ROBERTO TAKAOKA

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico

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  • article 173 Citação(ões) na Scopus
    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.
  • article 109 Citação(ões) na Scopus
    Report from the fourth international consensus meeting to harmonize core outcome measures for atopic eczema/dermatitis clinical trials (HOME initiative)
    (2016) CHALMERS, J. R.; SIMPSON, E.; APFELBACHER, C. J.; THOMAS, K. S.; KOBYLETZKI, L. von; SCHMITT, J.; SINGH, J. A.; SVENSSON, A.; WILLIAMS, H. C.; ABUABARA, K.; AOKI, V.; ARDELEANU, M.; AWICI-RASMUSSEN, M.; BARBAROT, S.; BERENTS, T. L.; BLOCK, J.; BRAGG, A.; BURTON, T.; CLEMMENSEN, K. K. Bjerring; CRESWELL-MELVILLE, A.; DINESEN, M.; DRUCKER, A.; ECKERT, L.; FLOHR, C.; GARG, M.; GERBENS, L. A. A.; GRAFF, A. L. B.; HANIFIN, J.; HEINL, D.; HUMPHREYS, R.; ISHII, H. A.; KATAOKA, Y.; LESHEM, Y. A.; MARQUORT, B.; MASSUEL, M. -A.; MERHAND, S.; MIZUTANI, H.; MUROTA, H.; MURRELL, D. F.; NAKAHARA, T.; NASR, I.; NOGRALES, K.; OHYA, Y.; OSTERLOH, I.; PANDER, J.; PRINSEN, C.; PURKINS, L.; RIDD, M.; SACH, T.; SCHUTTELAAR, M. -L. A.; SHINDO, S.; SMIRNOVA, J.; SULZER, A.; GJERDE, E. Synnove; TAKAOKA, R.; TALMO, H. Vestby; TAUBER, M.; TORCHET, F.; VOLKE, A.; WAHLGREN, C. -F.; WEIDINGER, S.; WEISSHAAR, E.; WOLLENBERG, A.; YAMAGA, K.; ZHAO, C. Y.; SPULS, P. I.
    This article is a report of the fourth meeting of the Harmonising Outcome Measures for Eczema (HOME) initiative held in Malmo, Sweden on 23-24 April 2015 (HOME IV). The aim of the meeting was to achieve consensus over the preferred outcome instruments for measuring patient-reported symptoms and quality of life for the HOME core outcome set for atopic eczema (AE). Following presentations, which included data from systematic reviews, consensus discussions were held in a mixture of whole group and small group discussions. Small groups were allocated a priori to ensure representation of different stakeholders and countries. Decisions were voted on using electronic keypads. For the patient-reported symptoms, the group agreed by vote that itch, sleep loss, dryness, redness/inflamed skin and irritated skin were all considered essential aspects of AE symptoms. Many instruments for capturing patient-reported symptoms were discussed [ including the Patient-Oriented SCOring Atopic Dermatitis index, Patient-Oriented Eczema Measure (POEM), Self-Administered Eczema Area and Severity Index, Itch Severity Scale, Atopic Dermatitis Quickscore and the Nottingham Eczema Severity Score] and, by consensus, POEM was selected as the preferred instrument to measure patient-reported symptoms. Further work is needed to determine the reliability and measurement error of POEM. Further work is also required to establish the importance of pain/soreness and the importance of collecting information regarding the intensity of symptoms in addition to their frequency. Much of the discussion on quality of life concerned the Dermatology Life Quality Index and Quality of Life Index for Atopic Dermatitis; however, consensus on a preferred instrument for measuring this domain could not be reached. In summary, POEM is recommended as the HOME core outcome instrument for measuring AE symptoms.
  • article 4 Citação(ões) na Scopus
    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
  • conferenceObject
    A 25-year overview of the atopic dermatitis outpatient clinic at the University of Sao Paulo Medical School, Brazil
    (2014) ZANIBONI, M. C.; ORFALI, R. L.; TAKAOKA, R.; ISHIZAKI, A. S.; AOKI, V.
  • article 55 Citação(ões) na Scopus
    Topical corticosteroid phobia in atopic dermatitis: International feasibility study of the TOPICOP score
    (2017) STALDER, J. -F.; AUBERT, H.; ANTHOINE, E.; FUTAMURA, M.; MARCOUX, D.; MORREN, M. -A.; TRZECIAK, M.; SZALAI, Z.; VERES, K.; DELEURAN, M.; VESTERGAARD, C.; BORALEVI, F.; CHU, C. -Y.; RAEVE, L. De; SVENSSON, A.; FOELSTER-HOLST, R.; BUCHNER, M.; TAKAOKA, R.; AOKI, V.; CHERNYSHOV, P.; CHERNYSHOVA, L.; MURRELL, D. F.; ZHAO, C.; MCKINSTER, C. D.; KOBYLETZKY, L. Von; EICHENFIELD, L.; TOTRI, C.; LIO, P.; SENESCHAL, J.; MORET, L.; BARBAROT, S.
    BackgroundAdherence to topical corticosteroids (TCS) is essential for the effective treatment of atopic dermatitis but can be limited by concerns about their use. This study examined the feasibility of applying the validated TOPICOP score for assessing TCS phobia across different countries. MethodsThis was a prospective multicentre feasibility study conducted in 21 hospitals in 17 countries. Patients >3 months of age with atopic dermatitis or their parents or legal representatives completed a validated translation of the TOPICOP questionnaire in the country's native language. Respondents also completed questionnaires collecting opinions about the feasibility and acceptability of the TOPICOP questionnaire. ResultsA total of 1564 participants in 15 countries were included in the analysis. 81% of respondents considered the questions clear or very clear, and 79% reported that it took less than 5 minutes to complete. Each of the individual items in the TOPICOP questionnaire was considered to be not at all difficult to answer by 49% to 74% of participants. The mean global TOPICOP score was 44.7%20.5. Mean TOPICOP subscores were 37.0 +/- 22.8% for knowledge and beliefs, 54.7 +/- 27.8% for fears and 50.1 +/- 29.1% for behaviours. Global scores and subscores differed between countries, although the subscores did not always vary in parallel, suggesting different levels of TCS phobia and different drivers for each country. ConclusionsThe TOPICOP score can be feasibly applied across countries and may therefore be useful for obtaining qualitative and quantitative data from international studies and for adapting patient education and treatment.
  • article 7 Citação(ões) na Scopus
    Education of Patients with Atopic Dermatitis and Their Caregivers
    (2016) TAKAOKA, Roberto; AOKI, Valeria
    Atopic 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.
  • conferenceObject
    Atopic dermatitis in adults: Augmented circulating IgG4 and IgE antibodies against Staphylococcus aureus enterotoxin B
    (2013) ORFALI, R. L.; SATO, M. N.; SANTOS, V. G. Dos; TITZ, T. O.; DUARTE, A. S.; TAKAOKA, R.; AOKI, V.
    The aim of this study was to evaluate the profile of anti-Staphylococcus aureus enterotoxin B (SEB) antibody (Ab) response in adults with AD. We selected 38 patients diagnosed as AD (Hanifin & Rajka's criteria), aged between 18 and 65, and 26 healthy controls (HC), aged between 20 and 47 years. Severity of the disease was established according to EASI (Eczema Area and Severity Index) and patients were graded as mild (28%), moderate (58%) and severe (14%). Sera were assessed for IgG subclasses, IgA, IgM and IgE against SEB by ELISA. The humoral response in AD patients to SEB showed elevated circulating IgE and IgG4 levels (p < 0.05 and p δ 0.001, respectively), and decreased IgA and IgM levels (p < 0.05). Severity of atopic dermatitis was related with low IgG1 and IgG3 levels (p < 0.05), and high IgE antibody response (p < 0.05) to SEB. Interestingly, absence of IgE and IgG1 response to SEB was seen in some AD patients (26.3% and 18.4% respectively). In AD, the immunoglobulin-related subtype Th2 lymphocytes, such as IgE and IgG4, appear to be relevant in the response to superantigens. These results emphasize an altered pattern of Ab response to SEB in AD, which is impaired according the disease severity.
  • article 18 Citação(ões) na Scopus
    Position Statement on Atopic Dermatitis in Sub-Saharan Africa: current status and roadmap
    (2019) SCHMID-GRENDELMEIER, P.; TAKAOKA, R.; AHOGO, K. C.; BELACHEW, W. A.; BROWN, S. J.; CORREIA, J. C.; CORREIA, M.; DEGBOE, B.; DORIZY-VUONG, V.; FAYE, O.; FULLER, L. C.; GRANDO, K.; HSU, C.; KAYITENKORE, K.; LUNJANI, N.; LY, F.; MAHAMADOU, G.; MANUEL, R. C. F.; DIA, M. Kebe; MASENGA, E. J.; BASEKE, C. Muteba; OUEDRAOGO, A. N.; RABENJA, F. Rapelanoro; SU, J.; TECLESSOU, J. N.; TODD, G.; TAIEB, A.
    Background The first International Society of Atopic Dermatitis (ISAD) global meeting dedicated to atopic dermatitis (AD) in Sub-Saharan Africa (SSA) was held in Geneva, Switzerland in April 2019. A total of 30 participants were present at the meeting, including those from 17 SSA countries, representatives of the World Health Organization (WHO), the International Foundation for Dermatology (IFD) (a committee of the International League of Dermatological Societies, ILDS ), the Fondation pour la Dermatite Atopique, as well as specialists in telemedicine, artificial intelligence and therapeutic patient education (TPE). Results AD is one of the most prevalent chronic inflammatory skin diseases in SSA. Besides neglected tropical diseases (NTDs) with a dermatological presentation, AD requires closer attention from the WHO and national Departments of Health. Conclusions A roadmap has been defined with top priorities such as access to essential medicines and devices for AD care, in particular emollients, better education of primary healthcare workers for adequate triage (e.g. better educational materials for skin diseases in pigmented skin generally and AD in particular, especially targeted to Africa), involvement of traditional healers and to a certain extent also patient education, bearing in mind the barriers to effective healthcare faced in SSA countries such as travel distances to health facilities, limited resources and the lack of dermatological expertise. In addition, several initiatives concerning AD research in SSA were discussed and should be implemented in close collaboration with the WHO and assessed at follow-up meetings, in particular, at the next ISAD meeting in Seoul, South Korea and African Society of Dermatology and Venereology (ASDV) meeting in Nairobi, Kenya, both in 2020.
  • article 6 Citação(ões) na Scopus
    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, Arturo
    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.
  • article 0 Citação(ões) na Scopus
    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, Valeria
    Background: 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/).