The University of Southampton
University of Southampton Institutional Repository

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

When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council
When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council
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.
0190-9622
623-633
Simpson, Eric L.
2ecb9d6f-70ee-4641-bb84-e16b62d5dd37
Bruin-Weller, Marjolein
d631f05a-a4ad-4a49-8b40-10b16467b356
Flor, Carsten
ddae1dd3-dc36-42eb-bb6f-eb88aecdb995
Ardern-Jones, Michael
7ac43c24-94ab-4d19-ba69-afaa546bec90
Barbarot, Sebastien
21733708-e6a2-4b5d-9559-eac8e437c18e
Deleuran, Mette
1404aa4f-df32-4ce2-bebe-bdc544c53731
Bieber, Thomas
f10faa5e-220d-456d-ab6f-1edc11199333
Vestergaard, Christian
edbe91fd-5667-4c21-abda-1c7b622a522e
Brown, Sara J.
4c6024a6-25f4-4e18-808e-d8263aea02fe
Cork, Michael J.
071e6a09-2869-45a5-a0b4-e47474610850
Drucker, Aaron M.
1c94c0a7-c14b-44c2-a1d6-62f6a0ee0e0c
Eichenfield, Lawrence F.
d9e2cee4-4f31-4172-80ce-d32adbd33b45
Foelster-Holst, Regina
26255c36-778e-4d51-bcdd-19e42e6c2df3
Guttman-Yassky, Emma
949deb9a-ccd1-445e-a860-6068cff3977d
Nosbaum, Audrey
cf1a4f92-9819-46e4-8f14-d05f1aef8b66
Reynolds, Nick J.
367df5df-0d5f-4e1d-ad3a-9d02f1c2a30d
Silverberg, Jonathan I.
3330e4d4-ce01-4833-a4e8-b1246dfdea95
Schmitt, Jochen
c04d9868-c247-4c9a-b19a-a9b55515a089
Seyger, Marieke M.B.
51fab4b8-b789-4723-bc96-ce9ba76b4ba5
Spuls, Phyllis I.
64e79fa0-52d6-46c1-b28f-fbf31724c52d
Stalder, Jean-Francois
628af7fd-948f-4fad-8fea-abe963b40460
Su, John C.
b6ecb3d5-08a9-46ed-83dd-3a160549aab6
Takaoka, Roberto
8b4ce62e-d32c-40ec-a991-d28354211670
Traidl-Hoffmann, Claudia
a4dfbb74-f0d7-441a-aa60-d526e2d76998
Thyssen, Jacob P.
744adffe-3748-4c94-8de0-ae09d5707c72
van der Schaft, Jorien
fe724926-4cab-4788-8ed7-f1fc87ee0461
Wollenberg, Andreas
df6e384b-5452-4388-86c4-f239e763cc4d
Irvine, Alan D.
c000686a-e6ef-486d-8bb9-09139433927a
Paller, Amy S.
cb450160-df18-4b02-8744-9f0a4fb94337
Simpson, Eric L.
2ecb9d6f-70ee-4641-bb84-e16b62d5dd37
Bruin-Weller, Marjolein
d631f05a-a4ad-4a49-8b40-10b16467b356
Flor, Carsten
ddae1dd3-dc36-42eb-bb6f-eb88aecdb995
Ardern-Jones, Michael
7ac43c24-94ab-4d19-ba69-afaa546bec90
Barbarot, Sebastien
21733708-e6a2-4b5d-9559-eac8e437c18e
Deleuran, Mette
1404aa4f-df32-4ce2-bebe-bdc544c53731
Bieber, Thomas
f10faa5e-220d-456d-ab6f-1edc11199333
Vestergaard, Christian
edbe91fd-5667-4c21-abda-1c7b622a522e
Brown, Sara J.
4c6024a6-25f4-4e18-808e-d8263aea02fe
Cork, Michael J.
071e6a09-2869-45a5-a0b4-e47474610850
Drucker, Aaron M.
1c94c0a7-c14b-44c2-a1d6-62f6a0ee0e0c
Eichenfield, Lawrence F.
d9e2cee4-4f31-4172-80ce-d32adbd33b45
Foelster-Holst, Regina
26255c36-778e-4d51-bcdd-19e42e6c2df3
Guttman-Yassky, Emma
949deb9a-ccd1-445e-a860-6068cff3977d
Nosbaum, Audrey
cf1a4f92-9819-46e4-8f14-d05f1aef8b66
Reynolds, Nick J.
367df5df-0d5f-4e1d-ad3a-9d02f1c2a30d
Silverberg, Jonathan I.
3330e4d4-ce01-4833-a4e8-b1246dfdea95
Schmitt, Jochen
c04d9868-c247-4c9a-b19a-a9b55515a089
Seyger, Marieke M.B.
51fab4b8-b789-4723-bc96-ce9ba76b4ba5
Spuls, Phyllis I.
64e79fa0-52d6-46c1-b28f-fbf31724c52d
Stalder, Jean-Francois
628af7fd-948f-4fad-8fea-abe963b40460
Su, John C.
b6ecb3d5-08a9-46ed-83dd-3a160549aab6
Takaoka, Roberto
8b4ce62e-d32c-40ec-a991-d28354211670
Traidl-Hoffmann, Claudia
a4dfbb74-f0d7-441a-aa60-d526e2d76998
Thyssen, Jacob P.
744adffe-3748-4c94-8de0-ae09d5707c72
van der Schaft, Jorien
fe724926-4cab-4788-8ed7-f1fc87ee0461
Wollenberg, Andreas
df6e384b-5452-4388-86c4-f239e763cc4d
Irvine, Alan D.
c000686a-e6ef-486d-8bb9-09139433927a
Paller, Amy S.
cb450160-df18-4b02-8744-9f0a4fb94337

Simpson, Eric L., Bruin-Weller, Marjolein, Flor, Carsten, Ardern-Jones, Michael, 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., van der Schaft, Jorien, Wollenberg, Andreas, Irvine, Alan D. and Paller, Amy S. (2017) When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council. Journal of the American Academy of Dermatology, 77 (4), 623-633. (doi:10.1016/j.jaad.2017.06.042).

Record type: Article

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.

Text
1-s2.0-S0190962217319448-main - Version of Record
Download (887kB)

More information

Accepted/In Press date: 19 June 2017
e-pub ahead of print date: 10 August 2017
Published date: October 2017

Identifiers

Local EPrints ID: 414700
URI: https://eprints.soton.ac.uk/id/eprint/414700
ISSN: 0190-9622
PURE UUID: e4a7ee71-eeef-4488-b58b-053eccee05c7

Catalogue record

Date deposited: 06 Oct 2017 16:31
Last modified: 09 Dec 2019 18:36

Export record

Altmetrics

Contributors

Author: Eric L. Simpson
Author: Marjolein Bruin-Weller
Author: Carsten Flor
Author: Sebastien Barbarot
Author: Mette Deleuran
Author: Thomas Bieber
Author: Christian Vestergaard
Author: Sara J. Brown
Author: Michael J. Cork
Author: Aaron M. Drucker
Author: Lawrence F. Eichenfield
Author: Regina Foelster-Holst
Author: Emma Guttman-Yassky
Author: Audrey Nosbaum
Author: Nick J. Reynolds
Author: Jonathan I. Silverberg
Author: Jochen Schmitt
Author: Marieke M.B. Seyger
Author: Phyllis I. Spuls
Author: Jean-Francois Stalder
Author: John C. Su
Author: Roberto Takaoka
Author: Claudia Traidl-Hoffmann
Author: Jacob P. Thyssen
Author: Jorien van der Schaft
Author: Andreas Wollenberg
Author: Alan D. Irvine
Author: Amy S. Paller

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of https://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×