For patients diagnosed with atopic dermatitis (AD), dermatologists should assess severity and quality of life while considering their patients general health status, psychologic needs, and personal attitudes before starting systemic medication for, suggests a recent consensus statement from an expert panel of the International Eczema Council. The statement was published in the Journal of the American Academy of Dermatology.
Often, patients with AD are effectively managed with topical medications, and there is a significant minority of patients who require systemic therapy. The current guidelines for decision making about advancement to systemic therapy are lacking.
In order to guide professionals considering systemic therapy in AD and prove a framework for evaluation before making the therapeutic decision, panel expert Eric Simpson, MD, and colleagues, assessed a subgroup of the International Eczema Council to determine aspects to consider before prescribing systemic therapy. Expert reviewers performed a topic-specific literature review. When possible, the experts referred to guidelines, and provided interpretation and expert opinion.
Based on the findings, the panel experts 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. The experts concluded that steps taken before commencing systemic therapy should 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.
—Julie Gould
Reference:
Simpson EL, Bruin-Weller M, Flohr C et al. When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council [published online October 2017]. JAAD. doi: https://dx.doi.org/10.1016/j.jaad.2017.06.042
