Encuesta a dermatólogos en Colombia: diagnóstico y tratamientos de preferencia en pacientes con dermatitis atópica

ilustraciones, gráficas, tablas

Autores:
Cardona Salazar, Marcela
Tipo de recurso:
Fecha de publicación:
2022
Institución:
Universidad Nacional de Colombia
Repositorio:
Universidad Nacional de Colombia
Idioma:
spa
OAI Identifier:
oai:repositorio.unal.edu.co:unal/80853
Acceso en línea:
https://repositorio.unal.edu.co/handle/unal/80853
https://repositorio.unal.edu.co/
Palabra clave:
610 - Medicina y salud::616 - Enfermedades
Dermatólogos
Dermatitis atópica
Encuestas y Cuestionarios
Dermatologists
Dermatitis, Atopic
Surveys and Questionnaires
Dermatitis atópica
Encuesta
Opciones terapéuticas
Criterios diagnósticos
Adultos
Atopic dermatitis
Survey
Therapeutic options
Diagnostic criteria
Adults
Rights
openAccess
License
Atribución-NoComercial 4.0 Internacional
id UNACIONAL2_e98626a7a465f859f0b6d7786a104fdc
oai_identifier_str oai:repositorio.unal.edu.co:unal/80853
network_acronym_str UNACIONAL2
network_name_str Universidad Nacional de Colombia
repository_id_str
dc.title.spa.fl_str_mv Encuesta a dermatólogos en Colombia: diagnóstico y tratamientos de preferencia en pacientes con dermatitis atópica
dc.title.translated.eng.fl_str_mv Survey of dermatologists in Colombia: diagnosis and preferred treatments in patients with atopic dermatitis
title Encuesta a dermatólogos en Colombia: diagnóstico y tratamientos de preferencia en pacientes con dermatitis atópica
spellingShingle Encuesta a dermatólogos en Colombia: diagnóstico y tratamientos de preferencia en pacientes con dermatitis atópica
610 - Medicina y salud::616 - Enfermedades
Dermatólogos
Dermatitis atópica
Encuestas y Cuestionarios
Dermatologists
Dermatitis, Atopic
Surveys and Questionnaires
Dermatitis atópica
Encuesta
Opciones terapéuticas
Criterios diagnósticos
Adultos
Atopic dermatitis
Survey
Therapeutic options
Diagnostic criteria
Adults
title_short Encuesta a dermatólogos en Colombia: diagnóstico y tratamientos de preferencia en pacientes con dermatitis atópica
title_full Encuesta a dermatólogos en Colombia: diagnóstico y tratamientos de preferencia en pacientes con dermatitis atópica
title_fullStr Encuesta a dermatólogos en Colombia: diagnóstico y tratamientos de preferencia en pacientes con dermatitis atópica
title_full_unstemmed Encuesta a dermatólogos en Colombia: diagnóstico y tratamientos de preferencia en pacientes con dermatitis atópica
title_sort Encuesta a dermatólogos en Colombia: diagnóstico y tratamientos de preferencia en pacientes con dermatitis atópica
dc.creator.fl_str_mv Cardona Salazar, Marcela
dc.contributor.advisor.spa.fl_str_mv Castellanos Lorduy, Héctor José
Cortés Correa, Carolina Ivette
Peñaranda, Elkin
dc.contributor.author.spa.fl_str_mv Cardona Salazar, Marcela
dc.contributor.researchgroup.spa.fl_str_mv Der+
dc.subject.ddc.spa.fl_str_mv 610 - Medicina y salud::616 - Enfermedades
topic 610 - Medicina y salud::616 - Enfermedades
Dermatólogos
Dermatitis atópica
Encuestas y Cuestionarios
Dermatologists
Dermatitis, Atopic
Surveys and Questionnaires
Dermatitis atópica
Encuesta
Opciones terapéuticas
Criterios diagnósticos
Adultos
Atopic dermatitis
Survey
Therapeutic options
Diagnostic criteria
Adults
dc.subject.decs.spa.fl_str_mv Dermatólogos
Dermatitis atópica
Encuestas y Cuestionarios
dc.subject.decs.eng.fl_str_mv Dermatologists
Dermatitis, Atopic
Surveys and Questionnaires
dc.subject.proposal.spa.fl_str_mv Dermatitis atópica
Encuesta
Opciones terapéuticas
Criterios diagnósticos
Adultos
dc.subject.proposal.eng.fl_str_mv Atopic dermatitis
Survey
Therapeutic options
Diagnostic criteria
Adults
description ilustraciones, gráficas, tablas
publishDate 2022
dc.date.accessioned.none.fl_str_mv 2022-02-02T14:06:17Z
dc.date.available.none.fl_str_mv 2022-02-02T14:06:17Z
dc.date.issued.none.fl_str_mv 2022-02-01
dc.type.spa.fl_str_mv Trabajo de grado - Especialidad Médica
dc.type.driver.spa.fl_str_mv info:eu-repo/semantics/masterThesis
dc.type.version.spa.fl_str_mv info:eu-repo/semantics/acceptedVersion
dc.type.content.spa.fl_str_mv Text
dc.type.redcol.spa.fl_str_mv http://purl.org/redcol/resource_type/TM
status_str acceptedVersion
dc.identifier.uri.none.fl_str_mv https://repositorio.unal.edu.co/handle/unal/80853
dc.identifier.instname.spa.fl_str_mv Universidad Nacional de Colombia
dc.identifier.reponame.spa.fl_str_mv Repositorio Institucional Universidad Nacional de Colombia
dc.identifier.repourl.spa.fl_str_mv https://repositorio.unal.edu.co/
url https://repositorio.unal.edu.co/handle/unal/80853
https://repositorio.unal.edu.co/
identifier_str_mv Universidad Nacional de Colombia
Repositorio Institucional Universidad Nacional de Colombia
dc.language.iso.spa.fl_str_mv spa
language spa
dc.relation.indexed.spa.fl_str_mv Bireme
dc.relation.references.spa.fl_str_mv Langan SM, Irvine AD, Weidinger S. Atopic dermatitis. Lancet. 2020;396(10247):345–60.
de María Díaz Granados L, Quijano MA, Ramírez PA, Aguirre N, Sanclemente G. Quality assessment of atopic dermatitis clinical practice guidelines in ≤ 18 years. Arch Dermatol Res [Internet]. 2018;310(1):29–37. Available from: http://dx.doi.org/10.1007/s00403-017-1791-7
Sacotte R, Silverberg JI. Epidemiology of adult atopic dermatitis. Clin Dermatol [Internet]. 2018;36(5):595–605. Available from: https://doi.org/10.1016/j.clindermatol.2018.05.007
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.
Torres T, Osório Ferreira E, Gonçalo M, Mendes-Bastos P, Selores M, Filipe P. Update on atopic dermatitis. Acta Med Port. 2019;32(9):606–13.
Silvestre Salvador JF, Romero-Pérez D, Encabo-Durán B. Atopic dermatitis in adults: A diagnostic challenge. J Investig Allergol Clin Immunol. 2017;27(2):78–88.
Serna LFN, Molina TG, Ramírez MCVGV, Restrepo SCM, Mejía CC, José William Cornejo Ochoa. Prevalencia de alergias en niños entre 5 y 14 años con trastorno de déficit de atención e hiperactividad. Medellín, 2012. Acta Neurol Colomb. 2014;30(3):156–62.
Kraft MT, Prince BT. Atopic Dermatitis Is a Barrier Issue, Not an Allergy Issue. Immunol Allergy Clin North Am. 2019;39(4):507–19.
Cabanillas B, Novak N. Atopic dermatitis and filaggrin. Curr Opin Immunol [Internet]. 2016;42:1–8. Available from: http://dx.doi.org/10.1016/j.coi.2016.05.002
Bolognia JL, Schaffer J V, Cerroni L. Atopic Dermatitis. In: Callen JP, Cowen EW, Hruza GJ, Jorizzo JL, Lui H, Requena L, et al., editors. Dermatology. 4th ed. Elsevier; 2018. p. 208–27.
Schmuth M, Elias PM, Franz TJ, Tsai J-C, Menon GK, Feingoldpg KR. Skin Barrier. In: Callen JP, Cowen EW, Hruza GJ, Jorizzo JL, Lui H, Requena L, et al., editors. Dermatology. 4th ed. Elsevier; 2018. p. 2176–80.
Kim J, Kim BE, Leung DYM. Pathophysiology of atopic dermatitis: Clinical implications. Allergy Asthma Proc. 2019;40(2):84–92.
Dainichi T, Kitoh A, Otsuka A, Nakajima S, Nomura T, Kaplan DH, et al. The epithelial immune microenvironment (EIME) in atopic dermatitis and psoriasis. Nat Immunol. 2018;19(12):1286–98.
Campione E, Lanna C, Diluvio L, Cannizzaro MV, Grelli S, Galluzzo M, et al. Skin immunity and its dysregulation in atopic dermatitis, hidradenitis suppurativa and vitiligo. Cell Cycle [Internet]. 2020;19(3):257–67. Available from: https://doi.org/10.1080/15384101.2019.1707455
Gavrilova T. Immune Dysregulation in the Pathogenesis of Atopic Dermatitis. Dermatitis. 2018;29(2):57–62.
Czarnowicki T, He H, Krueger JG, Guttman-Yassky E. Atopic dermatitis endotypes and implications for targeted therapeutics. J Allergy Clin Immunol [Internet]. 2019;143(1):1–11. Available from: https://doi.org/10.1016/j.jaci.2018.10.032
Aw M, Penn J, Gauvreau GM, Lima H, Sehmi R. Atopic March: Collegium Internationale Allergologicum Update 2020. Int Arch Allergy Immunol. 2020;181(1):1–10.
Hill DA, Spergel JM. The atopic march Critical evidence and clinical relevance. Asthma Prev. 2018;120(2018):131–7.
Urrutia-Pereira M, Solé D, Rosario NA, Neto HJC, Acosta V, Almendarez CF, et al. Allergologia et Sleep-related disorders in Latin-American children with atopic dermatitis: A case control study. Allergol Immunopathol (Madr). 2017;45(3):276–82.
Carrascosa JM, Morillas-Lahuerta V. Comorbidities in Atopic Dermatitis: An Update and Review of Controversies. Actas Dermosifiliogr. 2020;111(6):481–6.
Vakharia PP, Silverberg JI. Adult-Onset Atopic Dermatitis: Characteristics and Management. Am J Clin Dermatol. 2019;20(6):771–9.
Bieber T, D’Erme AM, Akdis CA, Traidl-Hoffmann C, Lauener R, Schäppi G, et al. Clinical phenotypes and endophenotypes of atopic dermatitis: Where are we, and where should we go? J Allergy Clin Immunol. 2017;139(4):S58–64.
Tanei R. Atopic Dermatitis in Older Adults: A Review of Treatment Options. Drugs and Aging [Internet]. 2020;37(3):149–60. Available from: https://doi.org/10.1007/s40266-020-00750-5
Andersen RM, Thyssen JP, Maibach HI. Qualitative vs. quantitative atopic dermatitis criteria - In historical and present perspectives. J Eur Acad Dermatology Venereol. 2016;30(4):604–18.
Williams HC, Burney PGJ, Pembrokef AC, Hay RJ. The U . K . Working Party ’ s Diagnostic Criteria for Atopic Dermatitis . III . Independent hospital validation. 1994;406–16.
Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, et al. Guidelines of care for the management of atopic dermatitis: Section 1. Diagnosis and assessment of atopic dermatitis Work Group. J Am Acad Dermatol. 2014;70(2):338–51.
Vakharia PP, Chopra R, Silverberg JI. Systematic Review of Diagnostic Criteria Used in Atopic Dermatitis Randomized Controlled Trials. Am J Clin Dermatol. 2018;19:15–22.
Claudia Patricia Ordoñez, Tamayo LM, Gamboa LA, Pradilla MT, Hernández Mantilla N, Candía MPN, et al. Guía de práctica clínica (GPC) para el diagnóstico y tratamiento de la dermatitis atópica en Colombia. Revista de la Asociación Colombiana de Dermatología y Cirugía Dermatológica. 2018. p. 1–250.
Barbarot S, Wollenberg A, Silverberg JI, Deleuran M, Pellacani G, Armario-Hita JC, et al. Dupilumab provides rapid and sustained improvement in SCORAD outcomes in adults with moderate-to-severe atopic dermatitis: combined results of four randomized phase 3 trials. J Dermatolog Treat. 2020;Jun 8:1–12.
Yang YB, Lynde CW, Fleming P. Common Atopic Dermatitis Rating Scales: A Practical Approach and Brief Review. J Cutan Med Surg. 2020;24(4):399–404.
Saclemente G, helena Lugo L, Medina L, Jones-Cabellero M, Garcia HI, Lugo L helena, et al. Preprueba para la adaptación cultural de la versión española del instrumento de calidad de vida dermatológico Skindex-29, en Colombia. Rev Asoc Colomb Dermatología Cirugía Dermatológica. 2011;19:273–9.
Restrepo C, Escobar Valencia C, Mejía Giraldo AM, Tamayo Arango S, García García HI, Lugo Agudelo LH, et al. Instrumentos de evaluación de la calidad de vida en dermatología. Iatreia. 2013;26(4):467–75.
Gooderham MJ, Bissonnette R, Grewal P, Lansang P, Papp KA, Hong CH. 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(supple 1):10s-16s.
Silverberg JI, Gelfand JM, Margolis DJ, Boguniewicz M, Fonacier L, Grayson MH, et al. Symptoms and diagnosis of anxiety and depression in atopic dermatitis in U.S. adults. Br J Dermatol. 2019;181(3):554–65.
van Zuuren EJ, Fedorowicz Z, Christensen R, Lavrijsen AP, Arents BWM. Emollients and moisturisers for eczema. Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd; 2017. p. 1465–858.
Wollenberg A, Christen-Zach S, Taieb A, Paul C, Thyssen JP, Bruin-Weller M de, et al. ETFAD/EADV Eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children. J Eur Acad Dermatology Venereol. 2020;34(12):2717–44.
Schadt CR, Jackson SM. Glucocorticoids. In: Callen JP, Cowen EW, Hruza GJ, Jorizzo JL, Lui H, Requena L, et al., editors. Dermatology. 4th ed. Elsevier; 2018. p. 2186–98.
Mayba JN, Gooderham MJ. Review of atopic dermatitis and topical therapies. J Cutan Med Surg. 2017;21(3):227–36.
Broeders JA, Ahmed Ali U, Fischer G. Systematic review and meta-analysis of randomized clinical trials (RCTs) comparing topical calcineurin inhibitors with topical corticosteroids for atopic dermatitis: A 15-year experience. J Am Acad Dermatol [Internet]. 2016;75(2):410-419.e3. Available from: http://dx.doi.org/10.1016/j.jaad.2016.02.1228
Wollenberg A, Bieber T. Proactive therapy of atopic dermatitis - An emerging concept. Allergy Eur J Allergy Clin Immunol. 2009;64(2):276–8.
Chung BY, Kim HO, Kim JH, Cho SI, Lee CH, Park CW. The proactive treatment of atopic dermatitis with tacrolimus ointment in Korean patients: A comparative study between once-weekly and thrice-weekly applications. Br J Dermatol. 2013;168(4):908–10.
Kemény L, Varga E, Novak Z. Advances in phototherapy for psoriasis and atopic dermatitis. Expert Rev Clin Immunol [Internet]. 2019;15(11):1205–14. Available from: https://doi.org/10.1080/1744666X.2020.1672537
Chan TC, Wu NL, Wong LS, Cho YT, Yang CY, Yu Y, et al. Taiwanese Dermatological Association consensus for the management of atopic dermatitis: A 2020 update. J Formos Med Assoc. 2020;(xxxx).
Ordóñez Rubiano MF, Arenas CM, Chalela JG. UVA-1 phototherapy for the management of atopic dermatitis: a large retrospective study conducted in a low-middle income country. Int J Dermatol. 2018;57(7):799–803.
Ortiz-Salvador JM, Pérez-Ferriols A. Phototherapy in atopic dermatitis. In: Advances in Experimental Medicine and Biology. Springer, Cham; 2017. p. 279–86.
Prezzano JC, Beck LA. Long-Term Treatment of Atopic Dermatitis. Dermatol Clin. 2017;35(3):335–49.
Drucker AM, Eyerich K, Bruin-Weller MS de, Thyssen JP, Spuls PI, Irvine AD, et al. Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement. Br J Dermatol. 2017;178(3):768–75.
Schram ME, Roekevisch E, Leeflang MMG, Bos JD, Schmitt J, Spuls PI. A randomized trial of methotrexate versus azathioprine for severe atopic eczema. J Allergy Clin Immunol [Internet]. 2011;128(2):353–9. Available from: http://dx.doi.org/10.1016/j.jaci.2011.03.024
Law Ping Man S, Bouzillé G, Beneton N, Safa G, Dupuy A, Droitcourt C. Drug survival and postdrug survival of first-line immunosuppressive treatments for atopic dermatitis: comparison between methotrexate and cyclosporine. J Eur Acad Dermatology Venereol. 2018;32(8):1327–35.
Gerbens LAA, Hamann SAS, Brouwer MWD, Roekevisch E, Leeflang MMG, Spuls PI. Methotrexate and azathioprine for severe atopic dermatitis: a 5-year follow-up study of a randomized controlled trial. Br J Dermatol. 2018;178(6):1288–96.
Simpson EL, Bieber T, Guttman-Yassky E, Beck LA, Blauvelt A, Cork MJ, et al. Two Phase 3 Trials of Dupilumab versus Placebo in Atopic Dermatitis. N Engl J Med. 2016;375(24):2335–48.
Blauvelt A, de Bruin-Weller M, Gooderham M, Cather JC, Weisman J, Pariser D, et al. Long-term management of moderate-to-severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): a 1-year, randomised, double-blinded, placebo-controlled, phase 3 trial. Lancet. 2017;389(10086):2287–303.
de Bruin-Weller M, Thaçi D, Smith CH, Reich K, Cork MJ, Radin A, et al. Dupilumab with concomitant topical corticosteroid treatment in adults with atopic dermatitis with an inadequate response or intolerance to ciclosporin A or when this treatment is medically inadvisable: a placebo-controlled, randomized phase III clinical t. Br J Dermatol. 2018;178(5):1083–101.
Saini S, Pansare M. New Insights and Treatments in Atopic Dermatitis. Pediatr Clin North Am. 2019;66(5):1021–33.
Aldredge LM. Atopic Dermatitis With a Focus on Moderate to Severe Disease. J Nurse Pract. 2020.
Ministerio de Salud y Protección Social. CICLOSPORINA CÓDIGO ATC: L04AD01 [Internet]. Available from: http://www.medicamentosaunclic.gov.co/Consultas/frmBusquedas.aspx?idPpio=frmBusquedasIfrm.aspx?idPpio=559
Vermeulen FM, Gerbens LAA, Schmitt J, Deleuran M, Irvine AD, Logan K, et al. The European TREatment of ATopic eczema (TREAT) Registry Taskforce survey: prescribing practices in Europe for phototherapy and systemic therapy in adult patients with moderate-to-severe atopic eczema. Br J Dermatol. 2020;183(6):1073–82.
Taylor K, Swan DJ, Affleck A, Flohr C, Reynolds NJ. Treatment of moderate-to-severe atopic eczema in adults within the U.K.: results of a national survey of dermatologists. Br J Dermatol. 2017;176(6):1617–23.
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.
Simpson EL, Keck LE, Chalmers JR, Williams HC. How should an incident case of atopic dermatitis be defined? A systematic review of primary prevention studies. J Allergy Clin Immunol. 2012;130(1):137–44.
Torrelo A. Methylprednisolone aceponate for atopic dermatitis. Int J Dermatol. 2017;56(6):691–7.
Waldman AR, Ahluwalia J, Udkoff J, Borok JF, Eichenfield LF. Atopic dermatitis. Pediatr Rev. 2018;39(4):180–93.
Sidbury R, Davis DM, Cohen DE, Cordoro KM, Berger TG, Bergman JN, et al. Guidelines of care for the management of atopic dermatitis: Section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol. 2014;71(2):327–49.
(Invima) IN de V de N y A. CONSULTA DATOS DE PRODUCTOS [Internet]. 2007. Available from: http://consultaregistro.invima.gov.co:8082/Consultas/consultas/consreg_encabcum.jsp
Majoie IML, Oldhoff JM, van Weelden H, Laaper-Ertmann M, Bousema MT, Sigurdsson V, et al. Narrowband ultraviolet B and medium-dose ultraviolet A1 are equally effective in the treatment of moderate to severe atopic dermatitis. J Am Acad Dermatol. 2009;60(1):77–84.
Rodenbeck DL, Silverberg JI, Silverberg NB. Phototherapy for atopic dermatitis. Clin Dermatol [Internet]. 2016;34(5):607–13. Available from: http://dx.doi.org/10.1016/j.clindermatol.2016.05.011
avari DR, Nieman EL, McShane DB, Morrell DS. Current perspectives on the systemic management of atopic dermatitis. J Asthma Allergy. 2021;14:595–607.
dc.rights.coar.fl_str_mv http://purl.org/coar/access_right/c_abf2
dc.rights.license.spa.fl_str_mv Atribución-NoComercial 4.0 Internacional
dc.rights.uri.spa.fl_str_mv http://creativecommons.org/licenses/by-nc/4.0/
dc.rights.accessrights.spa.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv Atribución-NoComercial 4.0 Internacional
http://creativecommons.org/licenses/by-nc/4.0/
http://purl.org/coar/access_right/c_abf2
eu_rights_str_mv openAccess
dc.format.extent.spa.fl_str_mv 75 páginas sin numerar
dc.format.mimetype.spa.fl_str_mv application/pdf
dc.coverage.country.spa.fl_str_mv Colombia
dc.publisher.spa.fl_str_mv Universidad Nacional de Colombia
dc.publisher.program.spa.fl_str_mv Bogotá - Medicina - Especialidad en Dermatología
dc.publisher.department.spa.fl_str_mv Departamento de Medicina Interna
dc.publisher.faculty.spa.fl_str_mv Facultad de Medicina
dc.publisher.place.spa.fl_str_mv Bogotá, Colombia
dc.publisher.branch.spa.fl_str_mv Universidad Nacional de Colombia - Sede Bogotá
institution Universidad Nacional de Colombia
bitstream.url.fl_str_mv https://repositorio.unal.edu.co/bitstream/unal/80853/3/1094927951.2022.pdf
https://repositorio.unal.edu.co/bitstream/unal/80853/4/license.txt
https://repositorio.unal.edu.co/bitstream/unal/80853/5/1094927951.2022.pdf.jpg
bitstream.checksum.fl_str_mv c84829bd602206f1a8ee1406158e4a8d
8153f7789df02f0a4c9e079953658ab2
cbc552f7b40182cced50930df6917f35
bitstream.checksumAlgorithm.fl_str_mv MD5
MD5
MD5
repository.name.fl_str_mv Repositorio Institucional Universidad Nacional de Colombia
repository.mail.fl_str_mv repositorio_nal@unal.edu.co
_version_ 1814090022729547776
spelling Atribución-NoComercial 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Castellanos Lorduy, Héctor José86401d7353959bd176228ac1ab37af8dCortés Correa, Carolina Ivette70e69f7c7bd80bcb5c9c1c1076ea9375Peñaranda, Elkin15aba3e526b79f7491a3912a62638a8dCardona Salazar, Marcela0f63be62e97ebc817de7229a2ef4c167Der+2022-02-02T14:06:17Z2022-02-02T14:06:17Z2022-02-01https://repositorio.unal.edu.co/handle/unal/80853Universidad Nacional de ColombiaRepositorio Institucional Universidad Nacional de Colombiahttps://repositorio.unal.edu.co/ilustraciones, gráficas, tablasLa dermatitis atópica es una enfermedad inmunomediada cada vez más estudiada. El objetivo de este estudio es identificar los criterios diagnósticos, las escalas de clinimetría, los tratamientos de preferencia. Además, las causas de elección y cambio de terapia y el tiempo de espera para ver la respuesta terapéutica. Es un estudio observacional, descriptivo de corte transversal. Se hizo por medio de una encuesta virtual distribuida durante actividades académicas, previa realización de prueba piloto. Se encuestaron 68 dermatólogos, el 29.3% basa el diagnóstico según la clínica, seguido de los criterios de Hanifin y Rajka (23.08%). Las escalas clínimétricas más usadas son DLQI, EASI, y valoración clínica (29.85%). La primera línea terapéutica para la enfermedad leve son corticoesteroides de mediana potencia (52.31%). En segunda línea prefieren cambio de potencia del corticoesteroide (38.46%). Las principales causas de iniciar terapia sistémica son: 1. la clínica severa y 2. alteración severa de la calidad de vida. Para elegir terapia sistémica se tiene en cuenta la severidad clínica y la eficacia del medicamento según literatura. En la DA moderada-severa la primera opción es fototerapia (59.38%) y corticoesteroides sistémicos (25%). Como segunda opción ciclosporina (25%), fototerapia (18.75%), azatioprina (18.75%). Conclusiones: es el primer estudio en Latinoamérica al respecto. Se encontró que no hay consenso sobre el diagnóstico y manejo de la enfermedad. En algunos casos no se está esperando el tiempo necesario para ver una respuesta clínica. Aporta información única sobre el tratamiento de dermatitis atópica y sugiere realizar actividades académicas para unificar conceptos entre especialistas. (Texto tomado de la fuente).Atopic dermatitis is an increasingly studied immune-mediated disease. The objective of this study is to identify the diagnostic criteria, the clinimetry scales, the preferred treatments, the causes of selection and change of therapy and the waiting time to see the therapeutic response. It is an observational, descriptive cross-sectional study. It was done through a virtual survey distributed during academic activities, after carrying out a pilot test. A total of 68 dermatologists were surveyed, 29.3% based the diagnosis on the clinic, followed by the Hanifin and Rajka criteria (23.08%). The most used clinimetric scales are DLQI, EASI, and clinical assessment (29.85%). The first-line treatment for mild disease is corticosteroids of medium potency (52.31%). For second-line treatment, they prefer a change in corticosteroid potency (38.46%). The main causes of starting systemic therapy are: 1. severe clinical symptoms and 2. severe quality of life impairment. To choose systemic therapy, the clinical severity and the efficacy of the drug according to the literature are taken into account. In moderate-severe AD, the first-line traetment is phototherapy (59.38%) and systemic corticosteroids (25%). As a second option, cyclosporine (25%), phototherapy (18.75%) and azathioprine (18.75%). Conclusions: it is the first study in Latin America in this regard. We find there is no consensus on the diagnosis and management of the disease. In some cases, they are not waiting long enough to see a clinical response. It provides unique information on the treatment of atopic dermatitis and suggests carrying out academic activities to unify concepts among specialists.Incluye anexosEspecialidades MédicasEspecialista en DermatologíaPara llevar a cabo el estudio se realizó una encuesta virtual mediante enlace para acceder a la misma el cual será distribuido de manera masiva en el 1er Congreso de Dermatología de Filiales y Capítulos Regionales ¨Porque AsocolDerma somos Todos¨ realizado en marzo el 2021. Además, de distribuirse en diferentes actividades académicas del gremio. El enlace se dejará disponible para el diligenciamiento de la encuesta por un tiempo de 6 meses. La encuesta fue diseñada teniendo en cuenta las recomendaciones de diagnóstico y tratamiento de las Guías de Práctica Clínica actuales (28)(36). Ver Anexo 1. Se realizó la encuesta piloto para evaluar si las preguntas eran difíciles de responder, confusas, difíciles de entender, molestas u ofensivas, o se proponen formular de manera distinta.Enfermedades autoinmunes de la piel75 páginas sin numerarapplication/pdfspaUniversidad Nacional de ColombiaBogotá - Medicina - Especialidad en DermatologíaDepartamento de Medicina InternaFacultad de MedicinaBogotá, ColombiaUniversidad Nacional de Colombia - Sede Bogotá610 - Medicina y salud::616 - EnfermedadesDermatólogosDermatitis atópicaEncuestas y CuestionariosDermatologistsDermatitis, AtopicSurveys and QuestionnairesDermatitis atópicaEncuestaOpciones terapéuticasCriterios diagnósticosAdultosAtopic dermatitisSurveyTherapeutic optionsDiagnostic criteriaAdultsEncuesta a dermatólogos en Colombia: diagnóstico y tratamientos de preferencia en pacientes con dermatitis atópicaSurvey of dermatologists in Colombia: diagnosis and preferred treatments in patients with atopic dermatitisTrabajo de grado - Especialidad Médicainfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/acceptedVersionTexthttp://purl.org/redcol/resource_type/TMColombiaBiremeLangan SM, Irvine AD, Weidinger S. Atopic dermatitis. Lancet. 2020;396(10247):345–60.de María Díaz Granados L, Quijano MA, Ramírez PA, Aguirre N, Sanclemente G. Quality assessment of atopic dermatitis clinical practice guidelines in ≤ 18 years. Arch Dermatol Res [Internet]. 2018;310(1):29–37. Available from: http://dx.doi.org/10.1007/s00403-017-1791-7Sacotte R, Silverberg JI. Epidemiology of adult atopic dermatitis. Clin Dermatol [Internet]. 2018;36(5):595–605. Available from: https://doi.org/10.1016/j.clindermatol.2018.05.007Fishbein 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.Torres T, Osório Ferreira E, Gonçalo M, Mendes-Bastos P, Selores M, Filipe P. Update on atopic dermatitis. Acta Med Port. 2019;32(9):606–13.Silvestre Salvador JF, Romero-Pérez D, Encabo-Durán B. Atopic dermatitis in adults: A diagnostic challenge. J Investig Allergol Clin Immunol. 2017;27(2):78–88.Serna LFN, Molina TG, Ramírez MCVGV, Restrepo SCM, Mejía CC, José William Cornejo Ochoa. Prevalencia de alergias en niños entre 5 y 14 años con trastorno de déficit de atención e hiperactividad. Medellín, 2012. Acta Neurol Colomb. 2014;30(3):156–62.Kraft MT, Prince BT. Atopic Dermatitis Is a Barrier Issue, Not an Allergy Issue. Immunol Allergy Clin North Am. 2019;39(4):507–19.Cabanillas B, Novak N. Atopic dermatitis and filaggrin. Curr Opin Immunol [Internet]. 2016;42:1–8. Available from: http://dx.doi.org/10.1016/j.coi.2016.05.002Bolognia JL, Schaffer J V, Cerroni L. Atopic Dermatitis. In: Callen JP, Cowen EW, Hruza GJ, Jorizzo JL, Lui H, Requena L, et al., editors. Dermatology. 4th ed. Elsevier; 2018. p. 208–27.Schmuth M, Elias PM, Franz TJ, Tsai J-C, Menon GK, Feingoldpg KR. Skin Barrier. In: Callen JP, Cowen EW, Hruza GJ, Jorizzo JL, Lui H, Requena L, et al., editors. Dermatology. 4th ed. Elsevier; 2018. p. 2176–80.Kim J, Kim BE, Leung DYM. Pathophysiology of atopic dermatitis: Clinical implications. Allergy Asthma Proc. 2019;40(2):84–92.Dainichi T, Kitoh A, Otsuka A, Nakajima S, Nomura T, Kaplan DH, et al. The epithelial immune microenvironment (EIME) in atopic dermatitis and psoriasis. Nat Immunol. 2018;19(12):1286–98.Campione E, Lanna C, Diluvio L, Cannizzaro MV, Grelli S, Galluzzo M, et al. Skin immunity and its dysregulation in atopic dermatitis, hidradenitis suppurativa and vitiligo. Cell Cycle [Internet]. 2020;19(3):257–67. Available from: https://doi.org/10.1080/15384101.2019.1707455Gavrilova T. Immune Dysregulation in the Pathogenesis of Atopic Dermatitis. Dermatitis. 2018;29(2):57–62.Czarnowicki T, He H, Krueger JG, Guttman-Yassky E. Atopic dermatitis endotypes and implications for targeted therapeutics. J Allergy Clin Immunol [Internet]. 2019;143(1):1–11. Available from: https://doi.org/10.1016/j.jaci.2018.10.032Aw M, Penn J, Gauvreau GM, Lima H, Sehmi R. Atopic March: Collegium Internationale Allergologicum Update 2020. Int Arch Allergy Immunol. 2020;181(1):1–10.Hill DA, Spergel JM. The atopic march Critical evidence and clinical relevance. Asthma Prev. 2018;120(2018):131–7.Urrutia-Pereira M, Solé D, Rosario NA, Neto HJC, Acosta V, Almendarez CF, et al. Allergologia et Sleep-related disorders in Latin-American children with atopic dermatitis: A case control study. Allergol Immunopathol (Madr). 2017;45(3):276–82.Carrascosa JM, Morillas-Lahuerta V. Comorbidities in Atopic Dermatitis: An Update and Review of Controversies. Actas Dermosifiliogr. 2020;111(6):481–6.Vakharia PP, Silverberg JI. Adult-Onset Atopic Dermatitis: Characteristics and Management. Am J Clin Dermatol. 2019;20(6):771–9.Bieber T, D’Erme AM, Akdis CA, Traidl-Hoffmann C, Lauener R, Schäppi G, et al. Clinical phenotypes and endophenotypes of atopic dermatitis: Where are we, and where should we go? J Allergy Clin Immunol. 2017;139(4):S58–64.Tanei R. Atopic Dermatitis in Older Adults: A Review of Treatment Options. Drugs and Aging [Internet]. 2020;37(3):149–60. Available from: https://doi.org/10.1007/s40266-020-00750-5Andersen RM, Thyssen JP, Maibach HI. Qualitative vs. quantitative atopic dermatitis criteria - In historical and present perspectives. J Eur Acad Dermatology Venereol. 2016;30(4):604–18.Williams HC, Burney PGJ, Pembrokef AC, Hay RJ. The U . K . Working Party ’ s Diagnostic Criteria for Atopic Dermatitis . III . Independent hospital validation. 1994;406–16.Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, et al. Guidelines of care for the management of atopic dermatitis: Section 1. Diagnosis and assessment of atopic dermatitis Work Group. J Am Acad Dermatol. 2014;70(2):338–51.Vakharia PP, Chopra R, Silverberg JI. Systematic Review of Diagnostic Criteria Used in Atopic Dermatitis Randomized Controlled Trials. Am J Clin Dermatol. 2018;19:15–22.Claudia Patricia Ordoñez, Tamayo LM, Gamboa LA, Pradilla MT, Hernández Mantilla N, Candía MPN, et al. Guía de práctica clínica (GPC) para el diagnóstico y tratamiento de la dermatitis atópica en Colombia. Revista de la Asociación Colombiana de Dermatología y Cirugía Dermatológica. 2018. p. 1–250.Barbarot S, Wollenberg A, Silverberg JI, Deleuran M, Pellacani G, Armario-Hita JC, et al. Dupilumab provides rapid and sustained improvement in SCORAD outcomes in adults with moderate-to-severe atopic dermatitis: combined results of four randomized phase 3 trials. J Dermatolog Treat. 2020;Jun 8:1–12.Yang YB, Lynde CW, Fleming P. Common Atopic Dermatitis Rating Scales: A Practical Approach and Brief Review. J Cutan Med Surg. 2020;24(4):399–404.Saclemente G, helena Lugo L, Medina L, Jones-Cabellero M, Garcia HI, Lugo L helena, et al. Preprueba para la adaptación cultural de la versión española del instrumento de calidad de vida dermatológico Skindex-29, en Colombia. Rev Asoc Colomb Dermatología Cirugía Dermatológica. 2011;19:273–9.Restrepo C, Escobar Valencia C, Mejía Giraldo AM, Tamayo Arango S, García García HI, Lugo Agudelo LH, et al. Instrumentos de evaluación de la calidad de vida en dermatología. Iatreia. 2013;26(4):467–75.Gooderham MJ, Bissonnette R, Grewal P, Lansang P, Papp KA, Hong CH. 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(supple 1):10s-16s.Silverberg JI, Gelfand JM, Margolis DJ, Boguniewicz M, Fonacier L, Grayson MH, et al. Symptoms and diagnosis of anxiety and depression in atopic dermatitis in U.S. adults. Br J Dermatol. 2019;181(3):554–65.van Zuuren EJ, Fedorowicz Z, Christensen R, Lavrijsen AP, Arents BWM. Emollients and moisturisers for eczema. Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd; 2017. p. 1465–858.Wollenberg A, Christen-Zach S, Taieb A, Paul C, Thyssen JP, Bruin-Weller M de, et al. ETFAD/EADV Eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children. J Eur Acad Dermatology Venereol. 2020;34(12):2717–44.Schadt CR, Jackson SM. Glucocorticoids. In: Callen JP, Cowen EW, Hruza GJ, Jorizzo JL, Lui H, Requena L, et al., editors. Dermatology. 4th ed. Elsevier; 2018. p. 2186–98.Mayba JN, Gooderham MJ. Review of atopic dermatitis and topical therapies. J Cutan Med Surg. 2017;21(3):227–36.Broeders JA, Ahmed Ali U, Fischer G. Systematic review and meta-analysis of randomized clinical trials (RCTs) comparing topical calcineurin inhibitors with topical corticosteroids for atopic dermatitis: A 15-year experience. J Am Acad Dermatol [Internet]. 2016;75(2):410-419.e3. Available from: http://dx.doi.org/10.1016/j.jaad.2016.02.1228Wollenberg A, Bieber T. Proactive therapy of atopic dermatitis - An emerging concept. Allergy Eur J Allergy Clin Immunol. 2009;64(2):276–8.Chung BY, Kim HO, Kim JH, Cho SI, Lee CH, Park CW. The proactive treatment of atopic dermatitis with tacrolimus ointment in Korean patients: A comparative study between once-weekly and thrice-weekly applications. Br J Dermatol. 2013;168(4):908–10.Kemény L, Varga E, Novak Z. Advances in phototherapy for psoriasis and atopic dermatitis. Expert Rev Clin Immunol [Internet]. 2019;15(11):1205–14. Available from: https://doi.org/10.1080/1744666X.2020.1672537Chan TC, Wu NL, Wong LS, Cho YT, Yang CY, Yu Y, et al. Taiwanese Dermatological Association consensus for the management of atopic dermatitis: A 2020 update. J Formos Med Assoc. 2020;(xxxx).Ordóñez Rubiano MF, Arenas CM, Chalela JG. UVA-1 phototherapy for the management of atopic dermatitis: a large retrospective study conducted in a low-middle income country. Int J Dermatol. 2018;57(7):799–803.Ortiz-Salvador JM, Pérez-Ferriols A. Phototherapy in atopic dermatitis. In: Advances in Experimental Medicine and Biology. Springer, Cham; 2017. p. 279–86.Prezzano JC, Beck LA. Long-Term Treatment of Atopic Dermatitis. Dermatol Clin. 2017;35(3):335–49.Drucker AM, Eyerich K, Bruin-Weller MS de, Thyssen JP, Spuls PI, Irvine AD, et al. Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement. Br J Dermatol. 2017;178(3):768–75.Schram ME, Roekevisch E, Leeflang MMG, Bos JD, Schmitt J, Spuls PI. A randomized trial of methotrexate versus azathioprine for severe atopic eczema. J Allergy Clin Immunol [Internet]. 2011;128(2):353–9. Available from: http://dx.doi.org/10.1016/j.jaci.2011.03.024Law Ping Man S, Bouzillé G, Beneton N, Safa G, Dupuy A, Droitcourt C. Drug survival and postdrug survival of first-line immunosuppressive treatments for atopic dermatitis: comparison between methotrexate and cyclosporine. J Eur Acad Dermatology Venereol. 2018;32(8):1327–35.Gerbens LAA, Hamann SAS, Brouwer MWD, Roekevisch E, Leeflang MMG, Spuls PI. Methotrexate and azathioprine for severe atopic dermatitis: a 5-year follow-up study of a randomized controlled trial. Br J Dermatol. 2018;178(6):1288–96.Simpson EL, Bieber T, Guttman-Yassky E, Beck LA, Blauvelt A, Cork MJ, et al. Two Phase 3 Trials of Dupilumab versus Placebo in Atopic Dermatitis. N Engl J Med. 2016;375(24):2335–48.Blauvelt A, de Bruin-Weller M, Gooderham M, Cather JC, Weisman J, Pariser D, et al. Long-term management of moderate-to-severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): a 1-year, randomised, double-blinded, placebo-controlled, phase 3 trial. Lancet. 2017;389(10086):2287–303.de Bruin-Weller M, Thaçi D, Smith CH, Reich K, Cork MJ, Radin A, et al. Dupilumab with concomitant topical corticosteroid treatment in adults with atopic dermatitis with an inadequate response or intolerance to ciclosporin A or when this treatment is medically inadvisable: a placebo-controlled, randomized phase III clinical t. Br J Dermatol. 2018;178(5):1083–101.Saini S, Pansare M. New Insights and Treatments in Atopic Dermatitis. Pediatr Clin North Am. 2019;66(5):1021–33.Aldredge LM. Atopic Dermatitis With a Focus on Moderate to Severe Disease. J Nurse Pract. 2020.Ministerio de Salud y Protección Social. CICLOSPORINA CÓDIGO ATC: L04AD01 [Internet]. Available from: http://www.medicamentosaunclic.gov.co/Consultas/frmBusquedas.aspx?idPpio=frmBusquedasIfrm.aspx?idPpio=559Vermeulen FM, Gerbens LAA, Schmitt J, Deleuran M, Irvine AD, Logan K, et al. The European TREatment of ATopic eczema (TREAT) Registry Taskforce survey: prescribing practices in Europe for phototherapy and systemic therapy in adult patients with moderate-to-severe atopic eczema. Br J Dermatol. 2020;183(6):1073–82.Taylor K, Swan DJ, Affleck A, Flohr C, Reynolds NJ. Treatment of moderate-to-severe atopic eczema in adults within the U.K.: results of a national survey of dermatologists. Br J Dermatol. 2017;176(6):1617–23.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.Simpson EL, Keck LE, Chalmers JR, Williams HC. How should an incident case of atopic dermatitis be defined? A systematic review of primary prevention studies. J Allergy Clin Immunol. 2012;130(1):137–44.Torrelo A. Methylprednisolone aceponate for atopic dermatitis. Int J Dermatol. 2017;56(6):691–7.Waldman AR, Ahluwalia J, Udkoff J, Borok JF, Eichenfield LF. Atopic dermatitis. Pediatr Rev. 2018;39(4):180–93.Sidbury R, Davis DM, Cohen DE, Cordoro KM, Berger TG, Bergman JN, et al. Guidelines of care for the management of atopic dermatitis: Section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol. 2014;71(2):327–49.(Invima) IN de V de N y A. CONSULTA DATOS DE PRODUCTOS [Internet]. 2007. Available from: http://consultaregistro.invima.gov.co:8082/Consultas/consultas/consreg_encabcum.jspMajoie IML, Oldhoff JM, van Weelden H, Laaper-Ertmann M, Bousema MT, Sigurdsson V, et al. Narrowband ultraviolet B and medium-dose ultraviolet A1 are equally effective in the treatment of moderate to severe atopic dermatitis. J Am Acad Dermatol. 2009;60(1):77–84.Rodenbeck DL, Silverberg JI, Silverberg NB. Phototherapy for atopic dermatitis. Clin Dermatol [Internet]. 2016;34(5):607–13. Available from: http://dx.doi.org/10.1016/j.clindermatol.2016.05.011avari DR, Nieman EL, McShane DB, Morrell DS. Current perspectives on the systemic management of atopic dermatitis. J Asthma Allergy. 2021;14:595–607.MaestrosORIGINAL1094927951.2022.pdf1094927951.2022.pdfTesis de Especialidad en Dermatologíaapplication/pdf951460https://repositorio.unal.edu.co/bitstream/unal/80853/3/1094927951.2022.pdfc84829bd602206f1a8ee1406158e4a8dMD53LICENSElicense.txtlicense.txttext/plain; charset=utf-84074https://repositorio.unal.edu.co/bitstream/unal/80853/4/license.txt8153f7789df02f0a4c9e079953658ab2MD54THUMBNAIL1094927951.2022.pdf.jpg1094927951.2022.pdf.jpgGenerated Thumbnailimage/jpeg4423https://repositorio.unal.edu.co/bitstream/unal/80853/5/1094927951.2022.pdf.jpgcbc552f7b40182cced50930df6917f35MD55unal/80853oai:repositorio.unal.edu.co:unal/808532023-07-31 23:04:33.907Repositorio Institucional Universidad Nacional de Colombiarepositorio_nal@unal.edu.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

Publicaciones similares