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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Main Authors: 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
Format: Article
Language:English
Published: Hindawi Limited 2020-01-01
Series:Dermatology Research and Practice
Online Access:http://dx.doi.org/10.1155/2020/1524293
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spelling 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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