When does atopic dermatitis warrant systemic therapy?

Recommendations from an expert panel of the International Eczema Council

Eric L. Simpson (Lead / Corresponding author), Marjolein Bruin-Weller, Carsten Flohr, Michael R. Ardern-Jones, Sebastien Barbarot, Mette Deleuran, Thomas Bieber, Christian Vestergaard, Sara J. Brown, Michael J. Cork, Aaron M. Drucker, Lawrence F. Eichenfield, Regina Foelster-Holst, Emma Guttman-Yassky, Audrey Nosbaum, Nick J. Reynolds, Jonathan I. Silverberg, Jochen Schmitt, Marieke M. B. Seyger, Phyllis I Spuls & 9 others Jean-Francois Stalder, John C. Su, Roberto Takaoka, Claudia Traidl-Hoffmann, Jacob P. Thyssen, Jorien van der Schaft, Andreas Wollenberg, Alan D. Irvine, Amy S. Paller

    Research output: Contribution to journalArticle

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    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.

    Original languageEnglish
    Pages (from-to)623-633
    Number of pages11
    JournalJournal of the American Academy of Dermatology
    Volume77
    Issue number4
    Early online date10 Aug 2017
    DOIs
    Publication statusPublished - Oct 2017

    Fingerprint

    Eczema
    Atopic Dermatitis
    Therapeutics
    Quality of Life
    Decision Making
    Guidelines
    Phototherapy
    Expert Testimony
    Patient Education
    Caregivers
    Health Status
    Signs and Symptoms
    Consensus
    Infection

    Keywords

    • atopic dermatitis
    • azathioprine
    • biologic
    • consensus statement
    • cyclosporine
    • eczema
    • methotrexate
    • quality of life
    • systemic therapy

    Cite this

    Simpson, Eric L. ; Bruin-Weller, Marjolein ; Flohr, Carsten ; Ardern-Jones, Michael R. ; 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. ; Paller, Amy S. / When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council. In: Journal of the American Academy of Dermatology. 2017 ; Vol. 77, No. 4. pp. 623-633.
    @article{f4b774fd43cb416cbdae0b623a17905a,
    title = "When does atopic dermatitis warrant systemic therapy?: Recommendations from an expert panel of the International Eczema Council",
    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.",
    keywords = "atopic dermatitis, azathioprine, biologic, consensus statement, cyclosporine, eczema, methotrexate, quality of life, systemic therapy",
    author = "Simpson, {Eric L.} and Marjolein Bruin-Weller and Carsten Flohr and Ardern-Jones, {Michael R.} and Sebastien Barbarot and Mette Deleuran and Thomas Bieber and Christian Vestergaard and Brown, {Sara J.} and Cork, {Michael J.} and Drucker, {Aaron M.} and Eichenfield, {Lawrence F.} and Regina Foelster-Holst and Emma Guttman-Yassky and Audrey Nosbaum and Reynolds, {Nick J.} and Silverberg, {Jonathan I.} and Jochen Schmitt and Seyger, {Marieke M. B.} and Spuls, {Phyllis I} and Jean-Francois Stalder and Su, {John C.} and Roberto Takaoka and Claudia Traidl-Hoffmann and Thyssen, {Jacob P.} and {van der Schaft}, Jorien and Andreas Wollenberg and Irvine, {Alan D.} and Paller, {Amy S.}",
    note = "Sara J. Brown holds a Wellcome Trust Senior Research Fellowship in Clinical Science (106865/Z/15/Z).",
    year = "2017",
    month = "10",
    doi = "10.1016/j.jaad.2017.06.042",
    language = "English",
    volume = "77",
    pages = "623--633",
    journal = "Journal of the American Academy of Dermatology",
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    number = "4",

    }

    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 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, vol. 77, no. 4, pp. 623-633. https://doi.org/10.1016/j.jaad.2017.06.042

    When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council. / Simpson, Eric L. (Lead / Corresponding author); Bruin-Weller, Marjolein; Flohr, Carsten; Ardern-Jones, Michael R.; 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. (Lead / Corresponding author); Paller, Amy S. (Lead / Corresponding author).

    In: Journal of the American Academy of Dermatology, Vol. 77, No. 4, 10.2017, p. 623-633.

    Research output: Contribution to journalArticle

    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

    VL - 77

    SP - 623

    EP - 633

    JO - Journal of the American Academy of Dermatology

    JF - Journal of the American Academy of Dermatology

    SN - 0190-9622

    IS - 4

    ER -