Clinical impact in the real life of guidelines recommendations for atopic dermatitis in a tropical population (TECCEMA cohort)

Abstract

Impacto clínico en la vida real de las recomendaciones de las guías para el manejo de la dermatitis atópica en una población tropical (cohorte TECCEMA) AbstractBackground: Real-life impact of guidelines for the management of atopic dermatitis has been poorly studied. Objective: To assess atopic dermatitis clinical control in residents of a tropical area managed according to international consensuses. Methods: Prospective study with a 24-month follow-up. Clinical response was assessed with SCORAD, DLQI and a subjective scale (SS) on severity perception by the patient. Results: Two-hundred and thirty-three patients were stratified according to SCORAD: 53 had mild severity (22%), 116 moderate (49%) and 64 severe (27%). Baseline SCORAD mean was 33 (15-41), for DLQI, it was 14 (11-20), and for the subjective scale, 85% (67-99). At 6 months, there was significant reduction (p < 0.5): SCORAD 29 (14-41), DLQI 12 (8-16) and subjective scale 62% (45-80). At 2 years, SCORAD was 21 (9-34), DLQI 7 (4-10) and subjective scale 41% (27-56); only 33% achieved complete control (SCORAD < 15%, DLQI < 5, subjective scale < 20%). Conclusions: Following international guidelines' recommendations reduces eczema severity and improves quality of life, although only 33% achieved complete control after 2 years.Keywords: Atopic; Dermatitis; Eczema; Guidelines; Quality of life; Pharmacotherapy ResumenAntecedentes: Se ha estudiado poco el impacto en la vida real de las guías de manejo de la dermatitis atópica. Objetivo: Evaluar el control clínico de la dermatitis atópica en residentes de un área tropical manejados conforme a los consensos internacionales. Métodos: Estudio prospectivo con seguimiento por 24 meses. La respuesta clínica fue evaluada mediante SCORAD, DLQI y una escala subjetiva (SS) de la percepción de severidad del paciente. Resultados: 233 pacientes fueron estratificados conforme el SCORAD: gravedad leve 53 (22 %), moderada 116 (49 %) y severa 64 (27 %). La media inicial del SCORAD fue de 33 (15-41), del DLQI de 14 (11-20) y de la escala subjetiva de 85 % (67-99). A los 6 meses existió reducción significativa (p < 0.5): SCORAD 29 (14-41), DLQI 12 (8-16) y escala subjetiva 62 % (45-80). A los 2 años, SCORAD (21, 9-34), DLQI (7, 4-10) y escala subjetiva (41 %, 27-56); solo 33 % consiguió control completo (SCORAD < 15 %, DLQI < 5, escala subjetiva < 20 %).Conclusiones: El apego a las guías internacionales reduce la gravedad del eccema y mejora de forma importante la calidad de vida de los pacientes con dermatitis. Sin embargo, solo 33 % de los pacientes alcanza un control completo a los 2 años de seguir las recomendaciones.

Interventions to improve primary care provider management of atopic dermatitis: A systematic review

“…25 Though some aspects of the PCPs' training were not clear, having physicians follow ET-FAD treatment recommendations based on SCORAD score arguably led to the most significant, measured, clinical gains. 17 The evidence from this study, and others that included the employment of an evidence-based tool such as an EAP, support the need for clear, objective guidelines that PCPs can follow in clinical practice. Asthma action plans, which are similar to EAPs, were once thought to improve asthma outcomes but have more recently been shown to be no more effective than parent education, and in some cases lead to worse outcomes.…”

Presence of IgE Autoantibodies Against Eosinophil Peroxidase and Eosinophil Cationic Protein in Severe Chronic Spontaneous Urticaria and Atopic Dermatitis

“…The CSU population was recruited from the “Urticaria Research of Tropical Impact and Control Assessment” cohort, 27 28 and severe AD patients were recruited from the “Tropical Environment Control for Chronic Eczema and Molecular Assessment” cohort. 29 30 CSU was defined as the recurrence of hives, with or without angioedema, for at least 6 weeks. 31 CSU group included patients older than 12 years with a urticaria activity score for 7 days > 28 points.…”

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

“…Therefore, some common aspects can be inferred to explain a lack of clinical control in AD patients: (1) diagnosis and classification errors, (2) treatment non-adherence, (3) lack of effective treatments, (4) economic impact of treatments, and (5) variability of control assessment due to not using clinometric tools. For example, Colombia's TECCEMA study evaluated the [13,44].…”

“…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.…”