Comorbidity identification and referral in atopic dermatitis: a consensus document

Abstract

Background

Atopic dermatitis (AD) is associated with different comorbidities.

Objective

To develop evidence-based and practical recommendations for comorbidity detection in patients with AD in daily practice.

Methods

We employed a modified RAND/UCLA methodology, including a systematic literature review (SLR). A group of six experts on AD was established. We conducted a comprehensive search strategy on Medline, Embase, and Cochrane Library up to June 2020. The selection criteria included studies with AD patients with any comorbidity reporting data on comorbidity prevalence, burden, and management. The included studies quality was assessed. The SLR results were discussed in a nominal group meeting, and several recommendations were generated. The recommendation agreement grade was tested on additional experts through a Delphi process.

Results

The recommendations cover the following issues: (1) Which comorbidities should be investigated at the first and subsequent visits; (2) how and when should comorbidities be investigated (screening); (3) how should patients with specific comorbidities be referred to confirm their diagnosis and initiate management; (4) specific recommendations to ensure an integral care approach for AD patients with any comorbidity.

Conclusions

These recommendations seek to guide dermatologists, patients, and other stakeholders in regard to early comorbidity identification and AD patient referral to improve decision-making.

Keywords:

• Atopic dermatitis
• comorbidity
• screening
• Delphi
• systematic literature review

Acknowledgements

We would like to thank the following doctors for their participation to the Delphi process: Carlos Pelayo Hernández Fernández, Jose Suarez Hernandez, Francisco Javier Miquel, Violeta Zaragoza Ninet, Pedro Mercader García, Javier Mataix Díaz, Mercedes Rodriguez Serna, Laia Curto, Constanza Riquelme, and Sara Gómez Armayones.

Disclosure statement

All of the authors received honoraria from Pfizer for project participation. Francisco Rebollo and Susana Gómez work for Pfizer. Estibaliz Loza has received research grants from Janssen, Lilly, MSD, Abbvie, Pfizer, UCB, Celgene-Amgen, Roche, Abbvie, BMS, Novartis. Juan Francisco Silvestre has received honoraria as a consultant/advisory board member/speaker and/or received grants from AbbVie, Lilly, LEO Pharma, Novartis, Pfizer, Regeneron, and Sanofi Genzyme. Susana Puig has received honoraria as speaker/advisory board/consultant or received grants from: Avene, Almirall, Abbvie, AMGEN, BMS, Cantabria, ISDIN, La Roche Posay Leo Pharma, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi, Sun pharma, and Regeneron. The rest of authors refer no conflicts of interest.

Data availability statement

The data that support the findings of this study are available from the corresponding author, JOF, upon reasonable request.

Additional information

Funding

This work was supported by Pfizer. Pfizer did not participate to the steering committee and formulation of the overarching principles and recommendations nor did Pfizer’s representatives impact either the Delphi process or manuscript writing. Estibaliz Loza belongs to the institute of musculoskeletal health (Instituto de Salud Musculoesquelética, INMUSC), which in turn was funded by Pfizer, while helping in methodological coordination and manuscript writing.