New guidelines for use of systemic therapies in atopic dermatitis
The American Academy of Dermatology has updated their 2014 guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies.[81]
The monoclonal antibodies dupilumab and tralokinumab may be considered for patients with moderate to severe atopic dermatitis who require systemic therapies. Both drugs are approved by the Food and Drug Administration for this indication.
The Janus kinase (JAK) inhibitors upadacitinib, abrocitinib, and baricitinib may be considered as a second-line systemic therapy. Upadacitnib and abrocitinib are approved by the FDA for use in moderate to severe atopic dermatitis.
Summary
Definition
History and exam
Key diagnostic factors
- pruritus
- xerosis (dry skin)
- sites of skin involvement
Other diagnostic factors
- erythema
- scaling
- vesicles
- papules
- keratosis pilaris
- excoriations
- lichenification
- hypopigmentation
Risk factors
- filaggrin gene mutation
- age <5 years
- family history of atopic dermatitis
- allergic rhinitis
- asthma
- active and passive exposure to smoke
- female sex
- African-American ethnicity
Diagnostic tests
1st tests to order
- clinical diagnosis
Tests to avoid
- IgG testing
- radioallergosorbent test
Tests to consider
- IgE levels
- skin-prick testing
- oral food challenge
- trial elimination diet
- patch testing
- skin biopsy
Treatment algorithm
acute flare
chronic or relapsing disease
Contributors
Authors
Adelaide A. Hebert, MD
Professor & Director of Pediatric Dermatology
Clinical Specialist
Department of Dermatology and Pediatrics
University of Texas Health Sciences Center at Houston
Houston
TX
Disclosures
AAH has received research grants paid to UTHealth McGovern Medical School Houston from Pfizer, GSK, Dermavant, Arcutis, and Novan; has received honoraria from Pfizer, Verrica, and Novan; and is on the data safety monitoring boards for GSK, Ortho Dermatologics, and Regeneron-Sanofi.
Alexander Jafari, MD
Dermatology Clinical Research Fellow
Department of Dermatology
University of Texas Health Science Center at Houston
Houston
TX
Disclosures
AJ declares that he has no competing interests.
Matthew Dallo, MD
Clinical Research Fellow
Department of Dermatology
University of Texas Health Science Center at Houston
Houston
TX
Disclosures
MD declares that he has no competing interests.
Acknowledgements
Dr Adelaide A. Hebert, Dr Alexander Jafari, and Dr Matthew Dallo would like to gratefully acknowledge Dr Eugenio G. Galindo, Dr Quoc-Bao D. Nguyen, Dr Mary D. DarConte, Dr Christina M. Gelbard, and Dr Daniel A. Grabella, previous contributors to this topic.
Disclosures
EGG, QBDN, MDD, CMG, and DAG declare that they have no competing interests.
Peer reviewers
Amor Khachemoune, MD
Assistant Professor
New York University School of Medicine
NY
Disclosures
AK declares that he has no competing interests.
John English, MBBS, FRCP
Consultant Dermatologist
Department of Dermatology
Queen's Medical Centre
Nottingham University Hospitals
Nottingham
UK
Disclosures
JE declares that he has no competing interests.
Differentials
- Seborrheic dermatitis
- Irritant contact dermatitis
- Allergic contact dermatitis
More DifferentialsGuidelines
- Living EuroGuiDerm guideline for the systemic treatment of atopic eczema
- Atopic eczema in under 12s: diagnosis and management
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Eczema
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