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Farmacoterapia do eczema atópico
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Abstract(s)
O eczema atópico (ou dermatite atópica) é uma doença inflamatória cutânea crónica, com uma prevalência média em crianças entre os 3 e os 20% e em adultos entre 5 e os 10%. A maioria dos casos ocorre antes dos cinco anos de idade, com ligeiro predomínio no sexo feminino. Em Portugal, estima-se que entre 0,7% e 1,6% da população adulta e cerca de 14,4% das crianças apresentem casos de eczema atópico, tendo por base consultas de dermatologia, onde cerca de 15 a 40% dos utentes apresentam doença moderada a severa. Tendo em conta os valores referidos e a resposta limitada às terapias disponíveis, o eczema atópico ainda continua a ser um desafio para os profissionais de saúde.
Com base nas considerações anteriores, os objetivos principais desta dissertação são os seguintes: i) abordar a prevalência, a incidência, a etiologia, a fisiopatologia, os fatores de risco, os sinais e sintomas, e o diagnóstico do eczema atópico; ii) mencionar o algoritmo de tratamento, tendo em conta os fármacos introduzidos recentemente no mercado farmacêutico. Para os fármacos mais relevantes, pretende-se retratar as suas indicações terapêuticas, posologia e modo de administração, contraindicações, interações medicamentosas, efeitos indesejáveis, grupo farmacoterapêutico e mecanismo de ação; iii) indicar as principais medidas não farmacológicas; e iv) fazer referência ao papel do farmacêutico no âmbito da farmacoterapia e gestão da patologia. Em relação à metodologia, recorreu-se à análise documental de diversas fontes bibliográficas, privilegiando-se os artigos científicos e as guidelines.
O tratamento de base consiste na aplicação tópica de emolientes e hidratantes, podendo ser administrados em concomitância com corticosteroides tópicos para casos de pele inflamada. Em casos ligeiros e/ou moderados pode-se optar pelos mesmos corticosteroides tópicos, tal como pelo Tacrolímus, um inibidor da calcineurina tópico ou ainda pela fototerapia, consoante a resposta obtida pelo utente. Em casos mais severos, o Eczema Atópico é tratado com inibidores da JAK (p. ex., Baricitinib e Upadacitinib), o Dupilumab ou o Tralocinumab, pela Ciclosporina ou ainda pela Azatioprina ou Metotrexato.
Atopic eczema (or atopic dermatitis) is a chronic inflammatory skin disease, with an average prevalence of between 3% and 20% in children and between 5% and 10% in adults. Most cases occur before the age of five, with a slight predominance in females. In Portugal, it is estimated that between 0.7% and 1.6% of the adult population and approximately 14.4% of children have cases of atopic eczema, based on dermatology consultations, where approximately 15% to 40% of patients have moderate to severe disease. Considering the figures reported and the limited response to available therapies, atopic eczema continues to be a challenge for health professionals. Based on the above considerations, the main objectives of this dissertation are the following: i) to address the prevalence, incidence, aetiology, pathophysiology, risk factors, signs and symptoms, and diagnosis of atopic eczema; ii) to mention the treatment algorithm, considering drugs recently introduced into the pharmaceutical market. For the most relevant drugs, the aim is to describe their therapeutic indications, dosage and method of administration, contraindications, drug interactions, undesirable effects, pharmacotherapeutic group and mechanism of action; iii) to indicate the main non-pharmacological measures; and iv) to refer the role of the pharmacist in the context of pharmacotherapy and management of the disease. Regarding the methodology, a documentary analysis of various bibliographic sources was performed, with emphasis on scientific articles and guidelines. The basic treatment consists of the topical application of emollients and moisturizers, which can be administered concomitantly with topical corticosteroids for cases of inflamed skin. In mild and/or moderate cases, the same topical corticosteroids can be used, such as Tacrolimus, a topical calcineurin inhibitor, or phototherapy, depending on the response obtained by the patient. In more severe cases, Atopic Eczema is treated with JAK inhibitors (e.g., Baricitinib and Upadacitinib), Dupilumab or Tralokinumab, Cyclosporine or even Azathioprine or Methotrexate.
Atopic eczema (or atopic dermatitis) is a chronic inflammatory skin disease, with an average prevalence of between 3% and 20% in children and between 5% and 10% in adults. Most cases occur before the age of five, with a slight predominance in females. In Portugal, it is estimated that between 0.7% and 1.6% of the adult population and approximately 14.4% of children have cases of atopic eczema, based on dermatology consultations, where approximately 15% to 40% of patients have moderate to severe disease. Considering the figures reported and the limited response to available therapies, atopic eczema continues to be a challenge for health professionals. Based on the above considerations, the main objectives of this dissertation are the following: i) to address the prevalence, incidence, aetiology, pathophysiology, risk factors, signs and symptoms, and diagnosis of atopic eczema; ii) to mention the treatment algorithm, considering drugs recently introduced into the pharmaceutical market. For the most relevant drugs, the aim is to describe their therapeutic indications, dosage and method of administration, contraindications, drug interactions, undesirable effects, pharmacotherapeutic group and mechanism of action; iii) to indicate the main non-pharmacological measures; and iv) to refer the role of the pharmacist in the context of pharmacotherapy and management of the disease. Regarding the methodology, a documentary analysis of various bibliographic sources was performed, with emphasis on scientific articles and guidelines. The basic treatment consists of the topical application of emollients and moisturizers, which can be administered concomitantly with topical corticosteroids for cases of inflamed skin. In mild and/or moderate cases, the same topical corticosteroids can be used, such as Tacrolimus, a topical calcineurin inhibitor, or phototherapy, depending on the response obtained by the patient. In more severe cases, Atopic Eczema is treated with JAK inhibitors (e.g., Baricitinib and Upadacitinib), Dupilumab or Tralokinumab, Cyclosporine or even Azathioprine or Methotrexate.
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Keywords
eczema atópico fisiopatologia farmacoterapia medidas não farmacológicas farmacêutico