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Clinical features and disease management of adult patients with atopic dermatitis receiving care at reference hospitals in Brazil: the ADAPT Study

Karla Arruda L1, Campos Yang A2, Aoki V3, Fachini Jardim Criado R4, Cezar Pires M5, Lupi O6, Helder Zambaldi Fabricio L7, Abreu D8, Silvi S8

1Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
2Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil.
3Hospital das Clínicas da Faculdade de Medicina da USP, Departamento de Dermatologia, São Paulo, Brazil.
4Faculdade de Medicina do ABC, São Paulo, Brazil.
5Hospital do Servidor Público Estadual, São Paulo, Brazil.
6Universidade Federal do Rio de Janeiro (UFRJ); Universidade Federal do Estado do Rio de Janeiro- UNIRIO; Policlínica Geral do Rio de Janeiro – PGRJ, Rio de Janeiro, Brazil.
7Hospital Universitário Evangélico de Curitiba da Faculdade Evangélica do Paraná – HUEC/FEPAR, Paraná, Brazil.
8Sanofi Genzyme, São Paulo, Brazil.

J Investig Allergol Clin Immunol 2021; Vol. 31(3)
doi: 10.18176/jiaci.0478

Background: Atopic dermatitis is a chronic inflammatory skin disease with a prevalence of 0.02% to 8.1% in adults. Adult patients with moderate-to-severe atopic dermatitis have frequent relapses and significant disease burden.
Objectives: Characterize clinical, immunological and therapeutic features of Brazilian adults with atopic dermatitis.
Methods: A multicenter, observational, retrospective, descriptive registry-based study, conducted at reference hospitals, between December 2016 and October 2017. Demographics, personal and family history of atopic diseases, clinical manifestations, laboratory tests, disease severity and management were collected.
Results: From the 187 subjects included in the analysis, 56.1% were female and 71.7% were Caucasian, with a mean age of 24.7 years. Mean follow-up duration was 9 years. Asthma or other allergic diseases were reported by 80.2% of the patients. The main comorbidity was hypertension (10.2%) and common disease manifestations included pruritus and erythema. Lesions were generally distributed in non-flexural and flexural areas, with typical morphology. Around 83% of patients had moderate to severe disease and 8.6% reported at least one hospitalization. Most patients received topical and/or systemic pharmacological therapies, including omalizumab (5.9%); 4.3% received phototherapy. Moreover, 66.8% of patients received adjuvant therapy and 79.1% changed or discontinued treatment for atopic dermatitis due to remission (46.5%), poor effectiveness (33.7%) or lack of therapeutic adherence (12.9%). Most patients presented characteristics of type 2 inflammation, with immunoglobulin E levels above 100 IU/mL (94.4%) and peripheral blood eosinophils above 5% (55.9%).
Conclusion: Brazilian adult patients with severe atopic dermatitis need treatments to efficiently control the disease and improve quality of life.

Key words: Atopic dermatitis, Epidemiologic study characteristics, Disease management, Adult, Tertiary care centers