ROBERTO TAKAOKA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
17 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 17
- When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council(2017) SIMPSON, Eric L.; BRUIN-WELLER, Marjolein; FLOHR, Carsten; ARDERN-JONES, Michael R.; BARBAROT, Sebastien; DELEURAN, Mette; BIEBER, Thomas; VESTERGAARD, Christian; BROWN, Sara J.; CORK, Michael J.; DRUCKER, Aaron M.; EICHENFIELD, Lawrence F.; FOELSTER-HOLST, Regina; GUTTMAN-YASSKY, Emma; NOSBAUM, Audrey; REYNOLDS, Nick J.; SILVERBERG, Jonathan I.; SCHMITT, Jochen; SEYGER, Marieke M. B.; SPULS, Phyllis I.; STALDER, Jean-Francois; SU, John C.; TAKAOKA, Roberto; TRAIDL-HOFFMANN, Claudia; THYSSEN, Jacob P.; SCHAFT, Jorien van der; WOLLENBERG, Andreas; IRVINE, Alan D.; PALLER, Amy S.Background: Although most patients with atopic dermatitis (AD) are effectively managed with topical medication, a significant minority require systemic therapy. Guidelines for decision making about advancement to systemic therapy are lacking. Objective: To guide those considering use of systemic therapy in AD and provide a framework for evaluation before making this therapeutic decision with the patient. Methods: A subgroup of the International Eczema Council determined aspects to consider before prescribing systemic therapy. Topics were assigned to expert reviewers who performed a topic-specific literature review, referred to guidelines when available, and provided interpretation and expert opinion. Results: We recommend a systematic and holistic approach to assess patients with severe signs and symptoms of AD and impact on quality of life before systemic therapy. Steps taken before commencing systemic therapy include considering alternate or concomitant diagnoses, avoiding trigger factors, optimizing topical therapy, ensuring adequate patient/caregiver education, treating coexistent infection, assessing the impact on quality of life, and considering phototherapy. Limitations: Our work is a consensus statement, not a systematic review. Conclusion: The decision to start systemic medication should include assessment of severity and quality of life while considering the individual's general health status, psychologic needs, and personal attitudes toward systemic therapies.
- Methotrexate for atopic dermatitis in adults: a prospective study from a reference center in Brazil(2021) SAMORANO, Luciana Paula; TAKAOKA, Roberto; ZANIBONI, Mariana Colombini; AOKI, Valeria
- Education of Patients with Atopic Dermatitis and Their Caregivers(2016) TAKAOKA, Roberto; AOKI, ValeriaAtopic dermatitis (AD) is the most prevalent dermatological disease in the pediatric population. It is a chronic, pruritic, and inflammatory skin disorder, with a complex etiology involving genetic predisposition, skin barrier defects, and immune dysfunction. AD can be a challenge for patients, physicians, and caregivers and has a clear impact in patients' quality of life (QoL). Educational programs for patients with AD and their caregivers are effective in improving adherence, QoL, and clinical outcomes. Different models of educational programs exist and their structures depend on cultural, social, and economic factors. To improve existing programs, the educational team should go beyond the disease and have a broader view of the many aspects involved in the pathological process. These include psychological, environmental, social, financial, and cultural aspects. Patients and their caregivers should have a more realistic expectation about the treatment. Innovative methods and approaches like design thinking can create new and effective solutions for patients with AD and their caregivers.
- Healthcare Disparities in Atopic Dermatitis in Latin America: A Narrative Review(2023) SANCHEZ, Jorge; ALE, Iris-Selva; ANGLES, Maria Valeria; FOGELBACH, Guillermo Guidos; JANSEN, Angela Marie; TAKAOKA, Roberto; BORZUTZKY, ArturoIntroduction: 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.
- Methotrexate for refractory adult atopic dermatitis leads to alterations in cutaneous IL-31 and IL-31RA expression(2024) SAMORANO, Luciana Paula; MANFRERE, Kelly Cristina Gomes; PEREIRA, Naiura Vieira; TAKAOKA, Roberto; VALENTE, Neusa Yuriko Sakai; SOTTO, Mirian Nacagami; SILVA, Luiz Fernando Ferraz; SATO, Maria Notomi; AOKI, ValeriaBackground: Methotrexate (MTX) is an alternative treatment for patients with moderate/severe atopic dermatitis (AD). Objective: The authors evaluated the effect of MTX on the cutaneous expression of cytokines and chemokines that are involved in the inflammatory response in adult AD patients who received treatment with methotrexate for 24 weeks. Methods: The authors conducted a prospective single-institution cohort study with 12 adults with moderate/severe AD who received oral MTX (15 mg/wk for 24 wks) and 10 non-atopic matched controls. The comparison was made of skin biopsies of lesional and non-lesional skin, pre- and post MTX treatment. The authors analyzed mean epidermal thickness and expression of IL-31, IL-31RA, OSMR, TSLP, Ki67, IL-4 mRNA, IL-6, IL-10, TNF-alpha, IFN-gamma, TARC, and CCL-22. Results: There was a reduction in mean epidermal thickness (p = 0.021), an increase in IL-31RA expression (immunohistochemistry) in the epidermis (p = 0.016) and a decrease in IL-31 gene expression (p = 0.019) on lesional AD skin post-MTX treatment. No significant changes in the cutaneous expression of the other evaluated markers were identified. Study limitations: Small sample size and limited length of follow-up. Conclusions: Treatment with MTX in adults with moderate/severe AD reduced epidermal hyperplasia and changed the cutaneous expression of inflammatory cytokines and receptors that are mainly related to pruritus, including IL-31 and IL-31RA. (c) 2023 Published by Elsevier Espana, S.L.U. on behalf of Sociedade Brasileira de Dermatologia. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
bookPart Doenças zooparasitárias(2019) BESSA, Vanessa Rolim; TAKAOKA, Roberto- Consensus on the therapeutic management of atopic dermatitis Brazilian Society of Dermatology(2019) AOKI, Valeria; LORENZINI, Daniel; ORFALI, Raquel Leao; ZANIBONI, Mariana Colombini; OLIVEIRA, Zilda Najjar Prado de; RIVITTI-MACHADO, Maria Cecilia; TAKAOKA, Roberto; WEBER, Magda Blessmann; CESTARI, Tania; GONTIJOS, Bernardo; RAMOSS, Andrea Machado Coelho; SILVA, Claudia Marcia de Resende; CESTARI, Silmara da Costa Pereira; SOUTO-MAYOR, Silvia; CARNEIRO, Francisca Regina; CERQUEIRA, Ana Maria Mosca de; LACZYNSKI, Cristina; PIRES, Mario CezarBACKGROUND: Atopic dermatitis is a highly prevalent inflammatory and pruritic dermatosis with a multifactorial etiology, which includes skin barrier defects, immune dysfunction, and microbiome alterations. Atopic dermatitis is mediated by genetic, environmental, and psychological factors and requires therapeutic management that covers all the aspects of its complex pathogenesis. OBJECTIVES: The aim of this article is to present the experience, opinions, and recommendations of Brazilian dermatology experts regarding the therapeutic management of atopic dermatitis. METHODS: Eighteen experts from 10 university hospitals with experience in atopic dermatitis were appointed by the Brazilian Society of Dermatology to organize a consensus on the therapeutic management of atopic dermatitis. The 18 experts answered an online questionnaire with 14 questions related to the treatment of atopic dermatitis. Afterwards, they analyzed the recent international guidelines on atopic dermatitis of the American Academy of Dermatology, published in 2014, and of the European Academy of Dermatology and Venereology, published in 2018. Consensus was defined as approval by at least 70% of the panel. RESULTS/CONCLUSION: The experts stated that the therapeutic management of atopic dermatitis is based on skin hydration, topical anti-inflammatory agents, avoidance of triggering factors, and educational programs. Systemic therapy, based on immunosuppressive agents, is only indicated for severe refractory disease and after failure of topical therapy. Early detection and treatment of secondary bacterial and viral infections is mandatory, and hospitalization may be needed to control atopic dermatitis flares. Novel target-oriented drugs such as immunobiologicals are invaluable therapeutic agents for atopic dermatitis.
conferenceObject Adult atopic dermatitis: Evaluation of TH17 and TH22 cytokines in peripheral blood mononuclear cells induced by staphylococcal enterotoxins A and B(2012) ORFALI, Raquel Lean; RIVITTI, Evandro; SATO, Maria Notomi; TAKAOKA, Roberto; AOKI, ValeriaObjective: Evaluation of interleukins (IL) 17, 22, and 23 induced by Staphylococcus aureus enterotoxin stimulation in peripheral blood mononuclear cells (PBMC) of adults with atopic dermatitis. Background: Atopic dermatitis (AD) is a chronic, inflammatory disease with a high prevalence and complex etiopathogenesis.S aureusis present in 80% to 100% of AD patients, and secretes exotoxins that might relate to its pathogenesis. TH17 has been described as playing a major role in inflammatory diseases with a close relationship to bacterial pathogens, as well as TH22 in modulating the immunopathogenesis of some skin diseases. Methods: Thirty-eight AD patients (mean age, 28.55), 19 female and 19 male, and 40 healthy controls (mean age, 34.1), 21 females and 19 males (without personal or family history of atopy and negative prick-test) were selected. Hanifin and Rajka’s criteria were used to diagnose AD. Disease severity was established according to EASI (Eczema Area and Severity Index). IL-17, IL-22, and IL-23 production from PBMC after staphylococcal enterotoxins A (SEA) and B (SEB), and phytohemaglutinin (PHA) stimuli and IL-22 serum levels were measured by ELISA. Results: In AD patients, there was increased IL-22 levels in sera as well as in vitro secretion by PBMC after SEA and SEB stimuli, when compared to healthy controls. No correlation between IL-22 levels and EASI was observed (P ≤ .05). Conclusion: These findings suggest an involvement of TH22 subtype in the pathogenesis of adults with AD, especially because of its link to S aureus enterotoxins.- Patient Education in Atopic Dermatitis: Why It Is Needed and How to Improve It(2018) TAKAOKA, Roberto; COELHO, ElisaPurpose of Review Demonstrate the need and objectives of patient education in atopic dermatitis (AD), provide an overview of the most recent studies regarding patient education, and propose new approaches to improve educational programs. Recent Findings Different models of patient education programs exist, and their structures depend on social and economic conditions. An active participation of patients is needed to improve new models of educational programs. Healthcare professionals who work with AD patients must have a comprehensive view of the many aspects involved in this disease, which includes psychological, environmental, social, financial, and cultural aspects. Summary AD is a complex disease and has a clear impact in patients' quality of life. Patients are often frustrated and confused by the information they receive. This information can often be conflicting and overwhelming. Education for patients with AD is now being proposed as an important step in major treatment guidelines. Most studies of patient education demonstrate a positive impact in patients' clinical outcomes, adherence, and quality of life.
- Towards global consensus on outcome measures for atopic eczema research: results of the HOME II meeting(2012) SCHMITT, Jochen; SPULS, Phyllis; BOERS, Maarten; THOMAS, Kim; CHALMERS, Joanne; ROEKEVISCH, Evelien; SCHRAM, Mandy; ALLSOPP, Richard; AOKI, Valeria; APFELBACHER, Christian; BRUIJNZEEL-KOOMEN, Carla; BRUIN-WELLER, Marjolein; CHARMAN, Carolyn; COHEN, Arnon; DOHIL, Magdalene; FLOHR, Carsten; FURUE, Masutaka; GIELER, Uwe; HOOFT, Lotty; HUMPHREYS, Rosemary; ISHII, Henrique Akira; KATAYAMA, Ichiro; KOUWENHOVEN, Willem; LANGAN, Sinead; LEWIS-JONES, Sue; MERHAND, Stephanie; MUROTA, Hiroyuki; MURRELL, Dedee F.; NANKERVIS, Helen; OHYA, Yukihiro; ORANJE, Arnold; OTSUKA, Hiromi; PAUL, Carle; ROSENBLUTH, Yael; SAEKI, Hidehisa; SCHUTTELAAR, Marie-Louise; STALDER, Jean-Francois; SVENSSON, Ake; TAKAOKA, Roberto; WAHLGREN, Carl-Fredrik; WEIDINGER, Stephan; WOLLENBERG, Andreas; WILLIAMS, HywelThe use of nonstandardized and inadequately validated outcome measures in atopic eczema trials is a major obstacle to practising evidence-based dermatology. The Harmonising Outcome Measures for Eczema (HOME) initiative is an international multiprofessional group dedicated to atopic eczema outcomes research. In June 2011, the HOME initiative conducted a consensus study involving 43 individuals from 10 countries, representing different stakeholders (patients, clinicians, methodologists, pharmaceutical industry) to determine core outcome domains for atopic eczema trials, to define quality criteria for atopic eczema outcome measures and to prioritize topics for atopic eczema outcomes research. Delegates were given evidence-based information, followed by structured group discussion and anonymous consensus voting. Consensus was achieved to include clinical signs, symptoms, long-term control of flares and quality of life into the core set of outcome domains for atopic eczema trials. The HOME initiative strongly recommends including and reporting these core outcome domains as primary or secondary endpoints in all future atopic eczema trials. Measures of these core outcome domains need to be valid, sensitive to change and feasible. Prioritized topics of the HOME initiative are the identification/development of the most appropriate instruments for the four core outcome domains. HOME is open to anyone with an interest in atopic eczema outcomes research.