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Clinical Features and Disease Management in Adult Patients With Atopic Dermatitis Receiving Care at Reference Hospitals in Brazil: the ADAPT Study

Arruda LK1, Yang AC2, Aoki V3, Criado RFJ4, Pires MC5, Lupi O6, Fabricio LHZ7, Richman D8, Silvi S9

1Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
2Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), Disciplina de Imunologia Clínica e Alergia, 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; Hospital Padre Bento, 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, Cambridge, USA
9Sanofi Genzyme, São Paulo, Brazil

J Investig Allergol Clin Immunol 2021; Vol 31(3) : 236-245
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 are affected by frequent relapses and a significant disease burden.
Objective: To determine the clinical, immunological, and therapeutic profile of Brazilian adults with atopic dermatitis.
Methods: A multicenter, observational, retrospective, descriptive registry-based study was conducted at reference hospitals between December 2016 and October 2017. The data collected were demographics, personal and family history of atopic diseases, clinical manifestations, laboratory tests, disease severity and management.
Results: Of the 187 patients included in the analysis, 56.1% were female and 71.7% were White, with a mean age of 24.7 years. Mean follow-up was 9 years. Asthma or other allergic diseases were reported by 80.2% of patients. The main comorbidity was hypertension (10.2%), and common disease manifestations included pruritus and erythema. Lesions generally affected flexural and nonflexural areas, with typical morphology. Around 83% of patients had moderate-to-severe disease, and 8.6% reported at least 1 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 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 treatment to efficiently control the disease and improve quality of life.

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