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Poveda-Montoyo I, García-Doval I, Descalzo MA, Betlloch-Mas I, Miquel-Miquel FJ, Serrano-Manzano M, Martín-Delgado MI, Sanz-Sánchez T, Knöpfel N, Córdoba S, Luca de Tena A, Martín-Santiago A, Silvestre JF. Quality Indicators in Care of Patients With Atopic Dermatitis: Consensus Document of the Spanish Academy of Dermatology and Venereology. Actas Dermosifiliogr (Engl Ed) 2020; 111:567-573. [PMID: 32401727 DOI: 10.1016/j.ad.2019.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/08/2019] [Accepted: 06/19/2019] [Indexed: 11/23/2022] Open
Abstract
No information is currently available on whether the available clinical practice guidelines on the management of atopic dermatitis are known or being applied in Spain. The aim of this study was to improve the care of patients with atopic dermatitis by developing a set of quality indicators based on existing clinical practice guidelines. Relevant clinical practice guidelines identified through a literature search were submitted to a panel of 11 specialists, who selected the highest quality guidelines using the AGREE (Appraisal of Guidelines for Research & Evaluation) II instrument. The panel then defined a subset of the recommendations supported by a high level of evidence and proposed a health care quality indicator for each one together with a standard for measuring degree of adherence. Consensus was achieved on 21 of the 150 proposed indicators using the modified Delphi method. The aim of implementing the indicators that achieved consensus in this study is to standardize the actions of health professionals providing care for patients with atopic dermatitis and ultimately to improve the quality of the care delivered.
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Affiliation(s)
- I Poveda-Montoyo
- Servicio de Dermatología, Hospital General Universitario de Alicante, Instituto de Investigación ISABIAL, Alicante, España.
| | - I García-Doval
- Unidad de Investigación, Fundación Piel Sana de la Academia Española de Dermatología y Venereología, Madrid, España; Servicio de Dermatología, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, España
| | - M A Descalzo
- Unidad de Investigación, Fundación Piel Sana de la Academia Española de Dermatología y Venereología, Madrid, España
| | - I Betlloch-Mas
- Servicio de Dermatología, Hospital General Universitario de Alicante, Instituto de Investigación ISABIAL, Alicante, España
| | - F J Miquel-Miquel
- Servicio de Dermatología, Hospital Arnau de Vilanova, Valencia, España
| | - M Serrano-Manzano
- Área de Atención Primaria, Equipo de Atención Primaria Martorell Rural, Masquefa, Barcelona, España
| | - M I Martín-Delgado
- Área de Pediatría de Atención Primaria, Centro de Salud Santa Ponsa, Santa Ponsa, Islas Baleares, España
| | - T Sanz-Sánchez
- Servicio de Dermatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - N Knöpfel
- Servicio de Dermatología, Hospital Niño Jesús, Madrid, España; Servicio de Dermatología Pediátrica, Hospital Infantil Universitario de Zúrich, Zúrich, Suiza
| | - S Córdoba
- Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - A Luca de Tena
- Representante de la Asociación de Afectados por la Dermatitis Atópica
| | - A Martín-Santiago
- Servicio de Dermatología, Hospital Universitario Son Espases, Palma, Islas Baleares, España
| | - J F Silvestre
- Servicio de Dermatología, Hospital General Universitario de Alicante, Instituto de Investigación ISABIAL, Alicante, España
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Poveda-Montoyo I, García-Doval I, Descalzo M, Betlloch-Mas I, Miquel-Miquel F, Serrano-Manzano M, Martín-Delgado M, Sanz-Sánchez T, Knöpfel N, Córdoba S, Luca de Tena A, Martín-Santiago A, Silvestre J. Quality Indicators in Care of Patients With Atopic Dermatitis: Consensus Document of the Spanish Academy of Dermatology and Venereology. Actas Dermo-Sifiliográficas (English Edition) 2020. [DOI: 10.1016/j.adengl.2019.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Luchsinger I, Vogler T, Schwieger-Briel A, Knöpfel N, Wälchli R, Weibel L, Theiler M. Safe and effective use of alitretinoin in children with recalcitrant hand eczema and other dermatoses - a retrospective analysis. J Eur Acad Dermatol Venereol 2019; 34:1037-1042. [PMID: 31742759 DOI: 10.1111/jdv.16088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/31/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Alitretinoin is a systemic retinoid licensed for use in adult patients suffering from chronic hand eczema recalcitrant to potent topical steroids. Experience with its use in childhood is lacking. OBJECTIVES To report on the efficacy and safety of alitretinoin treatment in a cohort of children and adolescents with chronic hand eczema (CHE) and other inflammatory skin diseases. METHODS We performed a retrospective chart review of all consecutive patients under the age of 18 years treated with alitretinoin at our paediatric skin centre. Physician's Global Assessment (PGA) was used as the primary outcome measure. RESULTS Thirteen children (9 girls and 4 boys) were enrolled in this study. The median age at start of treatment with alitretinoin was 11.5 years (range 5.8-15.8 years). Nine children were diagnosed with CHE, two with severe atopic dermatitis (AD), and two with inherited ichthyosis [netherton syndrome (NS), autosomal recessive congenital ichthyosis (ARCI)]. Moderate to excellent response (PGA decrease of ≥1 point) was observed in 7 (78%) of the nine patients with CHE, one of the two patients with extensive AD and in the one patient with ARCI. In the remaining four subjects, no convincing effect was documented. Tolerability was overall very good. The most common adverse event was headache in 10 patients (77%) during the initiation of treatment, leading to interruption of therapy in one subject. CONCLUSIONS Alitretinoin seems to be highly effective and safe for the treatment of paediatric CHE and should thus be considered in children with refractory disease under topical therapy. Larger studies are required to corroborate these findings.
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Affiliation(s)
- I Luchsinger
- Pediatric Skin Center, Dermatology Department, University Children's Hospital Zurich, Zurich, Switzerland
| | - T Vogler
- Pediatric Skin Center, Dermatology Department, University Children's Hospital Zurich, Zurich, Switzerland
| | - A Schwieger-Briel
- Pediatric Skin Center, Dermatology Department, University Children's Hospital Zurich, Zurich, Switzerland
| | - N Knöpfel
- Pediatric Skin Center, Dermatology Department, University Children's Hospital Zurich, Zurich, Switzerland
| | - R Wälchli
- Pediatric Skin Center, Dermatology Department, University Children's Hospital Zurich, Zurich, Switzerland
| | - L Weibel
- Pediatric Skin Center, Dermatology Department, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - M Theiler
- Pediatric Skin Center, Dermatology Department, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
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Noguera-Morel L, Knöpfel N, Torrelo A, Hernández-Martín A. A Retrospective Study of Systemic Treatment of Severe Atopic Dermatitis With Azathioprine: Effectiveness and Tolerance in 11 Pediatric Patients. Actas Dermo-Sifiliográficas (English Edition) 2019. [DOI: 10.1016/j.adengl.2018.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Noguera-Morel L, Knöpfel N, Torrelo A, Hernández-Martín A. A Retrospective Study of Systemic Treatment of Severe Atopic Dermatitis With Azathioprine: Effectiveness and Tolerance in 11 Pediatric Patients. Actas Dermosifiliogr (Engl Ed) 2018; 110:227-231. [PMID: 30376955 DOI: 10.1016/j.ad.2018.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/20/2018] [Accepted: 06/03/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory skin disease that typically affects children. Severe forms may have a profound effect on patients' quality of life. Some forms are resistant to conventional treatment and require the use of systemic immunosuppressants such as azathioprine (AZA) to adequately manage the disease. OBJECTIVE To evaluate the effectiveness and tolerance of AZA in children with severe AD. PATIENTS AND METHODS We performed a retrospective study of children with severe AD treated with AZA between January 2007 and May 2017. RESULTS We reviewed the cases of 11 patients (6 boys and 5 girls) with a mean age of 13 years (range, 8-18 years). The mean (SD) age at start of treatment was 10.9 (2.2) years (95% CI 8.6-13.1). The mean initial dosage of AZA was 1.8 (0.2) mg/kg/d. We evaluated treatment response after 4 weeks, 12 to 16 weeks, and 6 months. Mean treatment duration was 10.8 (5.7) months. Treatment had to be suspended in 2 patients because of adverse effects. Seven of the 9 remaining patients presented complete or almost complete clearance of the AD after 6 months of treatment. CONCLUSION In our experience, AZA is well tolerated and may be considered as a treatment option in children with severe AD resistant to conventional treatment.
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Affiliation(s)
- L Noguera-Morel
- Departamento de Dermatología, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - N Knöpfel
- Departamento de Dermatología, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - A Torrelo
- Departamento de Dermatología, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - A Hernández-Martín
- Departamento de Dermatología, Hospital Infantil Universitario Niño Jesús, Madrid, España.
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Latour I, Hernández-Martín A, Ged C, Knöpfel N, Taïeb A, Torrelo A. Reversed actinic damage in two children with xeroderma pigmentosum treated with topical imiquimod. J Eur Acad Dermatol Venereol 2018; 32:e282-e284. [PMID: 29377344 DOI: 10.1111/jdv.14818] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- I Latour
- Hospital Infantil Universitario Niño Jesús, Menéndez Pelayo 65, 28009, Madrid, Spain
| | - A Hernández-Martín
- Hospital Infantil Universitario Niño Jesús, Menéndez Pelayo 65, 28009, Madrid, Spain
| | - C Ged
- INSERUM U 1053, University of Bordeaux, 146 rue Léo Saignat FR-33000, Bordeaux, France
| | - N Knöpfel
- Hospital Infantil Universitario Niño Jesús, Menéndez Pelayo 65, 28009, Madrid, Spain
| | - A Taïeb
- INSERUM U 1053, University of Bordeaux, 146 rue Léo Saignat FR-33000, Bordeaux, France
| | - A Torrelo
- Hospital Infantil Universitario Niño Jesús, Menéndez Pelayo 65, 28009, Madrid, Spain
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Knöpfel N, Noguera-Morel L, Azorin D, Sanz F, Torrelo A, Hernández-Martín A. CutaneousLeishmania tropicain children: report of three imported cases successfully treated with liposomal amphotericin B. J Eur Acad Dermatol Venereol 2017; 32:e8-e10. [DOI: 10.1111/jdv.14434] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- N. Knöpfel
- Department of Dermatology; Hospital Infantil Universitario Niño Jesús; Av. de Menéndez Pelayo, 65 28009 Madrid Spain
| | - L. Noguera-Morel
- Department of Dermatology; Hospital Infantil Universitario Niño Jesús; Av. de Menéndez Pelayo, 65 28009 Madrid Spain
| | - D. Azorin
- Department of Pathology; Hospital Infantil Universitario Niño Jesús; 65, 28009 Madrid Spain
| | - F. Sanz
- Department of Pediatrics; Hospital Infantil Universitario Niño Jesús; 65, 28009 Madrid Spain
| | - A. Torrelo
- Department of Dermatology; Hospital Infantil Universitario Niño Jesús; Av. de Menéndez Pelayo, 65 28009 Madrid Spain
| | - A. Hernández-Martín
- Department of Dermatology; Hospital Infantil Universitario Niño Jesús; Av. de Menéndez Pelayo, 65 28009 Madrid Spain
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Knöpfel N, Martín-Santiago A, Saus C, Escudero-Góngora M, del Pozo L, Gómez C. Telangiectasias extensas adquiridas: comparación entre telangiectasia esencial generalizada y vasculopatía colágena cutánea. Actas Dermo-Sifiliográficas 2017; 108:e21-e26. [DOI: 10.1016/j.ad.2016.02.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/13/2016] [Accepted: 02/07/2016] [Indexed: 11/28/2022] Open
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Knöpfel N, Martín-Santiago A, Del Pozo LJ, Saus C, Pascual M, Requena L. Amelanotic naevoid melanoma in a 16-month-old albino infant. Clin Exp Dermatol 2016; 42:84-88. [DOI: 10.1111/ced.12996] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2016] [Indexed: 12/12/2022]
Affiliation(s)
- N. Knöpfel
- Department of Dermatology; Hospital Universitari Son Espases; Palma de Mallorca Spain
| | - A. Martín-Santiago
- Department of Dermatology; Hospital Universitari Son Espases; Palma de Mallorca Spain
| | - L. J. Del Pozo
- Department of Dermatology; Hospital Universitari Son Espases; Palma de Mallorca Spain
| | - C. Saus
- Department of Pathology; Hospital Universitari Son Espases; Palma de Mallorca Spain
| | - M. Pascual
- Department of Dermatology; Hospital de Manacor; Mallorca Spain
| | - L. Requena
- Department of Dermatology; Hospital Fundación Jiménez Diaz; Madrid Spain
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Escudero-Góngora M, Del Pozo L, Knöpfel N, Saus C, Giacaman A, Hierro F. Reactive perforating collagenosis on a tattoo. J Eur Acad Dermatol Venereol 2016; 31:e87-e89. [DOI: 10.1111/jdv.13782] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M.M. Escudero-Góngora
- Department of Dermatology; Hospital Universitari Son Espases; Palma de Mallorca Spain
| | - L.J. Del Pozo
- Department of Dermatology; Hospital Universitari Son Espases; Palma de Mallorca Spain
| | - N. Knöpfel
- Department of Dermatology; Hospital Universitari Son Espases; Palma de Mallorca Spain
| | - C. Saus
- Department of Pathology; Hospital Universitari Son Espases; Palma de Mallorca Spain
| | - A. Giacaman
- Department of Dermatology; Hospital Universitari Son Espases; Palma de Mallorca Spain
| | - F. Hierro
- Tecnoscientific Department; Universitat de les Illes Balears; Palma de Mallorca Spain
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del Pozo L, Knöpfel N, Martín-Santiago A, Escudero-Góngora M, Saus C, Izquierdo-Herce N, Bauzà-Alonso A. Dermoscopic Findings of Jellyfish Stings Caused by Pelagia noctiluca. Actas Dermo-Sifiliográficas (English Edition) 2016. [DOI: 10.1016/j.adengl.2016.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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del Pozo L, Knöpfel N, Martín-Santiago A, Escudero-Góngora M, Saus C, Izquierdo-Herce N, Bauzà-Alonso A. Dermoscopic Findings of Jellyfish Stings Caused by Pelagia noctiluca. Actas Dermo-Sifiliográficas 2016; 107:509-15. [DOI: 10.1016/j.ad.2016.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/15/2016] [Accepted: 02/17/2016] [Indexed: 01/22/2023] Open
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Knöpfel N, Hoeger P. FR - Hemangioma verrucoso o malformación venosa verrucosa? Hacia una clasificación asentada en el estudio genético. Actas Dermo-Sifiliográficas 2016; 107:427-8. [DOI: 10.1016/j.ad.2015.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/08/2015] [Accepted: 07/12/2015] [Indexed: 11/28/2022] Open
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Knöpfel N, Hoeger P. Verrucous Hemangioma or Verrucous Venous Malformation? Towards a Classification Based on Genetic Analysis. Actas Dermo-Sifiliográficas (English Edition) 2016. [DOI: 10.1016/j.adengl.2016.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Knöpfel N, Martín-Santiago A. A mi hija no le crece el pelo. Actas Dermo-Sifiliográficas 2016; 107:70. [DOI: 10.1016/j.ad.2015.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 03/26/2015] [Accepted: 04/13/2015] [Indexed: 10/23/2022] Open
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Martín-Santiago A, Rodríguez-Pascual M, Knöpfel N, Hernández-Martín Á. Otologic Manifestations of Autosomal Recessive Congenital Ichthyosis in Children. Actas Dermo-Sifiliográficas (English Edition) 2015. [DOI: 10.1016/j.adengl.2015.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Giacaman A, Knöpfel N, Campos M, Martín-Santiago A. Acquired Facial Hyperpigmented Macules in Children: 3 New Cases. Actas Dermosifiliogr 2015; 107:81-3. [PMID: 26344736 DOI: 10.1016/j.ad.2015.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/08/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- A Giacaman
- Servicio de Dermatología, Hospital Universitario Son Espases, Palma de Mallorca, España.
| | - N Knöpfel
- Servicio de Dermatología, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - M Campos
- Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Martín-Santiago
- Servicio de Dermatología, Hospital Universitario Son Espases, Palma de Mallorca, España
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Martín-Santiago A, Knöpfel N, del Pozo J, Escalas J, Bartolomé B, Janer V, Pascual M, Nieto C, Hervás J. Hypotrichosis associated with capillary malformation-arteriovenous malformation syndrome. Br J Dermatol 2014; 172:450-4. [DOI: 10.1111/bjd.13287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2014] [Indexed: 11/29/2022]
Affiliation(s)
- A. Martín-Santiago
- Department of Dermatology; Son Espases University Hospital; Ctra de Valldemosa 79 07010 Palma de Mallorca Spain
| | - N. Knöpfel
- Department of Dermatology; Son Espases University Hospital; Ctra de Valldemosa 79 07010 Palma de Mallorca Spain
| | - J. del Pozo
- Department of Dermatology; Son Espases University Hospital; Ctra de Valldemosa 79 07010 Palma de Mallorca Spain
| | - J. Escalas
- Department of Dermatology; Son Espases University Hospital; Ctra de Valldemosa 79 07010 Palma de Mallorca Spain
| | - B. Bartolomé
- Department of Dermatology; Inca Hospital; Mallorca Spain
| | - V. Janer
- Department of Dermatology; Inca Hospital; Mallorca Spain
| | - M. Pascual
- Department of Dermatology; Hospital Manacor; Mallorca Spain
| | - C. Nieto
- Department of Radiology, Son Espases University Hospital; Ctra de Valldemosa 79 07010 Palma de Mallorca Spain
| | - J.A. Hervás
- University Institute for Health Sciences Research-IUNICS; University of the Balearic Islands; Palma de Mallorca Spain
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Knöpfel N, Martín-Santiago A, Bauza A, Hervás J. Topical 0.2% Rapamycin to Treat Facial Angiofibromas and Hypomelanotic Macules in Tuberous Sclerosis. Actas Dermo-Sifiliográficas (English Edition) 2014. [DOI: 10.1016/j.adengl.2013.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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