Rincón-Pérez Catalina, Larenas-Linnemann Désirée, Figueroa-Morales Marco Antonio, Luna-Pech Jorge, García-Hidalgo Linda, Macías-Weinmann Alejandra, Gómez-Vera Javier, Barba-Gómez José Fernando, Matta-Campos Juan José, Guevara-Sangines Esther, Jurado-Santacruz Fermín, López Tello-Santillán Adriana, Ortega-Martell José Antonio, Pulido-Díaz Nancy, Serrano-Jaén Liliana Guadalupe, Toledo-Bahena Mirna, Villanueva-Quintero Guadalupe, Mayorga-Butrón José Luis
Secretaría de la Defensa Nacional, Unidad de Especialidades Médicas, Estado de México, México.
Fundación Clínica y Hospital Médica Sur, Unidad de investigación, Ciudad de México, México.
Rev Alerg Mex. 2018;65 Suppl 2:s8-s88. doi: 10.29262/ram.v65i6.526.
The diagnostic approaches and therapeutic strategies of atopic dermatitis (AD) are generally inconsistent among physicians and health institutions.
To develop a consensus statement among experts to reduce the variations in practice regarding the diagnosis and treatment of patients ≥ 12 years with AD to improve their care.
Systematic literature search in PubMed and GREAT. With methodological support and using the Delphi method, a formal consensus was developed among 16 experts in Dermatology and Allergology, based on the current evidence and its applicability in the Mexican context. Apart from intense electronic communication, several issues of disagreement were discussed in two face-to-face meetings.
The clinical experts reached consensus on 46 statements related to the definition, classification, diagnostic strategies and treatment of AD. For the diagnosis we suggest the Williams criteria and for severity scoring the SCORAD (by the doctor) and POEM (by the patient). In addition to general care and treatment education (workshops), we suggest four steps for treatment, depending on severity: 1. Topical treatment with anti-inflammatory agents (and systemic: antihistamines/antileukotrienes -low level evidence-) 2. Phototherapy, 3. Cyclosporin A and 4. Dupilumab, with the possibility of managing this biological earlier on if a fast effect is needed. In extrinsic AD we suggest evaluating the addition of allergen immunotherapy or an elimination diet, if there is an IgE-mediated respiratory or food allergy, respectively.
The panel of experts reached consensus on relevant aspects of AD with a focus on the transcultural adaptation of recent evidence.
特应性皮炎（AD）的诊断方法和治疗策略在医生和医疗机构之间通常不一致。
在专家之间制定一项共识声明，以减少12岁及以上AD患者诊断和治疗实践中的差异，从而改善他们的护理。
在PubMed和GREAT中进行系统的文献检索。在方法学支持下，采用德尔菲法，基于现有证据及其在墨西哥背景下的适用性，16名皮肤科和变态反应科专家达成了正式共识。除了密集的电子通信外，在两次面对面会议上还讨论了几个存在分歧的问题。
临床专家就46项与AD的定义、分类、诊断策略和治疗相关的声明达成了共识。对于诊断，我们建议采用威廉姆斯标准，对于严重程度评分，建议采用SCORAD（由医生进行）和POEM（由患者进行）。除了一般护理和治疗教育（讲习班）外，我们根据严重程度建议了四个治疗步骤：1. 使用抗炎药物进行局部治疗（全身治疗：抗组胺药/抗白三烯——低水平证据）；2. 光疗；3. 环孢素A；4. 度普利尤单抗，如果需要快速起效，有可能更早使用这种生物制剂。在外部性AD中，如果分别存在IgE介导的呼吸道或食物过敏，我们建议评估是否增加变应原免疫疗法或排除饮食。
专家小组就AD的相关方面达成了共识，重点是对最新证据进行跨文化调整。
