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

^*Corresponding author for this work

Dermatology and Allergology

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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
Pages (from-to)	623-633
Number of pages	11
Journal	Journal of the American Academy of Dermatology
Volume	77
Issue number	4
DOIs	https://doi.org/10.1016/j.jaad.2017.06.042
Publication status	Published - 2017

Keywords

Administration, Cutaneous
Administration, Oral
Biological Products
Clinical Decision-Making
Dermatitis, Atopic
Dermatologic Agents
Humans
Immunosuppressive Agents
Injections
Patient Education as Topic
Phototherapy
Quality of Life
Severity of Illness Index
Consensus Development Conference
Journal Article

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10.1016/j.jaad.2017.06.042

PIIS0190962217319448Final published version, 867 KB

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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

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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.",

keywords = "Administration, Cutaneous, Administration, Oral, Biological Products, Clinical Decision-Making, Dermatitis, Atopic, Dermatologic Agents, Humans, Immunosuppressive Agents, Injections, Patient Education as Topic, Phototherapy, Quality of Life, Severity of Illness Index, Consensus Development Conference, Journal Article",

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.}",

year = "2017",

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

language = "English",

volume = "77",

pages = "623--633",

journal = "Journal of the American Academy of Dermatology",

issn = "0190-9622",

publisher = "Mosby Inc.",

number = "4",

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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

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.

PY - 2017

Y1 - 2017

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 - Administration, Cutaneous

KW - Administration, Oral

KW - Biological Products

KW - Clinical Decision-Making

KW - Dermatitis, Atopic

KW - Dermatologic Agents

KW - Humans

KW - Immunosuppressive Agents

KW - Injections

KW - Patient Education as Topic

KW - Phototherapy

KW - Quality of Life

KW - Severity of Illness Index

KW - Consensus Development Conference

KW - Journal Article

UR - http://www.scopus.com/inward/record.url?scp=85028305777&partnerID=8YFLogxK

U2 - 10.1016/j.jaad.2017.06.042

DO - 10.1016/j.jaad.2017.06.042

M3 - Article

C2 - 28803668

AN - SCOPUS:85028305777

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 -

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

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