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When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council

Lookup NU author(s): Professor Nick Reynolds

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).


Abstract

© 2017 American Academy of Dermatology, Inc. 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.


Publication metadata

Author(s): Simpson EL, Bruin-Weller M, Flohr C, Ardern-Jones MR, Barbarot S, Deleuran M, Bieber T, Vestergaard C, Brown SJ, Cork MJ, Drucker AM, Eichenfield LF, Foelster-Holst R, Guttman-Yassky E, Nosbaum A, Reynolds NJ, Silverberg JI, Schmitt J, Seyger MMB, Spuls PI, Stalder J-F, Su JC, Takaoka R, Traidl-Hoffmann C, Thyssen JP, van der Schaft J, Wollenberg A, Irvine AD, Paller AS

Publication type: Article

Publication status: Published

Journal: Journal of the American Academy of Dermatology

Year: 2017

Volume: 77

Issue: 4

Pages: 623-633

Print publication date: 01/10/2017

Online publication date: 10/08/2017

Acceptance date: 19/06/2017

Date deposited: 05/10/2017

ISSN (print): 0190-9622

ISSN (electronic): 1097-6787

Publisher: Mosby Inc.

URL: https://doi.org/10.1016/j.jaad.2017.06.042

DOI: 10.1016/j.jaad.2017.06.042


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