Consensus on the clinical approach to moderate-to-severe atopic dermatitis in Spain: A Delphi survey
Entity
Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD); UAM. Departamento de MedicinaPublisher
Hindawi Ltd.Date
2020-04-07Citation
10.1155/2020/1524293
Dermatology Research and Practice 2020 (2020): 1524293
ISSN
1687-6105 (print); 1687-6113 (online)DOI
10.1155/2020/1524293Editor's Version
http://doi.org/10.1155/2020/1524293Subjects
AD; Delphi; Dermatologists; Allergologists; Spain; Severity of the disease; Treatment; Biomarkers; MedicinaRights
© 2020 Joaquín Sastre et al.Abstract
Background. -e 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. -ey 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 -2 inflammatory pathway (92.0%) and the potential role of dupilumab as first-line treatment
(90.4%) in moderate-to-severe AD patients. Conclusion. -is study contributes a reference framework to the care of AD patients.
-ere is no diagnostic test or biomarkers to direct treatment or to assess the severity of the disease, and many therapeutic challenges remain
Files in this item
Google Scholar:Sastre Domínguez, Joaquín
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Serra Baldrich, Esther
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Armario Hita, José Carlos
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Herráez, L.
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Jáuregui, Ignacio
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Martín-Santiago, Ana
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Ortiz de Frutos, Javier
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Siñvestre, Juan Francisco
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Valero, Antonio
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