When does atopic dermatitis warrant systemic therapy?: Recommendations from an expert panel of the International Eczema Council

Eric L Simpson; 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; 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

doi:10.1016/j.jaad.2017.06.042

When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council

Eric L Simpson, 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 SpulsJean-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

Department of Clinical Medicine

91 Citations (Scopus)

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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 language	English
Journal	Journal of the American Academy of Dermatology
Volume	77
Issue number	4
Pages (from-to)	623-633
ISSN	0190-9622
DOIs	https://doi.org/10.1016/j.jaad.2017.06.042
Publication status	Published - Oct 2017

Keywords

Administration, Cutaneous
Administration, Oral
Biological Products/therapeutic use
Clinical Decision-Making
Dermatitis, Atopic/diagnosis
Dermatologic Agents/administration & dosage
Humans
Immunosuppressive Agents/administration & dosage
Injections
Patient Education as Topic
Phototherapy
Quality of Life
Severity of Illness Index

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Simpson, E. L., Bruin-Weller, M., Flohr, C., Ardern-Jones, M. R., Barbarot, S., Deleuran, M., Bieber, T., Vestergaard, C., Brown, S. J., Cork, M. J., Drucker, A. M., Eichenfield, L. F., Foelster-Holst, R., Guttman-Yassky, E., Nosbaum, A., Reynolds, N. J., Silverberg, J. I., Schmitt, J., Seyger, M. M. B., ... Paller, A. 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. 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; Bruin-Weller, Marjolein; Flohr, Carsten et al.

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

Research output: Contribution to journal › Journal article › Research › peer-review

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

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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.",

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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}",

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doi = "10.1016/j.jaad.2017.06.042",

language = "English",

volume = "77",

pages = "623--633",

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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

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.

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KW - Administration, Oral

KW - Biological Products/therapeutic use

KW - Clinical Decision-Making

KW - Dermatitis, Atopic/diagnosis

KW - Dermatologic Agents/administration & dosage

KW - Humans

KW - Immunosuppressive Agents/administration & dosage

KW - Injections

KW - Patient Education as Topic

KW - Phototherapy

KW - Quality of Life

KW - Severity of Illness Index

U2 - 10.1016/j.jaad.2017.06.042

DO - 10.1016/j.jaad.2017.06.042

M3 - Journal article

C2 - 28803668

SN - 0190-9622

VL - 77

SP - 623

EP - 633

JO - American Academy of Dermatology. Journal

JF - American Academy of Dermatology. Journal

IS - 4

ER -

When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council

Abstract

Keywords

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