Clinical Features and Disease Management in Adult Patients With Atopic Dermatitis Receiving Care at Reference Hospitals in Brazil: the ADAPT Study

Abstract

Background: Atopic dermatitis is a chronic inflammatory skin disease with a prevalence of 0.02% to 8.1% in adults. Adult patients with moderate-to-severe atopic dermatitis have frequent relapses and significant disease burden.Objectives: Characterize clinical, immunological and therapeutic features of Brazilian adults with atopic dermatitis.Methods: A multicenter, observational, retrospective, descriptive registry-based study, conducted at reference hospitals, between December 2016 and October 2017. Demographics, personal and family history of atopic diseases, clinical manifestations, laboratory tests, disease severity and management were collected. Results:From the 187 subjects included in the analysis, 56.1% were female and 71.7% were Caucasian, with a mean age of 24.7 years. Mean follow-up duration was 9 years. Asthma or other allergic diseases were reported by 80.2% of the patients.The main comorbidity was hypertension (10.2%) and common disease manifestations included pruritus and erythema. Lesions were generally distributed in non-flexural and flexural areas, with typical morphology. Around 83% of patients had moderate to severe disease and 8.6% reported at least one hospitalization. Most patients received topical and/or systemic pharmacological therapies, including omalizumab (5.9%); 4.3% received phototherapy. Moreover, 66.8% of patients received adjuvant therapy and 79.1% changed or discontinued treatment for atopic dermatitis due to remission (46.5%), poor effectiveness (33.7%) or lack of therapeutic adherence (12.9%). Most patients presented characteristics of type 2 inflammation, with immunoglobulin E levels above 100 IU/mL (94.4%) and peripheral blood eosinophils above 5% (55.9%). Conclusion:Brazilian adult patients with severe atopic dermatitis need treatments to efficiently control the disease and improve quality of life. RESUMENAntecedentes: La dermatitis atópica es una enfermedad inflamatoria crónica de la piel con una prevalencia, en adultos, del 0,02% al 8,1%. Los pacientes adultos con dermatitis atópica moderada o grave tienen reagudizaciones frecuentes y una sintomatología importante.Objetivos: Describir las características clínicas e inmunológicas, así como las opciones terapéuticas de los pacientes brasileños adultos con dermatitis atópica.Métodos: Estudio multicéntrico, observacional, retrospectivo, descriptivo y basado en registros, realizado en hospitales de referencia, entre diciembre de 2016 y octubre de 2017.Se recopilaron datos demográficos, antecedentes personales y familiares de enfermedades atópicas, manifestaciones clínicas, pruebas de laboratorio, gravedad y manejo de la enfermedad.Resultados: De los 187 pacientes incluidos en el análisis, el 56,1% fueron mujeres y el 71,7% caucásicos, con una edad media de 24,7 años. La duración media del seguimiento fue de 9 años. El 80,2% de los pacientes referían asma u otras enfermedades alérgicas. La principal comorbilidad fue la hipertensión (10,2%) y las manifestaciones más frecuentes de la enfermedad fueron el prurito y el eritema. Las ...

The Symptom Characteristics and the Efficacy of Combining Therapies in Inpatients with Atopic Dermatitis: A Study on Vietnamese Population

“…While the pathogenesis of AD is linked to genetic factors, environmental factors such as air pollution and aeroallergens (e.g., pet hair, house dust mite, and pollen) may give rise to the growth of the incidence rate. Furthermore, stratum corneum wall could be damaged by altering lifestyles including frequently utilizing soap or staying a long time in air-conditioned room [23]. Thus, the average age of beginning of AD disease is increasing.…”

Atopic Dermatitis in Latin America: Considerations on Epidemiology, Clinical and Laboratory Features, Ethnic/Racial Variations, and Therapeutic Management

“…A recent study evaluating one-year prevalence of AD in Brazil through a population-based telephone survey, revealed that the age-adjusted prevalence of AD was 2.27% [9]. Data on the epidemiology of adult AD in Latin America are extremely limited, with one multicenter retrospective study in Brazil named ADAPT SA, a multicentric, non-interventional study to describe clinical features and disease management of adult patients with atopic dermatitis followed at tertiary hospitals [10].…”

“…The Brazilian ADAPT study analyzed the clinical characteristics of AD and found that most patients presented with flexural lesions in the popliteal and antecubital regions, and lesions distributed on extensor surfaces such as the extremities and trunk [10]. At the first visit, the main AD reported features were erythema (54.5%), pruritus (55.1%), and dry skin (48.7%), and lesions had the characteristic lichenified or eczematous morphology [10]. In a cohort of 1,650 Argentinian patients with AD, 40% experienced high itch intensity and frequency, and 96% reported bleeding and suppuration [24].…”

“…High CSHQ scores were also found to correlate with increased disease severity [28]. Unfortunately, these psychological factors are not usually adequately addressed in many LA countries, with only 11.8% of AD patients reporting they received therapy or psychological support in the ADAPT study [10].…”

The Unmet Needs in Atopic Dermatitis Control in Latin America: A Multidisciplinary Expert Perspective

“…Studies in Colombia and Brazil suggest a lower response to topical and systemic treatment in severe disease [44,45], and other LA studies suggest that comorbidities are linked to increased severity [13,14,46]. Control parameters such as QoL, disease persistence, and improvement of physical and mental comorbidities have not been studied adequately in LA.…”