Mexican consensus on the diagnosis and treatment of atopic dermatitis in adolescents and adults
Por:
Rincón-Pérez C., Larenas-Linnemann D., Figueroa-Morales M.A., Luna-Pech J., García-Hidalgo L., Macías-Weinmann A., Gómez-Vera J., Barba-Gómez J.F., Matta-Campos J.J., Guevara-Sangines E., Jurado-Santacruz F., López Tello-Santillán A., Ortega-Martell J.A., Pulido-Díaz N., Serrano-Jaén L.G., Toledo-Bahena M., Villanueva-Quintero G., Mayorga-Butrón J.L.
Publicada:
1 ene 2018
Categoría:
Immunology and allergy
Resumen:
Background: The diagnostic approaches and therapeutic strategies of atopic dermatitis (AD) are generally inconsistent among physicians and health institutions. Objective: To develop a consensus statement among experts to reduce the variations in practice regarding the diagnosis and treatment of patients = 12 years with AD to improve their care. Methods: Systematic literature search in PubMed and GREAT. With methodological support and using the Delphi method, a formal consensus was developed among 16 experts in Dermatology and Allergology, based on the current evidence and its applicability in the Mexican context. Apart from intense electronic communication, several issues of disagreement were discussed in two face-to-face meetings. Results: The clinical experts reached consensus on 46 statements related to the definition, classification, diagnostic strategies and treatment of AD. For the diagnosis we suggest the Williams criteria and for severity scoring the SCORAD (by the doctor) and POEM (by the patient). In addition to general care and treatment education (workshops), we suggest four steps for treatment, depending on severity: 1. Topical treatment with anti-inflammatory agents (and systemic: antihistamines/antileukotrienes -low level evidence-) 2. Phototherapy, 3. Cyclosporin A and 4. Dupilumab, with the possibility of managing this biological earlier on if a fast effect is needed. In extrinsic AD we suggest evaluating the addition of allergen immunotherapy or an elimination diet, if there is an IgE-mediated respiratory or food allergy, respectively. Conclusion: The panel of experts reached consensus on relevant aspects of AD with a focus on the transcultural adaptation of recent evidence. © 2018 Nieto Editores.All rights reserved.
Filiaciones:
Rincón-Pérez C.:
Secretaría de la Defensa Nacional, Unidad de Especialidades MédicasEstado de México, Mexico
Larenas-Linnemann D.:
Fundación Clínica y Hospital Médica Sur, Unidad de investigación, Ciudad de México, Mexico
Figueroa-Morales M.A.:
A2DAHT Iberoamerican Agency for Development & Assessment of Health Technology, Ciudad de México, Mexico
A2DAHT Iberoamerican Agency for Development & Assessment of Health Technology, Ciudad de México
Luna-Pech J.:
Centro Universitario de Ciencias de la Salud, Departamento de Disciplinas Filosóficas, Metodológicas e Instrumentales, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
García-Hidalgo L.:
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Secretaría de Salud, Ciudad de México, Mexico
Macías-Weinmann A.:
Universidad Autónoma de Nuevo León, Hospital Universitario Dr. José Eleuterio GonzálezNuevo León, Mexico
Gómez-Vera J.:
Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Hospital Adolfo López Mateos, Ciudad de México, Mexico
Barba-Gómez J.F.:
Instituto Dermatológico de Guadalajara, Secretaría de SaludJalisco, Mexico
Matta-Campos J.J.:
Instituto Mexicano del Seguro Social, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Ciudad de México, Mexico
Guevara-Sangines E.:
Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Hospital Adolfo López Mateos, Ciudad de México, Mexico
Jurado-Santacruz F.:
Centro Dermatológico Dr. Ladislao de la Pascua, Secretaría de Salud, Ciudad de México, Mexico
López Tello-Santillán A.:
Instituto de Seguridad Social del Estado de México y Municipios, Centro Médico TolucaEstado de México, Mexico
Ortega-Martell J.A.:
Clínica de Alergia Pediátrica PachucaHidalgo, Mexico
Pulido-Díaz N.:
Instituto Mexicano del Seguro Social, Centro Médico Nacional la Raza, Hospital de Especialidades, Ciudad de México, Mexico
Serrano-Jaén L.G.:
Instituto Mexicano del Seguro Social, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Ciudad de México, Mexico
Toledo-Bahena M.:
Hospital Infantil de México Federico Gómez, Secretaría de Salud, Ciudad de México, Mexico
Villanueva-Quintero G.:
Instituto Dermatológico de Jalisco Guadalajara, Secretaría de SaludJalisco, Mexico
Mayorga-Butrón J.L.:
A2DAHT Iberoamerican Agency for Development & Assessment of Health Technology, Ciudad de México
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