Consensus on the Clinical Approach to Moderate-to-Severe Atopic Dermatitis in Spain: A Delphi Survey
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 w...
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2020-01-01
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doaj-5d5ec4bd6b014c3db2faa728bc27cada2020-11-25T02:29:51ZengHindawi LimitedDermatology Research and Practice1687-61051687-61132020-01-01202010.1155/2020/15242931524293Consensus on the Clinical Approach to Moderate-to-Severe Atopic Dermatitis in Spain: A Delphi SurveyJoaquín Sastre0Esther Serra Baldrich1José Carlos Armario Hita2L. Herráez3Ignacio Jáuregui4Ana Martín-Santiago5Javier Ortiz de Frutos6Juan Francisco Silvestre7Antonio Valero8Service of Allergy, Fundación Jiménez Díaz, Madrid, CIBERES, Instituto Carlos III, Department of Medicine, Universidad Autónoma de Madrid, Madrid, SpainDermatology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, SpainService of Dermatology, Hospital Universitario Puerto Real, University of Cádiz, Cádiz, SpainService of Allergy, Hospital Universitario 12 de Octubre, Madrid, SpainService of Allergy, Hospital Universitario Cruces, Barakaldo, Vizcaya, SpainService of Dermatology, Hospital Universitari Son Espases, Palma, SpainService of Dermatology, Hospital Universitario 12 de Octubre, Madrid, SpainService of Dermatology, Hospital General Universitario de Alicante, Alicante, SpainSection of Allergy, Hospital Clinic i Provincial de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, SpainBackground. 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.http://dx.doi.org/10.1155/2020/1524293 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Joaquín Sastre Esther Serra Baldrich José Carlos Armario Hita L. Herráez Ignacio Jáuregui Ana Martín-Santiago Javier Ortiz de Frutos Juan Francisco Silvestre Antonio Valero |
spellingShingle |
Joaquín Sastre Esther Serra Baldrich José Carlos Armario Hita L. Herráez Ignacio Jáuregui Ana Martín-Santiago Javier Ortiz de Frutos Juan Francisco Silvestre Antonio Valero Consensus on the Clinical Approach to Moderate-to-Severe Atopic Dermatitis in Spain: A Delphi Survey Dermatology Research and Practice |
author_facet |
Joaquín Sastre Esther Serra Baldrich José Carlos Armario Hita L. Herráez Ignacio Jáuregui Ana Martín-Santiago Javier Ortiz de Frutos Juan Francisco Silvestre Antonio Valero |
author_sort |
Joaquín Sastre |
title |
Consensus on the Clinical Approach to Moderate-to-Severe Atopic Dermatitis in Spain: A Delphi Survey |
title_short |
Consensus on the Clinical Approach to Moderate-to-Severe Atopic Dermatitis in Spain: A Delphi Survey |
title_full |
Consensus on the Clinical Approach to Moderate-to-Severe Atopic Dermatitis in Spain: A Delphi Survey |
title_fullStr |
Consensus on the Clinical Approach to Moderate-to-Severe Atopic Dermatitis in Spain: A Delphi Survey |
title_full_unstemmed |
Consensus on the Clinical Approach to Moderate-to-Severe Atopic Dermatitis in Spain: A Delphi Survey |
title_sort |
consensus on the clinical approach to moderate-to-severe atopic dermatitis in spain: a delphi survey |
publisher |
Hindawi Limited |
series |
Dermatology Research and Practice |
issn |
1687-6105 1687-6113 |
publishDate |
2020-01-01 |
description |
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. |
url |
http://dx.doi.org/10.1155/2020/1524293 |
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