[Spanish translation, cross-cultural adaptation and validation of the ADTC scale (Atopic Dermatitis Control Tool)] / Traducción al español, adaptación transcultural y validación de la escala ADTC (Atopic Dermatitis Control Tool).

OBJETIVES: Obtain a version to validate it in a population of adults with AD. MATERIALS AND METHODS: 1) Translation into Spanish and cross-cultural adaptation of the questionnaire from the original version in English, through a seven-step process. 2) Evaluation of the unidimensionality of the resulting scale by means of an exploratory factor analysis (EFA), of its reliability by means of Cronbach's alpha coefficient, and of its validity by evaluating the correlation of its score with those of the POEM and DLQI questionnaires. (external reference criteria). RESULTS: The version resulting from the translation and cross-cultural adaptation process was well understood by the target population. The AFE of the 66 questionnaires documented the unidimensionality of the scale based on compliance with all the criteria used for its verification. Its reliability was excellent (Cronbach's Alpha: 0.917) and its score had a very high correlation with the external reference criteria (POEM: Spearman's Rho 0.85; p < 0.0001; DLQI Spearman's Rho = 0.81; p < 0 .0001). CONCLUSIONS: The version translated into Spanish and adapted for transculturation of the ADCT questionnaire has appropriate psychometric characteristics, which will contribute to optimizing the care processes of Spanish-speaking patients.

INTRODUCCIÓN: El cuestionario ADCT (Atopic Dermatitis Control Tool) permite objetivar en forma breve y autoadministrada la repercusión de la dermatitis atópica (DA) sobre la vida cotidiana de quien la padece. OBJETIVO: Obtener una versión validarla en una población de adultos con DA. MATERIALES Y METODOS: 1) Traducción al español y adaptación transcultural del cuestionario a partir de la versión original en inglés, a través de un proceso de siete pasos. 2) Evaluación de la unidimensionalidad de la escala resultante mediante un análisis factorial exploratorio (AFE), de su confiabilidad mediante el coeficiente alfa de Cronbach, y de su validez mediante la evaluación de la correlación de su puntaje con los de los cuestionarios POEM y DLQI (criterios externos de referencia). RESULTADOS: La versión resultante del proceso de traducción y adaptación transcultural fue bien comprendida por la población blanco. El AFE de los 66 cuestionarios documentó la unidimensionalidad de la escala a partir del cumplimiento de todos los criterios utilizados para su verificación. Su confiabilidad fue excelente (Alfa de Cronbach: 0,917) y su puntaje tuvo muy alta correlación con los criterios de referencia externos (POEM: Spearman's Rho 0,85; p < 0,0001; DLQI Spearman's Rho = 0,81; p < 0,0001). CONCLUSION: La versión traducida al español y adaptada transculturación del cuestionario ADCT tiene características psicométricas apropiadas, lo que contribuirá a optimizar los procesos de cuidado de pacientes de habla hispana.

Healthcare Disparities in Atopic Dermatitis in Latin America: A Narrative Review.

INTRODUCTION: Atopic dermatitis (AD) is a chronic, pruritic skin disease caused by a mixture of genetic, immunological, and environmental factors, characterized by periods of inflammation and remission. In Latin America (LA), the prevalence of AD ranges up to 25% in children and 1-3% in adults. The natural history of the disease for most patients is that AD goes into remission in adolescence and adult life. Only 10-30% of patients continue to have symptoms of the disease in adulthood. There are patients (3-4%) who have the onset of AD during adolescence or after adulthood. Those with limited access to healthcare services, such as diagnosis and treatment, have increased difficulties coping with AD. Healthcare disparities are a complex topic that include social, political, racial/ethnic, and geographical factors. Publications about healthcare disparities in AD in LA are scarce. As a result, recognizing and resolving healthcare inequalities is critical to improving the treatment and quality of life (QoL) of individuals with AD. METHODS: A panel of Latin American experts in dermatology and allergies was provided with a series of relevant questions to address before a multiday conference. During this conference, the entire group discussed and edited each narrative through numerous drafts and rounds of discussion until they reached a consensus. RESULTS: This paper examines the barriers to equal access to care and recommends realistic actions to overcome them. Inadequate disease knowledge, cultural and linguistic barriers, stigmatization, maldistribution of resources, absence of local clinical practice guidelines, arduous patient journey, and limited consultation time were identified as causes of health inequality. CONCLUSIONS: Among the suggested solutions are enhanced education for healthcare professionals, patients, and the general public, a focus on underprivileged communities, telemedicine and telementoring, translators, multidisciplinary teams, and local living clinical practice guidelines.

Impact of atopic dermatitis on quality of life: a large web-based survey from Argentina.

BACKGROUND: Atopic dermatitis (AD) is a chronic, recurrent, inflammatory skin condition that is associated with detrimental effects on the lives of patients and their families, including an impact on quality of life (QOL). Studies about QOL on Latin American AD patients are scarce and have generally included few patients. OBJECTIVE: describing AD impact on the QOL in a large cohort in Argentina. METHODS: a structured web-based survey including 1,650 AD pediatric and adult patients was performed. RESULTS: according to retrieved data, AD symptoms onset started during childhood in most patients, but 20 % of participants reported that manifestations of AD were initially perceived during late adolescence and adulthood. Important differences were observed among country regions, with a shorter time-to-diagnosis in most populated and richer districts. Main affected domains included frustration, anger, mood alterations, stress, sleep alterations, routine alterations, pain and economic impact of AD. LIMITATIONS: biases inherent to survey design. CONCLUSIONS: we consider that our study contributes to a better understanding of AD in Argentina, as well as its physical, social and financial impact on affected patients.

ECHO project in atopic dermatitis in Argentina: An innovative strategy to reach underserved areas with up to date knowledge, first year of experience.

BACKGROUND: The ECHO® (Extension for Community Healthcare Outcomes) project is a model of distance medical education developed in the United States to support health professionals in the management of patients with complex diseases. Since 2019, it has been implemented in atopic dermatitis (AD) in Argentina. The program consists of the periodic presentation of clinical cases by videoconference, virtual classes, and a permanently available open chat between professionals in charge of patients with AD and a group of experts. OBJECTIVE: The objective of this study was to analyze the impact of the ECHO Project AD on the medical knowledge and medical skills of Argentinian health professionals when treating patients with AD. METHODS: A survey was carried out among the participants in order to evaluate the impact of the program on the care of patients with AD. RESULTS: ECHO Project AD revealed a significant improvement in the management of patients with AD. The program contributed to the interpretation and use of severity scores, use of phototherapy, and management and prescription of both classic and innovative topical and systemic treatments. STUDY LIMITATIONS: The reduced number of participants and the short period of time. The answers of the survey may be biased by the enthusiasm of the participants. CONCLUSIONS: The ECHO project is an educational tool that enhances the medical skills of doctors and institutions, in which a climate of a partnership comes first and the participants look forward to learning from experiences, successes, and mistakes from one another, producing a scientific hub in constant evolution.

Designing an Atopic Dermatitis Community that Integrates Patient Self-Uploaded Information into the EHR to Optimize Follow-up.

Atopic dermatitis is a common chronic dermatological disease in childhood that can affect people's quality of life. The aim of this study was to inquire about the difficulties, needs and interests related to the disease that people with eczema and their caregivers have; in order to develop a tool that is useful for the follow-up of the illness. Electronic surveys were sent to potential users and interviews were conducted with professionals who are specialized on the subject. The main findings allowed us to understand the challenges and situations they face on a daily basis, such as the difficulties related to the family support, the queries on the eczema flare-ups, the struggles with the adherence to treatment and the needs of optimizing their quality of life. These results helped us design a tool that allows patients and their companions to better monitor their disease while optimizing communication with their health professionals.

[Analysis of a case series of adult patients with severe atopic dermatitis treated with dupilumab in Argentina]. / Análisis de una serie de casos de pacientes adultos con dermatitis atópica severa tratados con dupilumab en Argentina.

Introduction: Severe atopic dermatitis (AD) treatment is an unmet need, given the limited efficacy and safety of classical systemic treatments (CSTs). Dupilumab is a monoclonal antibody that blocks the signaling of the interleukins that mediate the inflammatory response involved in AD. Methods: the clinical response of a group of patients from Argentina with severe AD and insufficient response and/or toxicity to CSTs who were treated with dupilumab before commercial availability was analyzed. EASI, SCORAD, DLQI scales and analog visual scales of pruritus and sleep were evaluated, during a median follow-up of 189 days. In addition, the incidence of adverse events was analyzed. Results: 20 patients (13 male) were included; median age: 37.5 years; median AD evolution: 20 years; atopic comorbidity: 70%. 100% had received systemic corticosteroids (serious complications: 20%). Main reasons for discontinuation of CSTs were lack of efficacy and occurrence of adverse events. All scores were significantly and steadily reduced, with identifiable clinical response at the second month of treatment. At the end of the follow-up, only 3 patients required concomitant systemic immunosuppressive treatment. Dupilumab was well tolerated, with mild and controllable adverse events. Discussion: Dupilumab is the only biological agent with high efficacy demonstrated in clinical and observational studies. In this case series, its effectiveness was confirmed in difficult-to-treat patients with severe AD and inadequate response to CSTs. The safety profile was favorable and consistent.

Introducción: El tratamiento de la dermatitis atópica (DA) severa es una necesidad insatisfecha, dada la limitada eficacia y seguridad de los tratamientos sistémicos clásicos (TSC). Dupilumab es un anticuerpo monoclonal que bloquea la señalización de las interleuquinas mediadoras de la respuesta inflamatoria involucrada en la DA. Métodos: se analizó la respuesta clínica de un grupo de pacientes de Argentina con DA severa y respuesta insuficiente y/o toxicidad a los TSC que fueron tratados con dupilumab antes de su disponibilidad comercial. Se evaluaron las escalas EASI, SCORAD, DLQI y escalas visuales analógicas de prurito y sueño, durante una mediana de 189 días de seguimiento, así como la incidencia de eventos adversos. Resultados: Se incluyeron 20 pacientes (13 varones); mediana de edad: 37,5 años; mediana de evolución de la DA: 20 años; comorbilidad atópica: 70%. El 100% habían recibido corticoides sistémicos (complicaciones graves: 20%). Los principales motivos de suspensión de los TSC fueron falta de eficacia y aparición de eventos adversos. Los puntajes de todas las escalas se redujeron significativa y sostenidamente, con respuesta clínica evidente al segundo mes de tratamiento. Al final del seguimiento, solo 3 pacientes requerían tratamiento inmunosupresor sistémico concomitante. Dupilumab fue bien tolerado, con eventos adversos leves y controlables. Dsicusión: el dupilumab constituye el único agente biológico con elevada eficacia demostrada en estudios clínicos y observacionales. En esta casuística, se confirmó su efectividad en pacientes con DA severa de difícil tratamiento y respuesta inadecuada a los TSC. El perfil de seguridad resultó favorable y sostenido a mediano plazo.

ECHO project in atopic dermatitis in Argentina: An innovative strategy to reach underserved areas with up to date knowledge, first year of experience

Abstract Background: The ECHO® (Extension for Community Healthcare Outcomes) project is a model of distance medical education developed in the United States to support health professionals in the management of patients with complex diseases. Since 2019, it has been implemented in atopic dermatitis (AD) in Argentina. The program consists of the periodic presentation of clinical cases by videoconference, virtual classes, and a permanently available open chat between professionals in charge of patients with AD and a group of experts. Objective: The objective of this study was to analyze the impact of the ECHO Project AD on the medical knowledge and medical skills of Argentinian health professionals when treating patients with AD. Methods: A survey was carried out among the participants in order to evaluate the impact of the program on the care of patients with AD. Results: ECHO Project AD revealed a significant improvement in the management of patients with AD. The program contributed to the interpretation and use of severity scores, use of phototherapy, and management and prescription of both classic and innovative topical and systemic treatments. Study limitations: The reduced number of participants and the short period of time. The answers of the survey may be biased by the enthusiasm of the participants. Conclusions: The ECHO project is an educational tool that enhances the medical skills of doctors and institutions, in which a climate of a partnership comes first and the participants look forward to learning from experiences, successes, and mistakes from one another, producing a scientific hub in constant evolution.