Latin America; Treatment; Evidence-based guidelines.
References
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.
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