nach oben

Erschienen in:

Open Access 27.08.2021 | Review

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

verfasst von: Jorge Sanchez, Ivan Cherrez-Ojeda, Cesar Galvan, Elizabeth Garcia, Natalia Hernández-Mantilla, Angela Londoño Garcia, Elizabeth McElwee, Mariana Rico Restrepo, Enrique Rivas, Benjamin Hidalgo

Erschienen in: Dermatology and Therapy | Ausgabe 5/2021

Abstract

Introduction

Adoption of control tools for atopic dermatitis (AD) in Latin America (LA) is currently very limited. Clinical assessment tools represent a practical method to measure the impact of treatment on disease activity and on the quality of life of patients. However, the use of these tools in the LA clinical practice setting is limited.

Methods

A selected panel of Latin American experts in fields related to atopic dermatitis were provided with a series of relevant questions to address prior to the multi-day conference. Within this conference, each narrative was discussed and edited by the entire group, through numerous drafts and rounds of discussion, until a consensus was achieved.

Results

The panel proposes specific and realistic recommendations for implementing control tools for AD care in LA. In creating these recommendations, the authors strove to address all barriers to the widespread use of these tools.

Conclusion

This article includes a narrative analysis of barriers to AD control in LA and provides necessary recommendations to integrate and increase the use of validated AD control assessment tools throughout the region.

Key Summary Points

Achieving atopic dermatitis (AD) control is a complex task that requires concerted efforts between the patients and physicians, using the correct tools, and rigorous adherence to treatment

Clinical assessment tools are a practical method to measure treatment impact on disease activity and patient quality of life; however, despite global data supporting the use of these tools, their use in clinical practice is limited in Latin America (LA)

Within this article, the authors highlight the potential benefits of and barriers to incorporating a validated control assessment tool for AD into routine clinical practice in LA

Validated AD control assessment tools allow physicians to obtain information about disease control, treatment response, and patient satisfaction and can help develop optimal management strategies

In LA, AD assessment tools may provide a way forward in the comprehensive care of patients with AD and allow for shared decision-making, patient empowerment, and standardized care

Introduction

Atopic dermatitis (AD) is a chronic, relapsing, intensely pruritic inflammatory disease of variable course and prognosis, associated with physical and emotional comorbidities, especially in patients with moderate-to-severe AD [1, 2]. AD etiopathogenesis is multifactorial and is the result of disruptions in the cutaneous barrier, immune dysregulation, and certain genetic and environmental factors [3]. Dermatological disease burden is well studied, representing significant health expenditure and deteriorations in quality of life (QoL) [4].

Clinical assessment tools represent a practical method to measure the impact of treatment on disease activity and on patient's quality of life. However, their use in clinical practice is limited, especially in Latin America (LA). This article includes an analysis of barriers to AD control in LA and provides necessary recommendations to integrate and increase the use of validated AD control assessment tools throughout the LA region. Unifying criteria and universalizing the methods used for AD assessments are necessary to standardize AD care in LA. However, this concept is a challenging task due to the region’s diversity of ethnicity, culture, public spending, health policies, and climate.

Methods

To address the above issues, the Americas Health Foundation (AHF) identified clinicians and scientists with an academic or hospital affiliation who are experts in the field and who have published in the AD arena since 2014. As a result of this effort, AHF convened a six-member panel of clinical and scientific experts from LA. Great attention was paid to ensure a diverse group representing various disciplines related to AD (allergy, dermatology, immunology, and pediatrics).

To better focus discussion, AHF staff independently developed specific questions, addressing the salient issues on the subject, for the panel to address. A written response to each question was initially drafted by a different member of the panel. During the multi-day meeting of the panel, each narrative was discussed and edited by the entire group through numerous drafts and rounds of discussion until complete consensus was obtained. The objective of this article is to create a practical document with standardized recommendations for assessing AD in LA. This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

Epidemiology

The prevalence of AD has continuously increased globally in children and adults, reaching 5–20% and 2–10%, respectively, and is one of the highest prevalence of inflammatory dermatological diseases [5‐9]. A review on AD prevalence in tropical countries, predominantly in LA, found that prevalence was higher compared with other regions, suggesting that some genetic and environmental factors promote the development of AD [10]. The same study found prevalence discrepancies of 1–15%, even in the same population, possibly explained by the lack of unanimity in diagnostic criteria, among other factors [10].

Likewise, the ISAAC phase 3 trial included a large, representative sample of LA children over the span of 7 years that found varying prevalence. In the 6- and 7-year-old groups, prevalence in some LA countries was 8.9% in Costa Rica, 14.0% in Colombia, and 22.5% in Ecuador. In the 13- and 14-year-old groups, prevalence was 6.3% in Costa Rica, 10.5% in Peru, 12% in Colombia, and 20% in Ecuador [11, 12]. LA’s prevalence values were among the highest in this trial.

In Colombia, the TECCEMA found that in children diagnosed with AD, 47% were diagnosed before age 2, 37% between ages 3 and 5, and 16% after age 5 [13]. The main AD triggers reported by patients were sweat and heat (89%), followed by food allergy (33%) and pet epithelium (22%) [13]. A study in Mexico found that in patients diagnosed with AD before age 18, mild forms of disease were present in 89%, with moderate manifestations in 8% and severe manifestations in 2% [14]. Some studies have shown AD prevalence is higher in urban areas than in rural areas in Colombia (18.99% [15] versus 6.13% [16], respectively), Ecuador (5.9% and 4.7%, respectively [17]), and Bolivia (9.5% and 8.5%, respectively [18]).

In adults, peak incidence occurs between ages 20 and 40 years, with a prevalence of 9–24% [19]. However, AD research in LA is scarce, and further studies are needed evaluating prevalence and severity in relation to genetic, sociocultural, and environmental factors.

Clinical Practice Guidelines and Diagnosis in LA

Multiple AD guidelines are currently available for the LA region [7, 20], and some countries, such as Colombia [21], Mexico [22], Argentina [23], and Brazil [24], have their own AD guidelines. Most LA guidelines recommend the Williams’ criteria for AD diagnosis [21, 22, 25], as these are considered concise and easy to apply in low-complexity clinical contexts [26‐28]. However, because some of these criteria do not apply to adults, Hanifin and Rajka’s criteria are preferred for assessing AD in this group, because they tend to have more diverse signs and symptoms [29].

In LA countries, especially those located in the tropics, other causes of pruritus and lichenification are common, which can confound and delay AD diagnosis [30‐32]. Studies from Brazil and other non-LA tropical countries showed that 50–80% of infectious dermatosis cases, such as scabies, were initially misdiagnosed as AD. Other differential diagnoses of AD include miliaria, papular urticaria, seborrheic and contact dermatitis, ichthyosis, atypical psoriasis, cutaneous T-cell lymphoma, infective dermatitis, and primary immunodeficiencies [33‐35]. Because some of these diseases may appear simultaneously, they can further hinder AD diagnosis [36, 37].

After diagnosis, physicians perform additional tests to evaluate triggering factors and severity, especially in moderate-to-severe disease. These tests should be consistent with the patient’s sociocultural context and medical history [7, 21, 22, 25].

Importance of Disease Control

The importance of achieving AD disease control cannot be underestimated in improving outcomes and reducing disease burden. It is a complex task that requires concerted efforts between the patients and physicians, using the correct tools, and rigorous adherence. At present, AD has no cure, and management strategies are focused on symptom improvement, which should be assessed in the most practical and efficient way to guide effective decision-making. Although evaluation tools are available to measure, assess, and classify AD, patients continue to be assessed at physician discretion with non-standardized methodologies, in part because of the lack of practicality, technical knowledge, and time. Physician and patient responsibilities in disease control are outlined in Table 1.

Table 1

Patient and physician responsibilities in AD control

Physician	Patient
Perform correct diagnosis and disease stratification	Attend medical appointments punctually
Adequately explain AD, highlighting triggers or aggravating factors	Avoid exposure to triggers
Provide education on treatment through oral communications and handouts	Carry out complete recommendations given by physicians and adhere to treatment
Empower patients and caregivers by practicing shared decision-making	Take a proactive role in shared management of disease
Employ AD control assessment tools (both CROM and PROM) in routine clinical practice and treatment decisions	Make appointments in advance for flares, increases, or change in symptoms
Educate patient on the correct use of control assessment tools	Accurately respond to questions and prompts in AD control assessment tools

CROM clinician-reported outcome measures; PROM patient-reported outcome measures

AD control entails assessing risk factors, signs and symptoms, response to treatment, comorbidities, and social, psychological, and physical factors [38]. Limited data have been published on what eczema control means to those living with or treating AD, but severity, QoL, and self-perceptions are crucial to patient evaluation. Adequate clinical control is also key in reducing the physical and psychological comorbidities associated with AD [39]. The most common atopic comorbidities are asthma (15–20%), rhinitis (60–90%), and food allergy (3–15%), and psychological comorbidities include personality disorder (15–30%), anxiety (20–50%), sleep disorders (5–18%), depression (15–23%), attention deficit/hyperactivity (5–20%), and suicide ideation (3–8%) [40‐42]. Patients with severe clinical symptoms experience more frequent adverse social and economic effects and deterioration in school and work performance, further underlining the importance of disease control [39].

AD Control in LA

The scarce information about AD control in LA tends to be similar to that reported in multiple European and North American studies [43]. 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 clinical impact of implementing guidelines indicating different AD scales and found high variability depending on the scale used. Furthermore, all control parameters were < 50%, indicating generally poor disease control [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.

Measurement Tools

The two types of AD measurement tools available for evaluating AD components are clinician-reported outcome measures (CROMs) and patient-reported outcome measures (PROMs). CROMs are objective clinician evaluations of disease activity and symptoms, whereas PROMs emphasize patient perception of disease, including overall symptoms and/or QoL. Few CROMs can be used in clinical practice for AD assessment, and they do not always correlate well with patient perceptions. Additionally, the short time allotted for each physician-patient consultation often makes applying CROMs difficult.

PROMs complement CROMS and can be used as a tool to provide a more holistic and relevant evaluation of healthcare interventions [47]. These can be collected outside of scheduled office visits, thereby enhancing the understanding of the patient’s disease between physician visits. AD’s complexity and heterogeneity have led to the development of many measures for its assessment; however, none are considered the gold standard for assessing severity in clinical practice [48]. Studies show that a reliable assessment of AD severity requires applying at least two independent tools concomitantly [49].

CROMs

The most commonly used CROMs that measure disease severity in clinical trials are the SCORing Atopic Dermatitis (SCORAD) index, the Eczema Area and Severity Index (EASI), and the Investigator’s Global Assessment (IGA). These scales primarily are used in clinical trials and less frequently in clinical practice, because they were generally not designed for this purpose [50].

SCORAD Index

The SCORAD index was developed in 1993 by ETFAD and has become the most widely validated disease-severity instrument in clinical trials and practice. It assesses three domains: disease extent using body surface area (BSA), disease activity, and a patient-reported score for pruritus and sleep loss [51]. SCORAD has shown high inter-rater reliability for overall scores and specific clinical features, such as edema, oozing, and lichenification [49‐52], and has a high correlation with other objective assessments [50] and QoL measures, such as the Dermatology Life Quality Index (DLQI) [53]. Additionally, the objective SCORAD (oSCORAD) index was introduced to assess only objective symptoms [54].

Some research has shown that SCORAD has limitations related to its complexity. The ETFAD recommends an objective evaluation using the oSCORAD index and the Three-Item Severity (TIS) score, both of which exclude patient perspective [55]. The TIS score is a simple scoring system using three of the intensity items of the SCORAD index (erythema, edema, and excoriations) [49, 56] but is not widely used.

Eczema Area and Severity Index (EASI)

EASI assesses two domains: disease extent in four body regions (head and neck, torso, arms, and legs) and disease severity of four clinical signs (erythema, edema/papulation, excoriations, and lichenification). EASI shows good inter-rater reliability and can be learned easily, allowing clinicians and investigators to quickly standardize a baseline evaluation and assess changes in disease presentation over time [50, 57]. EASI has good correlation with CDLQI and DLQI; however, one of the main limitations is that a low EASI score does not always correlate with worse QoL [58].

Global Assessment Scales

Global assessment scales, including the investigator and physician global assessment (IGA and PGA), are a heterogeneous group of tools that assess clinical AD signs (i.e., erythema, infiltration, papulation, oozing, crusting) [59]. Although IGAs commonly are used to validate other outcome measures [50], many are not validated for this purpose and are difficult to interpret. These scales have notable differences compared with other assessment tools. These do not assess symptoms or QoL and possess a large variability in size, nomenclature, definitions, outcome descriptions, and analysis [60]. However, they remain one of the most employed assessment tools because of the usability in clinical practice and requirements by authorities for drug labeling. Although initiatives to validate global assessments are underway, variability and lack of standardization in these assessments do not produce sufficiently reliable data to inform decision-making and therefore are not optimal for this purpose [60‐67].

Other physician assessment tools exist but are not standardized for clinical practice and trials [62]. SCORAD and oSCORAD both have strong correlations with EASI and IGA in adult AD patients. However, none of the indexes show significant advantage over the other [49]. Several organizations have contradicting recommendations on which scales to use during particular scenarios. In clinical trials, the HOME initiative recommends the use of the EASI and SCORAD while the ETFAD recommends using the oSCORAD. Although recommendations are not conclusive regarding which tool to use in clinical practice, all LA guidelines agree that using a clinometric scale is the most important part of any assessment.

PROMs

AD has a significant impact on patient QoL; thus, physicians must not underestimate the importance of patient-perceived symptoms and severity [63, 64]. Although CROMs provide significant objective measures to assess extent and severity, not all include patient perspectives. Key symptoms of AD such as pruritus, sleep disturbance, and interference with daily activities can be challenging to assess [64]. PROMs are useful in clinical practice because of their ease of use and potential correlations with established objective scales [65].

Atopic Dermatitis Control Tool (ADCT)

The ADCT is a simple, recently introduced patient-reported measurement tool that allows patients to evaluate six AD symptoms and their impact in the previous 7 days: (1) overall severity of symptoms, (2) days with intense episodes of itching, (3) intensity of itching, (4) problems with sleep, (5) impact on daily activities, and (6) impact on mood/emotions. The patient assigns each item a score ranging from 0 (no problem) to 4 (worst effect) [66]. Further validation of the tool was demonstrated by the RELIEVE-AD study in patients > 18 years old with moderate-to-severe symptoms, which shows high correlation with the DLQI [67]. ADCT facilitates patient self-assessment, self-monitoring of disease, and communication improvement between patients and physicians as well as a quick disease assessment. It is cost free and available in Spanish. These attributes make ADCT a tool that provides comprehensive patient-perceived outputs.

Patient-Oriented SCORAD (PO-SCORAD)

PO-SCORAD is a SCORAD derivative that has been adapted for patients to assess disease extent, severity, and symptoms. It is simple, allows quick and easy use by patients and caregivers, and has a significant correlation with the SCORAD index [68, 69].

Patient-Oriented Eczema Measure (POEM)

POEM is a 5-point scale that assesses patient perception regarding the frequency of seven items: (1) dryness, (2) itching, (3) flaking, (4) cracking, (5) sleep disturbance, (6) bleeding, and (7) oozing during the past week [70]. The psychometric properties of POEM show high correlation with objective and QoL measurement tools [64, 70‐72].

RECAP of AD (RECAP)

RECAP is designed to evaluate AD control during the previous 7 days and is based on seven characteristics, similar to ADCT: (1) overall symptom severity, (2) days with intense itching episodes, (3) itching bother intensity, (4) sleep disturbance, (5) impact on daily activities, (6) impact on mood/emotions, and (7) disease acceptability. The initial validation demonstrated good correlation with POEM [73].

For clinical trials, the HOME initiative recommends POEM as the preferred instrument to measure patient-reported symptoms [74, 75]. In addition, the initiative recently recognized ADCT and RECAP for long-term disease control measures [76]. In clinical practice, HOME recommended POEM and PO-SCORAD. ADCT is a promising tool for the future but requires further studies for clinical practice use.

Incorporating a Validated Control Assessment Tool

Global data heavily support using assessment tools for AD control, but data specific to LA are lacking. Validated AD control assessment tools allow physicians to obtain information about disease control, treatment response, and patient satisfaction and can help develop optimal management strategies. These tools support a patient-centered approach to care, which emphasizes active patient participation. Any validated tool must be reliable and easy to complete for both patients and physicians.

Using PROMS in LA would create unified data collection in clinical practice and advance an understanding of disease burden, treatment trends, adherence, and AD phenotypes. Furthermore, validated data obtained from PROMs can improve care at the patient level and provide evidence on which to base policy decisions. Finally, these tools contribute to educational material development and help patients self-monitor control and improve treatment [77].

Despite recent efforts to validate certain AD control scales in Colombia [78], CROMs and PROMs largely lack validation for use in LA, and more data are needed. Linguistic variations of Spanish and diverse cultural contexts in LA require specific validation to ensure accurate transcultural application. Furthermore, practical and simple tools are key to ensure successful adoption given the limited time allotted per patient [79]. The lack of validated CROM and PROM scales in LA is a significant limitation to recommending one specific tool. However, it is clear that implementing CROM and PROM tools concomitantly in routine clinical practice to achieve a holistic evaluation of AD patients is imperative for the region. The statistical properties and characteristics of CROMs and PROMs are outlined in Table 2.

Table 2

Statistical properties and characteristics of CROMs and PROMs

	EASI	SCORAD	oSCORAD	PO-SCORAD	ADCT	RECAP	POEM	DLQI	Skindex29
Construction and validation
Inter observed evaluation	+ + +	+ + +	+ + +	+ + +	+	+	+ + +	//	//
Intra-observed evaluation	+ + +	+ + +	+ + +	+ + +	+	+	+ + +	//	//
Reliability	+ + +	+ + +	+ + +	+ + +	+	+	+ + +	//	//
Internal validation	+ + +	+ + +	+ +	+ + +	+	+	+ + +	//	//
Internal consistency	+ + +	+ + +	+ +	+ + +	+	+	+ + +	//	//
Interpretability	+ + +	+ + +	+ +	+ + +	+	–	+ + +	//	//
Acceptability	+ + +	+ + +	+ +	+ +	+	–	+ + +	//	//
Minimal clinically significant difference	+ /6.6	+ /8.7	+ /8.2	+ /8.2	+ /5	–	+ + /3.4	//	//
External validation	+ +	+ +	+	+	+	+	+ +	//	//
Minimum and maximum score	0–72	0–103	83^//	0–103.6	0–24	28	28
Targeted population and applicability
Age	Any age⁺	Any age⁺	Any age⁺	Any age	> 18 years	Any age⁺	Any age⁺	//	//
Current usage	C/T	C/T	C/T	//	T	T	C/T	//	//
Spanish translation	Yes	Yes	Yes	Yes	Yes	No	Yes	//	//
Portuguese translation	Yes	Yes	Yes	Yes	Yes	No	Yes	//	//
Language validation in Latin America	No	No	No	No	No	No	No	//	//
External validation in LA	No	No	No	No	No	No	No	//	//
Accessibility	Yes	Yes	Yes	Yes	Yes	Yes	Yes	//	//
Utility	Yes	Yes	Yes	Yes	Yes	Yes	Yes	//	//
Time to implement	< 10 min*	< 10 min*	< 10 min*	< 10 min*	< 10 min*	< 10 min*	< 10 min*	//	//
Patient perspective	No	Yes	No	Yes	Yes	Yes	Yes	//	//
Easy for physician	Yes*	Yes*	Yes*	No	Yes*	Yes*	Yes*	//	//
Easy for patient	Yes*	Yes*	Yes*	No	Yes*	Yes*	Yes*	//	//
When to implement	B/F	B/F	B/F	B/F	B/F	B/F	B/F	//	//
Time range analyzed	Present	Present	Present	Present	7 days	7 days	7 days	//	//
Strengths	Extent of affected skin	Several domains	Simplicity/ > specificity	Duality (CROM/PROM)	Simplicity	Simplicity	Simplicity
Limitations	MDA	Complexity*/ < specificity	Purely objective	< acceptability	Only for adults	Not in Spanish or Portuguese	No mood eval

+ + +: evaluated in at least two centers other than where the scale was constructed. + +: evaluated in one center other than where the scale was constructed. +: evaluated in the same center where the scale was constructed. –: no information. * depends on whether technological tools are available. C/R: clinical practice and trials. B/F: Baseline and follow-up. +: Most of the studies in children > 2 years old. //: additional points for severe disfiguring eczema of the face and hands

Treatment and Access

LA has a substantial diversity of cultures, sociodemographics, and climates, which present additional challenges to AD management. These factors must be individually evaluated because of their influence on AD onset, triggers, exacerbating factors, and tool application. Adherence to national or regional treatment guidelines is crucial to achieving optimal AD management. First-line management involves educational programs, adequate bathing, trigger avoidance, emollients, topical corticosteroids (TCS), and topical calcineurin inhibitors (TCI). Medication limitations include side effects, high direct costs, differences in coverage rates, and difficultly in adherence. Second-line management is phototherapy with ultraviolet (UV) A and UVB narrowband. Phototherapy generally is not easily accessible in LA, possibly due to limited availability of equipment [80]. Systemic immunosuppressive agents, such as cyclosporine, methotrexate, azathioprine, and mycophenolate mofetil, are third-line management. Some LA countries have limited access to these agents, whose indications are off-label and usually accrue out-of-pocket patient costs [7, 21, 22, 25].

Finally, fourth-line management is dupilumab, a promising biologic agent used in moderate-to-severe AD. Currently, several LA countries have approved dupilumab, mainly for use in adolescents and adults [81‐84]. A few countries, like Brazil, have also approved this biologic for children between ages 6 and 11 years. However, its high direct cost and lack of information among some physicians represent access barriers. Allergen-specific immunotherapy (ASIT) could be used in some highly sensitized patients, but more studies are needed to confirm its efficacy in AD [85, 86].

Treatment decisions, including when to scale therapy up or down, should be based on disease severity and control and continuously evaluated throughout disease course [5]. If the condition does not respond to topical treatment, upscaling to phototherapy or systemic agents is indicated [87]. Although most healthcare systems require an objective instrument to quantify disease to access high-cost AD medications or treatments, most LA physicians do not use official scores [7, 61]. Figures 1 and 2 and Table 3 below explore the ideal pathway for AD patients in LA, the management that must be followed for disease control, and the reality of what occurs in LA, respectively.

Table 3

The ideal patient pathway versus the reality of patients in LA

	Ideally (according to most guidelines)	Real life (in many AD patients)
First medical evaluation	As soon as possible	Sometimes years
Second medical evaluation	According to severity	According to insurance availability or economic capacity
Diagnosis	As soon as possible using Dx criteria	Sometimes years, without clear Dx criteria
Specific environmental control	Specific recommendations according to individual environment	In some patients, they are never carried out, and in others, recommendations are often unnecessary
Tropical therapies	Individually selected	Selected according to insurance or economic capacity
Severity score	Done in each medical evaluation	In most cases, it is omitted
QoL index	Done in each medical evaluation	In most cases, it is omitted
Patient perspective	Done in each medical evaluation	In most cases, it is omitted
Allergic comorbidities	Always handled according to each case	In most cases, it is omitted (time, lack of knowledge, etc.)
Non-allergic comorbidities	Always handled according to each case	In most cases, it is omitted (time, lack of knowledge, etc.)
Following medical evaluations	According to medical criteria	According to insurance availability or economic capacity
Atopic dermatitis specialist	As soon as the need is identified	According to insurance availability or economic capacity, sometimes may be years

Barriers to AD Control

The authors have identified the following barriers to adopting and standardizing AD control in LA:

Lack of physician education***

In the primary care setting, general physicians, pediatricians, and family doctors lack training for appropriate diagnosis, treatment, and control of AD. Furthermore, primary care physicians (PCPs) must be trained on when they can manage patients and when referral to a specialist is indicated. Even among specialists, continued medical education (CME) is imperative to providing optimal AD care and incorporating validated assessment tools. In a recent publication, only 30% of LA physicians surveyed use Cochrane, UpToDate, and other medical information sources [88].

Low use of validated AD control assessment tools

Before initiating AD treatment, most guidelines recommend measuring AD severity by a validated control assessment tool, such as EASI or SCORAD [21, 22, 25]. Although regional and international guidelines provide clear stepwise approaches to treatment guided by these scores, some studies show that only 30–50% of dermatologists and allergists employ them in routine clinical practice [14].

Lack of patient education

Comprehensive patient education on disease, skin care, treatment application, and behavioral modifications for patients and caregivers is critical to successful management. However, the time that physicians have with patients is insufficient to provide comprehensive education [89]. AD patient education programs can have a significantly positive effect in disease outcomes [90‐92]. Patient education programs should aim to dissipate misconceptions about treatment options and raise awareness on the value of control assessment tools [93]. Information and communication technology (ICT) is a powerful tool that can be leveraged in LA to provide medical information to healthcare providers and patients and promote validated tools for AD severity and control [88, 94, 95]. The COVID-19 pandemic has dramatically increased the use of ICT for the management of dermatologic patients [96].

Fragmented care

AD is not limited to the skin, and each patient must receive holistic medical control. In LA, AD care is fragmented, presenting challenges to ideal contemporary management that involves multidisciplinary teams focused on prevention, emotional support, and disease and comorbidity control. Collaborative and coordinated efforts must exist between the treating physician and those treating individual comorbidities.

5. lack of national clinical practice guidelines (CPGs)

Few LA countries have national AD CPGs, resulting in unstandardized diagnostic criteria, workups, control evaluations, and treatment strategies. AD management needs may diverge among countries because of differences in access to medical care, socioeconomic circumstances, and cultural beliefs. Patients, physicians, and health systems would therefore benefit from national guidelines that can be translated to real-life clinical settings adapted to each national context [97, 98]. Incorporating all stakeholders’ perspectives, including dermatology, allergology, pediatric, and primary care medical societies, as well as patient advocacy groups, government institutions, and payers, in guideline development is essential to give academic relevance to knowledge dispersion regarding AD control.

Limited access to care

Disparities in therapy access, especially interventions such as phototherapy and biologic therapy, exist between LA’s private and public health systems. In LA, access to AD treatments varies by country.

Conclusion

In LA, AD patients face many challenges. The high cost of disease management ranges from maintenance measures to high direct-cost biologics and non-biologic drugs, which can be exacerbated in countries with limited resources, inefficient and limited health systems, and scarce access to drugs and specialists. AD assessment tools may provide a way forward and allow for shared decision-making, patient empowerment, and standardized care. To overcome barriers and improve knowledge dissemination, all stakeholders, including government institutions, academic centers, industry, NGOs, patient associations, medical societies, and payers, must align. The panel proposes the following recommendations:

Develop Continued Medical Education (CME) programs (Fig. 3): use validated AD control assessment tools in routine clinical practice

Physicians must:

Incorporate AD control assessment tools in routine clinical practice and be consistent in using the same tools for the same patient.
Use CROMs and PROMs concomitantly for reliable assessments [49].

Medical societies, academic institutions, and governments should collaborate to validate AD control assessment tools for LA.

Develop patient education programs

These provide comprehensive information on disease activity, preventive measures, treatment, and control strategies through oral communication and patient educational material. Information must be reinforced at each consult.
Train patients on using control assessment tools and feeling empowered in their role.
Programs must be adapted to educational levels and cultural contexts [21].
Patient education must be considered an integral part of management and be covered by health systems.

Multidisciplinary Care Approach

Ensure a multidisciplinary approach for AD patients with a team of PCPs, dermatologists, allergists, psychiatrists, psychologists, pediatricians, nurses, and nutritionists focused on delivering comprehensive care.
Enable an individualized strategy that addresses comorbidities [99].

Develop National CPGs

All countries should develop local guidelines adapted to their national reality. If this is not possible in the short to medium term, each country’s leading medical societies should reach consensus on which guideline physicians should adopt.

Increase Access to AD Therapy

Governments must increase coverage of basic and advanced AD therapies for both public and private systems supported by cost-effectivity analyses.

Acknowledgements

Funding

This manuscript and the journal’s Rapid Service Fee were supported by a grant given to the Americas Health Foundation, a 501(c)3 nonprofit organization dedicated to improving health care throughout the Latin American region. The AHF was responsible for the development, organization, and implementation of the consensus conference, along with independently selecting the experts to serve on the panel. The AHF had no role in deciding on the content of the manuscript and the recommendations are those solely of the panel members.

Authorship

All named authors (Jorge Sanchez, Ivan Cherrez-Ojeda, Cesar Galvan, Elizabeth Garcia, Natalia Hernández-Mantilla, Angela Londoño Garcia, Elizabeth McElwee, Mariana Rico-Restrepo, Enrique Rivas, and Benjamin Hidalgo) meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Author Contributions

Jorge Sanchez, Ivan Cherrez-Ojeda, Cesar Galvan, Elizabeth Garcia, Natalia Hernández-Mantilla, Angela Londoño Garcia, Elizabeth McElwee, Mariana Rico-Restrepo, Enrique Rivas and Benjamin Hidalgo participated in concept and design, statistical analysis, drafting the manuscript, as well as finalization of the manuscript.

Disclosures

The co-authors (Jorge Sanchez, Ivan Cherrez-Ojeda, Cesar Galvan, Elizabeth Garcia, Natalia Hernández-Mantilla, Angela Londoño Garcia, Elizabeth McElwee, Mariana Rico-Restrepo, Enrique Rivas, and Benjamin Hidalgo) declare no conflicts of interest. The organization and implementation of the consensus conference was carried out by the Americas Health Foundation (AHF), a 501(c)3 nonprofit organization dedicated to improving healthcare throughout the Latin American region, and was supported by unrestricted grants from Sanofi.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

Werfel T, Allam JP, Biedermann T, Eyerich K, Gilles S, Guttman-Yassky E, et al. Cellular and molecular immunologic mechanisms in patients with atopic dermatitis. J Allergy Clin Immunol. 2016;138(2):336–49. https://doi.org/10.1016/j.jaci.2016.06.010.CrossRefPubMed

Sociedad Argentina de Dermatología. Consenso Nacional de Dermatitis Atópica. Sociedad Argentina de Dermatología. 2004. http://www.dermatolarg.org.ar/index.php/dermatolarg/article/viewFile/379/189

Boothe WD, Tarbox JA, Tarbox MB. Atopic dermatitis: pathophysiology. Adv Exp Med Biol. 2017;1027:21–37. https://doi.org/10.1007/978-3-319-64804-0_3.CrossRef

Drucker AM, Wang AR, Li WQ, Sevetson E, Block JK, Qureshi AA. The burden of atopic dermatitis: summary of a report for the National Eczema Association. J Invest Dermatol. 2017;137(1):26–30. https://doi.org/10.1016/j.jid.2016.07.012.CrossRefPubMed

Weidinger S, Beck LA, Bieber T, Kabashima K, Irvine AD. Atopic dermatitis. Nat Rev Dis Prim. 2018;4(1):1. https://doi.org/10.1038/s41572-018-0001-z.CrossRefPubMed

Silverberg J. Public health burden and epidemiology of atopic dermatitis. Dermatol Clin. 2017;35(33):283–9. https://doi.org/10.1016/j.det.2017.02.002.CrossRefPubMed

Sánchez J, Páez B, Macías A, Olmos C, De Falco A. Atopic dermatitis guideline. Position paper from the Latin America Society of Allergy, Asthma and Immunology. Rev Alerg Mex. 2014;61(3):178–211 (PMID: 25177854).PubMed

Langan SM, Irvine AD, Weidinger S. Atopic dermatitis. Lancet. 2020;396(10247):345–60. https://doi.org/10.1016/S0140-6736(20)31286-1.CrossRefPubMed

Weng Y, Thyssen J, Silverberg J. A systematic review and meta-analysis of the regional and age-related differences in atopic dermatitis clinical characteristics. J Am Acad Dermatol. 2019;80:390–401. https://doi.org/10.1016/j.jaad.2018.09.035.CrossRef

10.

Sánchez J, Sánchez A, Cardona R. Critical review of ISAAC results for atopic dermatitis in tropical cities. Rev Alerg Mex. 2018;65(4):389–99. https://doi.org/10.29262/ram.v63i4.238.CrossRefPubMed

11.

Garg N, Silverberg J. Epidemiology of childhood atopic dermatitis. Clin Dermatol. 2015;33:281–8. https://doi.org/10.1016/j.clindermatol.2014.12.004.e.CrossRefPubMed

12.

Solé D, Mallol J, Wandalsen GF, Aguirre V, Latin American ISAAC Phase 3 Study Group. Prevalence of Symptoms of Eczema in Latin America: Results of the International Study of Asthma and Allergies in Childhood (ISAAC) Phase 3. J Investig Allergol Clin Immunol. 2010;20(4):311–23.PubMed

13.

Sánchez J, Sánchez A, Cardona R. Particular characteristics of atopic eczema in tropical environments. The Tropical Environment Control for Chronic Eczema and Molecular Assessment (TECCEMA) cohort study. An Bras Dermatol. 2017;92(2):177–83. https://doi.org/10.1590/abd1806-4841.20175140.CrossRefPubMedPubMedCentral

14.

Herrera-Sánchez DA, Hernández-Ojeda M, Vivas-Rosales IJ. Estudio epidemiológico sobre dermatitis atópica en México [Epidemiological study on atopic dermatitis in Mexico]. Rev Alerg Mex. 2019;66(2):192–204. https://doi.org/10.29262/ram.v66i2.591.CrossRefPubMed

15.

Dennis RJ, Caraballo L, García E, Rojas MX, Rondon MA, Pérez A, et al. Prevalence of asthma and other allergic conditions in Colombia 2009–2010: a cross-sectional study. BMC Pulm Med. 2012;12(1):17. https://doi.org/10.1186/1471-2466-12-17.CrossRefPubMedPubMedCentral

16.

Moreno-lópez S, Pérez-herrera LC, Peñaranda D, Hernández D, García E, Peñaranda A. Prevalence and associated factors of allergic diseases in school children and adolescents aged 6–7 and 13–14 years from two rural areas in Colombia. Allergol Immunopathol (Madr). 2021;49(116):2–9. https://doi.org/10.15586/aei.v49i2.183.CrossRef

17.

Cooper PJ, Vaca M, Rodriguez A, Chico ME, Santos DN, Rodrigues LC, et al. Hygiene, atopy and wheeze–eczema–rhinitis symptoms in schoolchildren from urban and rural Ecuador. Thorax. 2014. https://doi.org/10.1136/thoraxjnl-2013-203818.CrossRefPubMed

18.

Solis-Soto MT, Patiño A, Nowak D, Radon K. Association between environmental factors and current asthma, rhinoconjunctivitis and eczema symptoms in school-aged children from Oropeza Province–Bolivia: a cross-sectional study. Environ Heal. 2013;12(1):95. https://doi.org/10.1186/1476-069X-12-95.CrossRef

19.

Lee HH, Patel KR, Singam V, Rastogi S, Silverberg JI. A systematic review and meta-analysis of the prevalence and phenotype of adult-onset atopic dermatitis. J Am Acad Dermatol. 2019;80(6):1526-1532.e7. https://doi.org/10.1016/j.jaad.2018.05.1241.CrossRefPubMed

20.

Sánchez J, Sánchez MR, Macías-Weinmann A, Barreto B, Ensina LF, Uriarte-Obando SA, et al. Systematic review about 10 interventions in dermatitis. A document from the Latin American Society of Allergy, Asthma, and Immunology. Rev Alerg Mex. 2019;66(4):426–55. https://doi.org/10.29262/ram.v66i4.636.CrossRefPubMed

21.

Asociación Colombiana de Dermatología y Cirugía Dermatológica (AsoColDerma). Guía de práctica clínica (GPC) para el diagnóstico y tratamiento de la dermatitis atópica en Colombia [Clinical practice guidelines (CPG) for the diagnosis and treatment of atopic dermatitis in Colombia]. Rev Asoc Colomb Dermatol Cir Dermatol. 2020.

22.

Rincón-Pérez C, Larenas-Linnemann D, Figueroa-Morales MA, Luna-Pech J, García-Hidalgo L, Macías-Weinmann A, et al. Consenso mexicano para el diagnóstico y tratamiento de la dermatitis atópica en adolescentes y adultos [Mexican consensus on the diagnosis and treatment of atopic dermatitis in adolescents and adults]. Rev Alerg Mex. 2018;65(Suppl 2):s8–88. https://doi.org/10.29262/ram.v65i6.526.CrossRefPubMed

23.

Comité Nacional de Dermatología. Consenso Nacional de Dermatitis Atópica 2013: resumen ejecutivo [Atopic dermatitis: national consensus 2013]. Arch Argent Pediatr. 2014;112(3):293–4. https://doi.org/10.5546/aap.2014.293.CrossRef

24.

Aoki V, Lorenzini D, Orfali RL, Zaniboni MC, de Oliveira ZNP, Rivitti-Machado MC, et al. Consensus on the therapeutic management of atopic dermatitis-Brazilian Society of Dermatology. An Bras Dermatol. 2019. https://doi.org/10.1590/abd1806-4841.2019940210.CrossRefPubMedPubMedCentral

25.

Antunes AA, Solé D, Carvalho VO, Bau AEK, Kuschnir FC, Mallozi MC, et al. Guia prático de atualização em dermatite atópica-parte I: etiopatogenia, clínica e diagnóstico. Posicionamento conjunto da Associação Brasileira de Alergia e Imunologia e da Sociedade Brasileira de Pediatria [Updated practical guide on atopic dermatitis-part I: etiopathogenesis, clinical features, and diagnosis. Joint position paper of the Brazilian Association of Allergy and Immunology and the Brazilian Society of Pediatrics]. Arq Asma Alerg Imunol. 2017;1(2):131–56. https://doi.org/10.5935/2526-5393.20170019.CrossRef

26.

Thomas J, Peterson GM, Walton SF, Carson CF, Naunton M, Baby KE. Scabies: an ancient global disease with a need for new therapies. BMC Infect Dis. 2015;15:250. https://doi.org/10.1186/s12879-015-0983-z.CrossRefPubMedPubMedCentral

27.

Heukelbach J, Wilcke T, Winter B, Feldmeier H. Epidemiology and morbidity of scabies and pediculosis capitis in resource-poor communities in Brazil. Br J Dermatol. 2005;153(1):150–6. https://doi.org/10.1111/j.1365-2133.2005.06591.x.CrossRefPubMed

28.

Zhang W, Zhang Y, Luo L, Huang W, Shen X, Dong X, et al. Trends in prevalence and incidence of scabies from 1990 to 2017: findings from the global Burden of disease study 2017. Emerg Microbes Infect. 2020;9(1):813–6. https://doi.org/10.1080/22221751.2020.1754136.CrossRefPubMedPubMedCentral

29.

Fishbein AB, Silverberg JI, Wilson EJ, Ong PY. Update on atopic dermatitis: diagnosis, severity assessment, and treatment selection. J Allergy Clin Immunol Pract. 2020;8(1):91–101. https://doi.org/10.1016/j.jaip.2019.06.044.CrossRefPubMed

30.

Karthikeyan K, Thappa DM, Jeevankumar B. Pattern of pediatric dermatoses in a referral center in South India. Indian Pediatr. 2004;41(4):373–7 (PMID: 15123866).PubMed

31.

Bechelli LM, Haddad N, Pimenta WP, Pagnano PM, Melchior E Jr, Fregnan RC, et al. Epidemiological survey of skin diseases in schoolchildren living in the Purus Valley (Acre State, Amazonia, Brazil). Dermatologica. 1981;163(1):78–93. https://doi.org/10.1159/000250144.CrossRefPubMed

32.

Inanir I, Sahin MT, Gunduz K, Dinc G, Turel A, Ozturkcan S. Prevalence of skin conditions in primary school children in Turkey: differences based on socioeconomic factors. Pediatr Dermatol. 2002;19(4):307–11. https://doi.org/10.1046/j.1525-1470.2002.00087.x.CrossRefPubMed

33.

Bravo FG. Infective dermatitis: a purely cutaneous manifestation of HTLV-1 infection. Semin Diagn Pathol. 2019. https://doi.org/10.1053/j.semdp.2019.04.002.CrossRefPubMed

34.

Peled A, Sarig O, Sun G, Samuelov L, Ma CA, Zhang Y, et al. Loss-of-function mutations in caspase recruitment domain-containing protein 14 (CARD14) are associated with a severe variant of atopic dermatitis. J Allergy Clin Immunol. 2019;143(1):173-181.e10. https://doi.org/10.1016/j.jaci.2018.09.002.CrossRefPubMed

35.

Mellett M. Regulation and dysregulation of CARD14 signalling and its physiological consequences in inflammatory skin disease. Cell Immunol. 2020;354: 104147. https://doi.org/10.1016/j.cellimm.2020.104147.CrossRefPubMed

36.

Caraballo L, Zakzuk J, Lee BW, Acevedo N, Soh JY, Sánchez-Borges M, et al. Particularities of allergy in the Tropics. World Allergy Organ J. 2016. https://doi.org/10.1186/s40413-016-0110-7.CrossRefPubMedPubMedCentral

37.

Lozano AM, López JF, Zakzuk J, García E. Papular urticaria: a review of causal agents in Colombia. Biomedica. 2016;36:632–45. https://doi.org/10.7705/biomedica.v36i4.3258.CrossRefPubMed

38.

Chalmers JR, Thomas KS, Apfelbacher C, Williams HC, Prinsen CA, Spuls PI, et al. Report from the fifth international consensus meeting to harmonize core outcome measures for atopic eczema/dermatitis clinical trials (HOME initiative). Br J Dermatol. 2018;178(5):e332–41. https://doi.org/10.1111/bjd.16543.CrossRefPubMed

39.

de Bruin-Weller M, Simpson EL, Cork M, Chen Z, Msihid J, Taniou C, et al. Dupilumab reduces absenteeism in patients with moderate to severe atopic dermatitis: Pooled results from the LIBERTY AD SOLO clinical trials. J Am Acad Dermatol. 2020;83(5):1499–501. https://doi.org/10.1016/j.jaad.2020.05.142.CrossRefPubMed

40.

Genuneit J, Braig S, Brandt S, Wabitsch M, Florath I, Brenner H, et al. Infant atopic eczema and subsequent attention-deficit/hyperactivity disorder–a prospective birth cohort study. Pediatr Allergy Immunol. 2014;25(1):51–6. https://doi.org/10.1111/pai.12152.CrossRefPubMed

41.

Ivert LU, Wahlgren CF, Lindelöf B, Dal H, Bradley M, Johansson EK. Association between atopic dermatitis and autoimmune diseases: a population-based case-control study. Br J Dermatol. 2020. https://doi.org/10.1111/bjd.19624.CrossRefPubMedPubMedCentral

42.

Cheng BT, Silverberg NB, Silverberg JI. Association of childhood atopic dermatitis with atopic and nonatopic multimorbidity. Dermatitis. 2020. https://doi.org/10.1097/DER.0000000000000644.CrossRefPubMed

43.

Busse WW, Maspero JF, Rabe KF, Papi A, Wenzel SE, Ford LB, et al. Liberty asthma QUEST: phase 3 randomized, double-blind, placebo-controlled, Parallel-Group study to evaluate dupilumab efficacy/safety in patients with uncontrolled moderate-to-severe asthma. Adv Ther. 2018;35(5):737–48. https://doi.org/10.1007/s12325-018-0702-4.CrossRefPubMedPubMedCentral

44.

Sánchez J, Toro Y, Cardona R. Clinical impact in the real life of guidelines recommendations for atopic dermatitis in a tropical population (TECCEMA cohort). Rev Alerg Mex. 2017;64(3):260–9. https://doi.org/10.29262/ram.v64i3.244.CrossRefPubMed

45.

Arruda LK, Campos Yang A, Aoki V, Fachini RJC, Cezar Pires M, Lupi O, et al. Clinical features and disease management of adult patients with atopic dermatitis receiving care at reference hospitals in Brazil: the ADAPT Study. J Investig Allergol Clin Immunol. 2021. https://doi.org/10.18176/jiaci.0478.CrossRefPubMed

46.

Urrutia-Pereira M, Solé D, Rosario NA, Neto HJC, Acosta V, Almendarez CF, et al. Sleep-related disorders in Latin-American children with atopic dermatitis: a case control study. Allergol Immunopathol (Madr). 2017;45(3):276–82. https://doi.org/10.1016/j.aller.2016.08.014.CrossRef

47.

Gooderham MJ, Bissonnette R, Grewal P, Lansang P, Papp KA, Hong C. Approach to the assessment and management of adult patients with atopic dermatitis: a consensus document. Section II: tools for assessing the severity of atopic dermatitis. J Cutan Med Surg. 2018;22(1):10S-16S. https://doi.org/10.1177/1203475418803628.CrossRefPubMed

48.

Reich A. Reliable assessment of atopic dermatitis severity: do we need more tools? Br J Dermatol. 2021;184(1):6–7. https://doi.org/10.1111/bjd.19392.CrossRefPubMed

49.

Bożek A, Reich A. Assessment of intra- and inter-rater reliability of three methods for measuring atopic dermatitis severity: EASI, objective SCORAD, and IGA. Dermatology. 2017;233(1):16–22. https://doi.org/10.1159/000472711.CrossRefPubMed

50.

Rehal B, Armstrong AW. Health outcome measures in atopic dermatitis: a systematic review of trends in disease severity and quality-of-life instruments 1985–2010. PLoS ONE. 2011;6(4): e17520. https://doi.org/10.1371/journal.pone.0017520.CrossRefPubMedPubMedCentral

51.

European Task Force on Atopic Dermatitis. Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology. 1993;186(1):23–31. https://doi.org/10.1159/000247298.CrossRef

52.

Kunz B, Oranje AP, Labrèze L, Stalder JF, Ring J, Taïeb A. Clinical validation and guidelines for the SCORAD index: consensus report of the European Task Force on Atopic Dermatitis. Dermatology. 1997;195(1):10–9. https://doi.org/10.1159/000245677.CrossRefPubMed

53.

Kim DH, Li K, Seo SJ, Jo SJ, Yim HW, Kim CM, et al. Quality of life and disease severity are correlated in patients with atopic dermatitis. J Korean Med Sci. 2012;27(11):1327–32. https://doi.org/10.3346/jkms.2012.27.11.1327.CrossRefPubMedPubMedCentral

54.

Schram ME, Spuls PI, Leeflang MM, Lindeboom R, Bos JD, Schmitt J. EASI, (objective) SCORAD and POEM for atopic eczema: responsiveness and minimal clinically important difference. Allergy. 2012;67(1):99–106. https://doi.org/10.1111/j.1398-9995.2011.02719.x.CrossRefPubMed

55.

Oranje AP, Glazenburg EJ, Wolkerstorfer A, van der Waard SFB. Practical issues on interpretation of scoring atopic dermatitis: the SCORAD index, objective SCORAD and the three-item severity score. Br J Dermatol. 2007;157(4):645–8. https://doi.org/10.1111/j.1365-2133.2007.08112.x.CrossRefPubMed

56.

Wolkerstorfer AA, van der Waard SFB, Glazenburg EJ, Mulder PG, Oranje AP. Scoring the severity of atopic dermatitis: three item severity score as a rough system for daily practice and as a pre-screening tool for studies. Acta Derm Venereol. 1999;79(5):356–9. https://doi.org/10.1080/000155599750010256.CrossRefPubMed

57.

Hanifin JM, Thurston M, Omoto M, Cherill R, Tofte SJ, Graeber M. The eczema area and severity index (EASI): assessment of reliability in atopic dermatitis. EASI Eval Group Exp Dermatol. 2001;10(1):11–8. https://doi.org/10.1034/j.1600-0625.2001.100102.x.CrossRef

58.

Chopra R, Vakharia PP, Sacotte R, Patel N, Immaneni S, White T, et al. Relationship between EASI and SCORAD severity assessments for atopic dermatitis. J Allergy Clin Immunol. 2017;140(6):1708-10.e1. https://doi.org/10.1016/j.jaci.2017.04.052.CrossRefPubMedPubMedCentral

59.

Eichenfield LF, Lucky AW, Boguniewicz M, Langley RG, Cherill R, Marshall K, et al. Safety and efficacy of pimecrolimus (ASM 981) cream 1% in the treatment of mild and moderate atopic dermatitis in children and adolescents. J Am Acad Dermatol. 2002;46(4):495–504. https://doi.org/10.1067/mjd.2002.122187.CrossRefPubMed

60.

Futamura M, Leshem YA, Thomas KS, Nankervis H, Williams HC, Simpson EL. A systematic review of Investigator Global Assessment (IGA) in atopic dermatitis (AD) trials: Many options, no standards. J Am Acad Dermatol. 2016;74(2):288–94. https://doi.org/10.1016/j.jaad.2015.09.062.CrossRefPubMed

61.

Simpson E, Bissonnette R, Eichenfield LF, Guttman-Yassky E, King B, Silverberrg JI, et al. The Validated Investigator Global Assessment for Atopic Dermatitis (vIGA-AD): the development and reliability testing of a novel clinical outcome measurement instrument for the severity of atopic dermatitis. J Am Acad Dermatol. 2020;83(3):839–46. https://doi.org/10.1016/j.jaad.2020.04.104.CrossRefPubMed

62.

Chopra R, Silverberg JI. Assessing the severity of atopic dermatitis in clinical trials and practice. Clin Dermatol. 2018;36(5):606–15. https://doi.org/10.1016/j.clindermatol.2018.05.012.CrossRefPubMed

63.

Birdi G, Cooke R, Knibb RC. Impact of atopic dermatitis on quality of life in adults: a systematic review and meta-analysis. Int J Dermatol. 2020;59(4):e75–91. https://doi.org/10.1111/ijd.14763.CrossRefPubMed

64.

Barrett A, Hahn-Pedersen J, Kragh N, Evans E, Gnanasakthy A. Patient-reported outcome measures in atopic dermatitis and chronic hand eczema in adults. Patient. 2019;12(5):445–59. https://doi.org/10.1007/s40271-019-00373-y.CrossRefPubMedPubMedCentral

65.

Lara-Corrales I, Bergman JN, Landells I, Ramien ML, Lansang P. Approach to the assessment and management of pediatric patients with atopic dermatitis: a consensus document. Section I: Overview Of Pediatric Atopic Dermatitis. J Cutan Med Surg. 2019;23(5):3S-11S. https://doi.org/10.1177/1203475419882654.CrossRefPubMed

66.

Pariser DM, Simpson EL, Gadkari A, Bieber T, Margolis DJ, Brown M, et al. Evaluating patient-perceived control of atopic dermatitis: design, validation, and scoring of the Atopic Dermatitis Control Tool (ADCT). Curr Med Res Opin. 2020;36(3):367–76. https://doi.org/10.1080/03007995.2019.1699516.CrossRefPubMed

67.

Simpson E, Eckert L, Gadkari A, Mallya UG, Yang M, Nelson L, et al. Validation of the atopic dermatitis control tool (ADCT©) using a longitudinal survey of biologic-treated patients with atopic dermatitis. BMC Dermatol. 2019;19(1):15. https://doi.org/10.1186/s12895-019-0095-3.CrossRefPubMedPubMedCentral

68.

Vourc’h-Jourdain M, Barbarot S, Taieb A, Diepgen T, Ambonati M, Durosier V, et al. Patient-oriented SCORAD: a self-assessment score in atopic dermatitis. A preliminary feasibility study. Dermatology. 2009;218(3):246–51. https://doi.org/10.1159/000193997.CrossRefPubMed

69.

Stalder JF, Barbarot S, Wollenberg A, Holm EA, De Raeve L, Seidenari S, et al. Patient-Oriented SCORAD (PO-SCORAD): a new self-assessment scale in atopic dermatitis validated in Europe. Allergy. 2011;66(8):1114–21. https://doi.org/10.1111/j.1398-9995.2011.02577.x.CrossRefPubMed

70.

Charman CR, Venn AJ, Williams HC. The patient-oriented eczema measure: development and initial validation of a new tool for measuring atopic eczema severity from the patients’ perspective. Arch Dermatol. 2004;140(12):1513–9. https://doi.org/10.1001/archderm.140.12.1513.CrossRefPubMed

71.

Yew YW, Zhao X, Apfelbacher CJ. The Patient-Oriented Eczema Measure: estimating the minimal important change in an outpatient clinic cohort. J Eur Acad Dermatol Venereol. 2020;34(6):1273–9. https://doi.org/10.1111/jdv.16122.CrossRefPubMed

72.

Silverberg JI, Lei D, Yousaf M, Singam V, Kantor R, Hsu DY, et al. Comparison of patient-oriented eczema measure and patient-oriented scoring atopic dermatitis vs eczema area and severity index and other measures of atopic dermatitis. A validation study. Ann Allergy Asthma Immunol. 2020;120(5):78–83. https://doi.org/10.1016/j.anai.2020.03.006.CrossRef

73.

Howells LM, Chalmers JR, Gran S, Ahmed A, Apfelbacher C, Burton T, et al. Development and initial testing of a new instrument to measure the experience of eczema control in adults and children: Recap of atopic eczema (RECAP). Br J Dermatol. 2020;183(3):524–36. https://doi.org/10.1111/bjd.18780.CrossRefPubMedPubMedCentral

74.

Chalmers JR, Schmitt J, Apfelbacher C, Dohil M, Eichenfield LF, Simpson EL, et al. Report from the third international consensus meeting to harmonise core outcome measures for atopic eczema/dermatitis clinical trials (HOME). Br J Dermatol. 2014;171(6):1318–25. https://doi.org/10.1111/bjd.13237.CrossRefPubMedPubMedCentral

75.

Chalmers JR, Simpson E, Apfelbacher CJ, Thomas KS, von Kobyletzki L, Schmitt J, et al. Report from the fourth international consensus meeting to harmonize core outcome measures for atopic eczema/dermatitis clinical trials (HOME initiative). Br J Dermatol. 2016;175(1):69–79. https://doi.org/10.1111/bjd.14773.CrossRefPubMed

76.

Thomas KS, Apfelbacher CA, Chalmers JR, Simpson E, Spuls PI, Gerbens LAA, et al. Recommended core outcome instruments for health-related quality of life, long-term control and itch intensity in atopic eczema trials: results of the HOME VII consensus meeting. Br J Dermatol. 2020. https://doi.org/10.1111/bjd.19673.CrossRefPubMedPubMedCentral

77.

Luján-Tangarife J, Cardona-Arias J. Construcción y validación de escalas de medición en salud: revisión de propiedades psicométricas. Arch Med. 2015;11(3):1. https://doi.org/10.3823/1251.CrossRef

78.

Sanclemente-Mesa G, García H, Aguirre-Acevedo D, Jones-Caballero M, Lugo LH, Escobar C, et al. Fiabilidad y validez de constructo de la versión colombiana del instrumento de calidad de vida Skindex-29© en Medellín, Colombia. IATREIA. 2017;30(1):21–33. https://doi.org/10.17533/udea.iatreia.v30n1a02.CrossRef

79.

Hernández-Mantilla N, Cárdenas-Rojas PJ, Picó J, Pareja-Zabala MJ. Dermatitis atópica: tratamiento y costos desde la perspectiva de expertos clínicos colombianos. Dermatol Rev Mex. 2020;64(5):528–34.

80.

Casara C, Eidt L, Cunha V. Prevalence study of dermatoses referred to the phototherapy unit at the Dermatology Service of the Clinics Hospital of Porto Alegre, RS, Brazil. An Bras Dermatol. 2013;88(2):211–5. https://doi.org/10.1590/S0365-05962013000200004.CrossRefPubMedPubMedCentral

81.

Asociación Argentina de Alergia e Inmunología Clínica. Guías para el Diagnóstico y Tratamiento de la Dermatitis Atópica [Guidelines for the Diagnosis and Treatment of Atopic Dermatitis]. 2019. https://alergia.org.ar/pdfs/guias_argentinas_dermatitis_atopica_2019.pdf

82.

Instituto Nacional de Vigilancia de Medicamentos y Alimentos. Resolución No. 2019006204. Por la cual se concede un Registro Sanitario [Resolution No. 2019006204. By which a Sanitary Registry is granted] 2019. http://web.sivicos.gov.co/registros/pdf/15726943_2019006204.pdf.

83.

Comisión Federal para la Protección contra Riesgos Sanitarios de México. 2020. https://www.gob.mx/cofepris.

84.

Agência Nacional de Vigilância Sanitária. Dupixent (dupilumabe): nova indicação [Dupixent(dupilumab): new indications]. 2020. https://www.gov.br/anvisa/pt-br/assuntos/medicamentos/novos-medicamentos-e-indicacoes/dupixentdupilumabe-nova-indicacao.

85.

Sánchez J, Cardona R. Effect of immunotherapy on basophil activation induced by allergens in patients with atopic dermatitis. Rev Alerg Mex. 2014;61(3):168–77.PubMed

86.

Cardona R, Lopez E, Beltrán J, Sánchez J. Safety of immunotherapy in patients with rhinitis, asthma or atopic dermatitis using an ultra-rush buildup. A retrospective study. Allergol Immunopathol (Madr). 2014;42(2):90–5. https://doi.org/10.1016/j.aller.2012.07.005.CrossRef

87.

Boguniewicz M, Alexis AF, Beck LA, Block J, Eichenfield LF, Fonacier L, et al. Expert perspectives on Mmanagement of moderate-to-severe atopic dermatitis: a multidisciplinary consensus addressing current and emerging therapies. J Allergy Clin Immunol Pract. 2017;5(6):1519–31. https://doi.org/10.1016/j.jaip.2017.08.005.CrossRefPubMed

88.

Cherrez-Ojeda I, Vanegas E, Felix M, Mata VL, Jiménez FM, Sanchez M, et al. Frequency of use, perceptions and barriers of information and communication technologies among Latin American physicians: an Ecuadorian cross-sectional Study. J Multidis Healthc. 2020;2020(13):259–69. https://doi.org/10.2147/JMDH.S246253.CrossRef

89.

Lee MK, Seo JH, Chu H, Kim H, Jang YH, Jeong JW, et al. Current status of patient education in the management of atopic dermatitis in Korea. Yonsei Med J. 2019;60(7):694–9. https://doi.org/10.3349/ymj.2019.60.7.694.CrossRefPubMedPubMedCentral

90.

Saito-Abe M, Futamura M, Yamamoto-Hanada K, Yang L, Suzuki K, Ohya Y. Topical corticosteroid phobia among caretakers of children with atopic dermatitis: a cross-sectional study using TOPICOP in Japan. Pediatr Dermatol. 2019;36(3):311–6. https://doi.org/10.1111/all.13189.CrossRefPubMed

91.

Gonzales F, Ramdane N, Delebarre-Sauvage C, Modiano P, Duhamel A, Lasek A. Monitoring of topical corticosteroid phobia in a population of parents with children with atopic dermatitis using the TOPICOP® scale: prevalence, risk factors and the impact of therapeutic patient education. J Eur Acad Dermatol Venereol JEADV. 2017;31(3):e172–4. https://doi.org/10.1111/jdv.13961.CrossRefPubMed

92.

Pickett K, Loveman E, Kalita N, Frampton GK, Jones J. Educational interventions to improve quality of life in people with chronic inflammatory skin diseases: systematic reviews of clinical effectiveness and cost-effectiveness. Health Technol Assess Winch Engl. 2015;19(86):1–176. https://doi.org/10.3310/hta19860.CrossRef

93.

Schmitt J, Csötönyi F, Bauer A, Meurer M. Determinants of treatment goals and satisfaction of patients with atopic eczema. J Dtsch Dermatol Ges. 2008;6(6):458–65. https://doi.org/10.1111/j.1610-0387.2007.06609.x.CrossRefPubMed

94.

Greis C, Meier Zürcher C, Djamei V, Moser A, Lautenschlager S, Navarini AA. Unmet digital health service needs in dermatology patients. J Dermatol Treat. 2018;29(7):643–7. https://doi.org/10.1080/09546634.2018.1441488.CrossRef

95.

Maurer M, Weller K, Magerl M, Maurer RR, Vanegas E, Felix M, et al. The usage, quality and relevance of information and communications technologies in patients with chronic urticaria: A UCARE study. World Allergy Organ J. 2020. https://doi.org/10.1016/j.waojou.2020.100475.CrossRefPubMedPubMedCentral

96.

Kocatürk E, Salman A, Cherrez-Ojeda I, Criado PR, Peter J, Comert-Ozer E, et al. The global impact of the COVID-19 pandemic on the management and course of chronic urticaria. Allergy. 2020;76(3):816–30. https://doi.org/10.1111/all.14687.CrossRefPubMed

97.

Chan Y-C, Tay Y-K, Sugito T-L, Boediardja SA, Chau D-D, Nguyen K-V, et al. A study on the knowledge, attitudes and practices of Southeast Asian dermatologists in the management of atopic dermatitis. Ann Acad Med Singapore. 2006;35(11):794–803.PubMed

98.

Chérrez Ojeda I, Calderon JC, Mori J, Colombaro D, Braido F, Soria E, et al. Patient-physician relationship in the management of asthma: Multicentric approach in Latin America. J Asthma Off J Assoc Care Asthma. 2016;53(7):751–60. https://doi.org/10.3109/02770903.2016.1145691.CrossRef

99.

van Os-Medendorp H, Deprez E, Maes N, Ryan S, Jackson K, Winders T, et al. The role of the nurse in the care and management of patients with atopic dermatitis. BMC Nurs. 2020;19:102. https://doi.org/10.1186/s12912-020-00494-y.CrossRefPubMedPubMedCentral

Titel: The Unmet Needs in Atopic Dermatitis Control in Latin America: A Multidisciplinary Expert Perspective
verfasst von: Jorge Sanchez
Ivan Cherrez-Ojeda
Cesar Galvan
Elizabeth Garcia
Natalia Hernández-Mantilla
Angela Londoño Garcia
Elizabeth McElwee
Mariana Rico Restrepo
Enrique Rivas
Benjamin Hidalgo
Publikationsdatum: 27.08.2021
Verlag: Springer Healthcare
Erschienen in: Dermatology and Therapy / Ausgabe 5/2021
Print ISSN: 2193-8210
Elektronische ISSN: 2190-9172
DOI: https://doi.org/10.1007/s13555-021-00595-9

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

24.04.2024 | DGIM 2024 | Kongressbericht | Nachrichten

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Introduction

Methods

Results

Conclusion

Introduction

Methods

Epidemiology

Clinical Practice Guidelines and Diagnosis in LA

Importance of Disease Control

AD Control in LA

Measurement Tools

CROMs

SCORAD Index

Eczema Area and Severity Index (EASI)

Global Assessment Scales

PROMs

Atopic Dermatitis Control Tool (ADCT)

Patient-Oriented SCORAD (PO-SCORAD)

Patient-Oriented Eczema Measure (POEM)

RECAP of AD (RECAP)

Incorporating a Validated Control Assessment Tool

Treatment and Access

Barriers to AD Control

Conclusion

Develop Continued Medical Education (CME) programs (Fig. 3): use validated AD control assessment tools in routine clinical practice

Develop patient education programs

Multidisciplinary Care Approach

Develop National CPGs

Increase Access to AD Therapy

Acknowledgements

Funding

Authorship

Author Contributions

Disclosures

Compliance with Ethics Guidelines

Weitere Artikel der Ausgabe 5/2021

Selectivity Profile of the Tyrosine Kinase 2 Inhibitor Deucravacitinib Compared with Janus Kinase 1/2/3 Inhibitors

Inadequate Disease Control, Treatment Dissatisfaction, and Quality-of-Life Impairments Among US Patients Receiving Topical Therapy for Atopic Dermatitis

A Randomized Double-Blind Parallel-Group Study to Evaluate the Long-Term Effects of a Medical Device Containing 0.3% Octatrienoic Acid in the Treatment of Grade III Actinic Keratosis

Current Trends of Immunotherapy in the Treatment of Cutaneous Melanoma: A Review

Recognition and Management of Hereditary Angioedema: Best Practices for Dermatologists

Practical Management of Patients with Atopic Dermatitis on Dupilumab

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Metformin rückt in den Hintergrund

Myokarditis nach Infekt – richtig schwierig wird es bei Profisportlern

Thrombophiliescreening – Wenn, dann richtig und nur bei therapeutischer Konsequenz

Bei Senioren mit Prostatakarzinom auf Anämie achten!

Update Innere Medizin