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

Eric 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

Research output: Contribution to journalArticle

56 Citations (Scopus)

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 (US)
JournalJournal of the American Academy of Dermatology
DOIs
StateAccepted/In press - 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

ASJC Scopus subject areas

  • Dermatology

Cite this

When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council. / Simpson, Eric; 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.

In: Journal of the American Academy of Dermatology, 2017.

Research output: Contribution to journalArticle

Simpson, E, 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, JF, 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. https://doi.org/10.1016/j.jaad.2017.06.042
Simpson, Eric ; 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.
@article{49979a7a61294eb2b3a144c9aefcf532,
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 = "Eric Simpson 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 Stalder, {Jean Francois} 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 (US)",
journal = "Journal of the American Academy of Dermatology",
issn = "0190-9622",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council

AU - Simpson, Eric

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 - Atopic dermatitis

KW - Azathioprine

KW - Biologic

KW - Consensus statement

KW - Cyclosporine

KW - Eczema

KW - Methotrexate

KW - Quality of life

KW - Systemic therapy

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

UR - http://www.scopus.com/inward/citedby.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

JO - Journal of the American Academy of Dermatology

JF - Journal of the American Academy of Dermatology

SN - 0190-9622

ER -