Consensus on the therapeutic management of atopic dermatitis - Brazilian Society of Dermatology

Abstract

BACKGROUND Atopic dermatitis is a highly prevalent inflammatory and pruritic dermatosis with a multifactorial etiology, which includes skin barrier defects, immune dysfunction, and microbiome alterations. Atopic dermatitis is mediated by genetic, environmental, and psychological factors and requires therapeutic management that covers all the aspects of its complex pathogenesis. OBJECTIVES The aim of this article is to present the experience, opinions, and recommendations of Brazilian dermatology experts regarding the therapeutic management of atopic dermatitis. METHODS Eighteen experts from 10 university hospitals with experience in atopic dermatitis were appointed by the Brazilian Society of Dermatology to organize a consensus on the therapeutic management of atopic dermatitis. The 18 experts answered an online questionnaire with 14 questions related to the treatment of atopic dermatitis. Afterwards, they analyzed the recent international guidelines on atopic dermatitis of the American Academy of Dermatology, published in 2014, and of the European Academy of Dermatology and Venereology, published in 2018. Consensus was defined as approval by at least 70% of the panel. RESULTS/CONCLUSION The experts stated that the therapeutic management of atopic dermatitis is based on skin hydration, topical anti-inflammatory agents, avoidance of triggering factors, and educational programs. Systemic therapy, based on immunosuppressive agents, is only indicated for severe refractory disease and after failure of topical therapy. Early detection and treatment of secondary bacterial and viral infections is mandatory, and hospitalization may be needed to control atopic dermatitis flares. Novel target-oriented drugs such as immunobiologicals are invaluable therapeutic agents for atopic dermatitis.

Atopic dermatitis: Tofacitinib, an option for refractory disease

“…1 AD is characterized by xeroxis, eczematous lesions, marked dryness and redness, persistent, and severe pruritus. 2 AD is associated with a high burden: sleep disturbance, anxiety and depression and impair quality of life. 3 The management of atopic dermatitis involves emollients, topical corticosteroids, and calcineurin inhibitors and for refractory disease, immunomodulatory agents, often inadequate for moderate to severe disease.…”

Mesenchymal Stem Cells and Atopic Dermatitis: A Review

“…Due to the multifactorial pathogenetic mechanisms of AD, a single therapeutic approach is hardly capable of achieving disease control. Topical treatment with moisturizers, emollients or corticosteroids, oral therapy with immunomodulators (corticosteroids, calcineurin inhibitors, leukotriene receptor antagonists and antihistamines) and antibiotics have been the basis for the management of atopic dermatitis (Ring et al, 2012a,b;Aoki et al, 2019). In general, topical treatment is the first option of choice, being effective for the most patients with mild disease.…”

“…In general, topical treatment is the first option of choice, being effective for the most patients with mild disease. Systemic therapy may be offered to those with severe disease or treatment-resistant eczema, however, invariably, in the long term, comes along with side effects (Apfelbacher et al, 2013;Wong et al, 2017;Aoki et al, 2019). New therapeutic approaches, such as monoclonal antibodies, are passing through the drug discovery pipeline and may reinforce the therapeutic arsenal against AD in a near future (Weidinger and Novak, 2016;Snast et al, 2018;Pistone et al, 2019).…”

Progression of mycosis fungoides after treatment with dupilumab: A case report

“…It was approved by the United States Food and Drug Administration (US FDA) and Brazil's National Health Surveillance Agency (ANVISA) for moderate-tosevere atopic dermatitis (AD). 3,4 Two studies described progression of CTCL after treatment with dupilumab for misdiagnosis of AD or MFassociated pruritus. These patients presented with thickening of the plaques or development of erythroderma and typical CTCL findings on skin biopsies after dupilumab.…”