Atopic Dermatitis

IEC: Consider Severity, Quality of Life Before Initiating Systemic Therapy for AD

The International Eczema Council has released a consensus statement regarding the decision to initiate systemic therapy in patients with severe atopic dermatitis (AD).

Topical medication is an effective treatment for most patients with AD. However, a significant minority of patients with AD require systemic therapy. Current guidelines regarding the decision to advance patients with AD to systemic therapy are not well established.
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To improve current guidelines, a subgroup of expert reviewers from the International Eczema Council identified important information to consider before initiating systemic therapy in patients with AD. Specific topics were assigned to each reviewer, and a topic-specific literature review was conducted. Reviewers referred to existing guidelines when available, and provided interpretation and expert opinion for each topic.

Prior to initiating systemic therapy, the panel recommends:

  • A systematic and holistic approach should be used to evaluate patients with severe signs and symptoms of AD.
  • The impact on quality of life should be examined.
  • Alternate or concomitant diagnoses should be considered.
  • Trigger factors should be avoided.
  • Topical therapy should be optimized.
  • Adequate education should be provided to both patients and caregivers.
  • Coexistent infection should be treated.
  • Phototherapy should be considered.

“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,” the researchers concluded.

—Christina Vogt

Reference:

Simpson EL, Bruin-Weller M, Flohr C, et al; International Eczema Council. When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council. J Am Acad Dermatol. 2017;77(4):623-633. http://dx.doi.org/10.1016/j.jaad.2017.06.042.