Italian guidelines for therapy of atopic dermatitis—Adapted from consensus‐based European guidelines for treatment of atopic eczema (atopic dermatitis)

Abstract

Atopic dermatitis (AD) therapeutic approach calls for a long‐term treatment. Treatment options for AD have recently undergone a revolutionary change by the introduction of the first biologic drug. Availability in daily practice of the last version of international AD guidelines, taking peculiarities of the country into account, can contribute to good clinical practice in Italy. To adapt European Dermatology Forum (EDF) guidelines for AD to the Italian medical–legal context, the EDF guidelines were assessed independently by two independent Italian renowned experts in the field and further integrated with articles published and systematically reviewed before May 2019. The first draft was collegially corrected and updated by the members of the SIDEMAST, ADOI, and SIDAPA. Recommendation levels (A; B; C; D) were graded based on the evidence levels (1–4). The adapted guidelines presented here focus on topical and systemic therapies in AD patients, both children and adults. As opposed to previous Italian guidelines, they include indications about biologics. New relevant evidence available from very recent literature and peculiarities of the Italian medical and legal context have been integrated in the revision process. If compared to general guidelines for AD not adapted to a specific national and cultural context, a revision for specific Italian needs is now available: It comprises the option of implementing the new biologic treatments and is likely to provide an important contribution to the improvement of clinical practice in Italy. Cooperation between patients, dermatologists, allergologists, and pediatricians remains mandatory in AD management. The authors of the present revision recommend an update of the Italian guidelines to be performed at least every second year.

Dupilumab therapy of atopic dermatitis of the elderly: a multicentre, real‐life study

“…Conjunctivitis was confirmed to be the most frequent AE, affecting 3.9% of our elderly patients, but to a lesser extent than the 18‐ to 64‐year‐old population (8.6%). Furthermore, this percentage is lower than that reported by in both clinical trials (range 5–28%) 12,22,23 and real‐life studies (range 8–62%) 10,26,28 . It should be noted that a quite frequently (10/276; 3.6%) reported AE was flushing, which is only rarely described in literature 2 as occurring in association with alcohol intake, due to a possible competitive inhibition of cytochrome P450 2E1 by dupilumab and ethanol 29 .…”

“…asteatotic dermatitis, senile pruritus, uraemic pruritus or adverse drug reaction 14 . Management is often complicated by the presence of comorbidities or daily intake of several drugs, making it difficult to administer traditional immunosuppressive drugs 9,10 . Few AD studies have assessed elderly atopic patients separately from other age groups, reporting differences in disease manifestations and management 1,4,15 .…”

Atopic Dermatitis and Comorbidity

“…Topical therapy involves the application of topical corticosteroids and topical calcineurin inhibitors. Systemic therapies comprise immunosuppressants (antihistamines), biologics, and antimicrobial therapy [40][41][42][43][44]. In this research, the most frequently prescribed topical corticosteroid was mometasone (32% of subjects).…”

COVID‐19 knowledge prevents biologics discontinuation: Data from an Italian multicenter survey duringRED‐ZONEdeclaration

“…After verifying medical history and demographics already recorded in the database, two board‐certified, independent dermatologists clinically assessed the enrolled patients collecting the appropriate severity scores in compliance with the Italian guidelines 19‐23 …”

“…After verifying medical history and demographics already recorded in the database, two board-certified, independent dermatologists clinically assessed the enrolled patients collecting the appropriate severity scores in compliance with the Italian guidelines. [19][20][21][22][23] AD patients were evaluated using Dermatologic Quality of Life Score (DLQI) 23,24 and Eczema Area and Severity Index (EASI). PsO patients were evaluated using DLQI, PASI and DAPSA (if psoriatic arthritis was co-diagnosed), whilst HS patients underwent DLQI, Hurley score, IHS4 and Autoinflammatory Disease Damage Index (ADDI).…”