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Rev Alerg Mex. 2018;65 Suppl 2:s8-s88. doi: 10.29262/ram.v65i6.526.

[Mexican consensus on the diagnosis and treatment of atopic dermatitis in adolescents and adults].

[Article in Spanish; Abstract available in Spanish from the publisher]

Author information

1
Secretaría de la Defensa Nacional, Unidad de Especialidades Médicas, Estado de México, México. dermatologia.medica.avanzada@gmail.com.
2
Fundación Clínica y Hospital Médica Sur, Unidad de investigación, Ciudad de México, México. marlar1@prodigy.net.mx.
3
A2DAHT Iberoamerican Agency for Development & Assessment of Health Technology, Ciudad de México, México.
4
Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Departamento de Disciplinas Filosóficas, Metodológicas e Instrumentales, Jalisco, Guadalajara, México, México.
5
Secretaría de Salud, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
6
Universidad Autónoma de Nuevo León, Hospital Universitario Dr. José Eleuterio González, Nuevo León, México, México.
7
Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Hospital Adolfo López Mateos, Ciudad de México, México.
8
Secretaría de Salud, Instituto Dermatológico de Guadalajara, Jalisco, México.
9
Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Especialidades, Ciudad de México, México.
10
Instituto de Seguridad y Servicios Sociales de los trabajadores del Estado, Hospital Adolfo López Mateos, Ciudad de México, México.
11
Secretaría de Salud, Centro Dermatológico Dr. Ladislao de la Pascua, Ciudad de México, México.
12
Instituto de Seguridad Social del Estado de México y Municipios, Centro Médico Toluca, Estado de México, México.
13
Clínica de Alergia Pediátrica Pachuca, Hidalgo, México, México.
14
Instituto Mexicano del Seguro Social, Centro Médico Nacional la Raza, Hospital de Especialidades, Ciudad de México, México.
15
Secretaría de Salud, Hospital Infantil de México Federico Gómez, Ciudad de México, México.
16
Secretaría de Salud, Instituto Dermatológico de Jalisco Guadalajara, Jalisco, México, México.
17
A2DAHT Iberoamerican Agency for Development & Assessment of Health Technology, Ciudad de México, Méxic.

Abstract

in English, Spanish

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.

KEYWORDS:

Atopic dermatitis; Atopic dermatitis treatment; Biological treatment; Consensus; Cyclosporin A; Dupilumab; Omalizumab

PMID:
30278478
DOI:
10.29262/ram.v65i6.526

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