Guia prático de atualização em dermatite atópica - Parte II: abordagem
                        terapêutica. Posicionamento conjunto da Associação Brasileira de Alergia e
                        Imunologia e da Sociedade Brasileira de Pediatria

Carvalho, Vânia Oliveira; Solé, Dírceu; Antunes, Adriana A.; Kiszewski, Ana Elisa; Kuschnir, Fábio Chigres; Mallozi, Márcia C.; Markus, Jandrei Rogério; Silva, Maria G. Nascimento e; Pires, Mário Cézar; Mello, Marice E. El Achkar; Filho, Nelson Augusto Rosário; Sarinho, Emanuel Sávio Cavalcanti; Chong-Neto, Herberto José; Silva, Luciana Rodrígues; Rubini, Norma

doi:10.5935/2526-5393.20170020

Cited by 18 publications

(51 citation statements)

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“…Furthermore, the consistent use of moisturizers decreases the amount of topical anti-inflammatory agents needed to control the disease, especially those moisturizers referred to as advantageous due to the sparing effect of topical corticosteroids. To ensure adequate hydration, generous and frequent use of moisturizers is suggested [9,18,20,21,25].…”

Section: Discussionmentioning

confidence: 99%

“…e BAAI/BSP, EADV, and BSD guidelines discuss the benefit of these "plus" emollients with active ingredients, such as saponins, flavonoids, riboflavin, and bacterial lysates from Aquaphilus dolomiae or Vitreoscilla filiformis. Although recognized, there is no official recommendation for the adoption of these emollients to the detriment of standard moisturizers [9,18,20].…”

Section: Discussionmentioning

confidence: 99%

“…Regarding wet-wrap therapy, although unanimously recommended to rapidly reduce the severity of the disease in situations of significant crises or even in cases of recalcitrant disease [9,18,20,21,25], approximately 50% of the participants indicated never or almost never prescribing this therapy. e use of topical corticosteroids as a first-line antiinflammatory treatment in adults and children with AD to rescue the patient from inflammatory crises when the moisturizer alone is unable to control the disease [9,18,20,21,25] is consistently suggested by all guidelines and was reported by most of the participants instead of calcineurin inhibitors. Maintenance therapy or proactive therapy with the intermittent application once or twice a week in specific locations is recommended by all analyzed guidelines and is more effective than the use of emollients alone to reduce relapses and the severity of AD.…”

Section: Discussionmentioning

confidence: 99%

“…e main objective of therapeutic management is to control these signs and symptoms to provide relief and ensure a better quality of life [14][15][16]. For this, there is a wide range of therapies, multidisciplinary care [17], and guidelines published by Brazilian and international medical societies that are derived from expert consensus based on available scientific data [9,15,[18][19][20][21][22][23][24][25]. Adherence to the guidelines does not ensure successful treatment in every situation [21], but it can help physicians make decisions grounded in evidence-based medicine in daily clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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Different Approaches to Atopic Dermatitis by Allergists, Dermatologists, and Pediatricians

Bortoli

Neto

Filho

2021

Dermatology Research and Practice

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Objectives. Atopic dermatitis (AD) is the most prevalent chronic inflammatory skin disease, with a vast drug arsenal and guidelines available for its management and diagnosis and different medical specialties engaged in providing care. This study aimed to outline the therapeutic and diagnostic approaches to the AD of allergists, dermatologists, and pediatricians and verify whether they are compliant with the guidelines. Methods. A cross-sectional study using an electronic questionnaire administered through the SurveyMonkey® platform was disclosed by participating medical societies to their medical associates. Results. Of the 1,473 participating physicians, the use of moisturizers as part of AD treatment was observed among pediatricians (91.9%), dermatologists (97.5%), and allergists (100%; p = 0.07 ). The preference for the use of new emollients was lower among pediatricians (57%) than dermatologists (75.9%) and allergists (71.4%; p < 0.001 ). The prevalence of wet-wrap therapy was lower among dermatologists (16.3%) than allergists (51%; p < 0.001 ). The recommendation of proactive treatment with topical corticosteroids was more frequently reported by allergists (65.3%) than pediatricians (43.3%) and dermatologists (40.8%; p < 0.001 ), and the same trend was observed in relation to proactive treatment using calcineurin inhibitors. The use of oral anti-histamines to control pruritus was mainly considered by pediatricians (69.2%) and dermatologists (59.2% p < 0.001 ). Clinical experience with systemic immunomodulating agents was greater among allergists (77.5%) and dermatologists (60.8%; p < 0.001 ), with cyclosporine being the most cited systemic immunomodulating agent. Environmental control of aeroallergens was recommended by pediatricians (89.8%), dermatologists (86.9%), and allergists (100%; p = 0.01 ). Conclusion. There were differences in the therapeutic and diagnostic approaches to AD used by allergists, dermatologists, and pediatricians and those recommended by the guidelines, especially regarding the use of wet-wrap therapy, proactive treatment with topical corticosteroids or calcineurin inhibitors, prescription of anti-histamines, recommendation of phototherapy, and control of aeroallergens.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Different Approaches to Atopic Dermatitis by Allergists, Dermatologists, and Pediatricians

Bortoli

Neto

Filho

2021

Dermatology Research and Practice

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“…Cyclosporine, mycophenolate mofetil, azathioprine, and methotrexate are the most commonly used immunosuppressive treatments. (4)(5)(6)(7) New therapies, such as dupilumab and Janus kinase enzyme (JAK) inhibitors, based on the pathogenesis of AD, are more effective and less harmful, and have been changing the approach to moderate to severe AD. (5) Currently, dupilumab is approved for moderate to severe AD, severe asthma, and chronic rhinosinusitis with nasal polyposis in children 6 years and older, adolescents 12 years and older, and adults 18 years and older, respectively.…”

Section: ❚ Resumomentioning

confidence: 99%

Efficacy and safety of dupilumab in two adolescents with severe atopic dermatitis

Giavina-Bianchi¹,

Giavina‐Bianchi

2021

Einstein (São Paulo)

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We report the cases of two adolescent siblings with severe atopic dermatitis, who, despite weighing approximately 40kg, presented a good response to dupilumab with the off-label dose for individuals aged 12 years and weighing 60kg. Both had already used cyclosporine, azathioprine, methotrexate and oral corticosteroids for long periods, plus topical treatments with no adequate disease control. Skin lesions were constant and widespread, with frequent skin infections and very poor quality of life, with numerous physical and psychosocial consequences, such as dropping out of school activities due to severe itching, appearance and bullying. They also showed delayed growth and development. In 2018, dupilumab, an immunobiological agent, was approved for treatment of moderate to severe atopic dermatitis in adults and, in 2019, extended to the 12-17year age group. Although it had already been approved by the Brazilian Health Surveillance Agency, the 200mg presentation (indicated for the weight of patients) was not available, with no expected arrival date. Therefore, weighing the risks and benefits of the situation of both, we chose to treat them with an adult dose (loading dose of 600mg subcutaneously, and 300mg subcutaneously every 2 weeks) despite the low weight. So far, they have received eight injections, showing significant improvement of disease and quality of life. There were no major adverse effects, only worsening of allergic conjunctivitis in one of them. The patients and their family are very satisfied, and we believe that the therapy has been successful.

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Healthcare Disparities in Atopic Dermatitis in Latin America: A Narrative Review

Sánchez

Ale

Angles

et al. 2022

Dermatol Ther (Heidelb)

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Introduction Atopic dermatitis (AD) is a chronic, pruritic skin disease caused by a mixture of genetic, immunological, and environmental factors, characterized by periods of inflammation and remission. In Latin America (LA), the prevalence of AD ranges up to 25% in children and 1–3% in adults. The natural history of the disease for most patients is that AD goes into remission in adolescence and adult life. Only 10–30% of patients continue to have symptoms of the disease in adulthood. There are patients (3–4%) who have the onset of AD during adolescence or after adulthood. Those with limited access to healthcare services, such as diagnosis and treatment, have increased difficulties coping with AD. Healthcare disparities are a complex topic that include social, political, racial/ethnic, and geographical factors. Publications about healthcare disparities in AD in LA are scarce. As a result, recognizing and resolving healthcare inequalities is critical to improving the treatment and quality of life (QoL) of individuals with AD. Methods A panel of Latin American experts in dermatology and allergies was provided with a series of relevant questions to address before a multiday conference. During this conference, the entire group discussed and edited each narrative through numerous drafts and rounds of discussion until they reached a consensus. Results This paper examines the barriers to equal access to care and recommends realistic actions to overcome them. Inadequate disease knowledge, cultural and linguistic barriers, stigmatization, maldistribution of resources, absence of local clinical practice guidelines, arduous patient journey, and limited consultation time were identified as causes of health inequality. Conclusions Among the suggested solutions are enhanced education for healthcare professionals, patients, and the general public, a focus on underprivileged communities, telemedicine and telementoring, translators, multidisciplinary teams, and local living clinical practice guidelines.

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Guia prático de atualização em dermatite atópica - Parte II: abordagem terapêutica. Posicionamento conjunto da Associação Brasileira de Alergia e Imunologia e da Sociedade Brasileira de Pediatria

Cited by 18 publications

References 0 publications

Different Approaches to Atopic Dermatitis by Allergists, Dermatologists, and Pediatricians

Different Approaches to Atopic Dermatitis by Allergists, Dermatologists, and Pediatricians

Efficacy and safety of dupilumab in two adolescents with severe atopic dermatitis

Healthcare Disparities in Atopic Dermatitis in Latin America: A Narrative Review

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