TY - JOUR
T1 - When does atopic dermatitis warrant systemic therapy?
T2 - Recommendations from an expert panel of the International Eczema Council
AU - Simpson, Eric L.
AU - Bruin-Weller, Marjolein
AU - Flohr, Carsten
AU - Ardern-Jones, Michael R.
AU - Barbarot, Sebastien
AU - Deleuran, Mette
AU - Bieber, Thomas
AU - Vestergaard, Christian
AU - Brown, Sara J.
AU - Cork, Michael J.
AU - Drucker, Aaron M.
AU - Eichenfield, Lawrence F.
AU - Foelster-Holst, Regina
AU - Guttman-Yassky, Emma
AU - Nosbaum, Audrey
AU - Reynolds, Nick J.
AU - Silverberg, Jonathan I.
AU - Schmitt, Jochen
AU - Seyger, Marieke M. B.
AU - Spuls, Phyllis I
AU - Stalder, Jean-Francois
AU - Su, John C.
AU - Takaoka, Roberto
AU - Traidl-Hoffmann, Claudia
AU - Thyssen, Jacob P.
AU - van der Schaft, Jorien
AU - Wollenberg, Andreas
AU - Irvine, Alan D.
AU - Paller, Amy S.
N1 - Sara J. Brown holds a Wellcome Trust Senior Research Fellowship in Clinical Science (106865/Z/15/Z).
PY - 2017/10
Y1 - 2017/10
N2 - 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.
AB - 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.
KW - atopic dermatitis
KW - azathioprine
KW - biologic
KW - consensus statement
KW - cyclosporine
KW - eczema
KW - methotrexate
KW - quality of life
KW - systemic therapy
U2 - 10.1016/j.jaad.2017.06.042
DO - 10.1016/j.jaad.2017.06.042
M3 - Article
C2 - 28803668
SN - 0190-9622
VL - 77
SP - 623
EP - 633
JO - Journal of the American Academy of Dermatology
JF - Journal of the American Academy of Dermatology
IS - 4
ER -