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

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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: http://eprints.soton.ac.uk/id/eprint/414700
ISSN: 0190-9622
PURE UUID: e4a7ee71-eeef-4488-b58b-053eccee05c7
ORCID for Michael Ardern-Jones: ORCID iD orcid.org/0000-0003-1466-2016

Catalogue record

Date deposited: 06 Oct 2017 16:31
Last modified: 16 Mar 2024 03:55

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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

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