Eric L Simpson1, Marjolein Bruin-Weller2, Carsten Flohr3, Michael R Ardern-Jones4, Sebastien Barbarot5, Mette Deleuran6, Thomas Bieber7, Christian Vestergaard8, Sara J Brown9, Michael J Cork10, Aaron M Drucker11, Lawrence F Eichenfield12, Regina Foelster-Holst13, Emma Guttman-Yassky14, Audrey Nosbaum15, Nick J Reynolds16, Jonathan I Silverberg17, Jochen Schmitt18, Marieke M B Seyger19, Phyllis I Spuls20, Jean-Francois Stalder5, John C Su21, Roberto Takaoka22, Claudia Traidl-Hoffmann23, Jacob P Thyssen24, Jorien van der Schaft25, Andreas Wollenberg26, Alan D Irvine27, Amy S Paller28. 1. Department of Dermatology, Oregon Health and Science University, Portland, Oregon. Electronic address: simpsone@ohsu.edu. 2. National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands. 3. Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' National Health Service Foundation Trust and King's College London, London, United Kingdom. 4. Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom. 5. Department of Dermatology, Nantes University Hospital, Nantes, France. 6. Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark. 7. Department of Dermatology and Allergy, University of Bonn, Bonn, Germany; Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland. 8. Department of Dermatology Aarhus University Hospital, Aarhus, Denmark. 9. Skin Research Group, School of Medicine, University of Dundee, Dundee, United Kingdom; Department of Dermatology, Ninewells Hospital and Medical School, Dundee, United Kingdom. 10. Sheffield Dermatology Research Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom. 11. Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island. 12. Department of Dermatology, University of California, San Diego, California; Department of Pediatrics, University of California, San Diego, California; Rady Children's Hospital, San Diego, California. 13. Dermatology, Venereology and Allergology, University of Schleswig-Holstein, Kiel, Germany. 14. Icahn School of Medicine at Mount Sinai Medical Center, New York, New York. 15. Department of Allergy and Clinical Immunology, University Hospital Lyon Sud, Hospices Civiles de Lyon, Lyon, France. 16. Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Newcastle Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom. 17. Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 18. Center for Evidence-Based Healthcare, Technische Universität Dresden, Dresden, Germany. 19. Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. 20. Department of Dermatology, Academic Medical Centre, Amsterdam, The Netherlands. 21. Department of Dermatology, Monash University, Eastern Health and Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia; Department of Paediatrics, Monash University, Eastern Health and Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia. 22. Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil. 23. Institute of Environmental Medicine, UNIKA-T, Technical University of Munich and Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Munich, Germany; CK CARE, Christine-Kühne-Center for Allergy Research and Education, Davos, Switzerland. 24. Department of Dermatology and Allergy, Herlev-Gentofte Hospital, University of Copenhagen, Hellerup, Denmark. 25. Department of Dermatology and Allergology, University Medical Centre Utrech, Utrecht, Germany. 26. Department of Dermatology and Allergy, Ludwig-Maximilian-University Munich, Munich, Germany. 27. Trinity College Dublin, National Children's Research Centre, Paediatric Dermatology Our Lady's Children's Hospital, Dublin, United Kingdom. Electronic address: irvinea@tcd.ie. 28. Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. Electronic address: apaller@northwestern.edu.
Abstract
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.
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.
Authors: Jennifer C Li; Anna Fishbein; Vivek Singam; Kevin R Patel; Phyllis C Zee; Hrayr Attarian; David Cella; Jonathan I Silverberg Journal: Dermatitis Date: 2018 Sep/Oct Impact factor: 4.845
Authors: K R Patel; V Singam; P P Vakharia; R Chopra; R Sacotte; N Patel; S Immaneni; R Kantor; D Y Hsu; J I Silverberg Journal: Br J Dermatol Date: 2018-11-12 Impact factor: 9.302
Authors: A R Mulick; K E Mansfield; R J Silverwood; A Budu-Aggrey; A Roberts; A Custovic; N Pearce; A D Irvine; L Smeeth; K Abuabara; S M Langan Journal: Br J Dermatol Date: 2021-05-09 Impact factor: 11.113