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

JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY

卷:77

Article

Simpson, Eric L.¹  Bruin-Weller, Marjolein²  Flohr, Carsten^3,4  Ardern-Jones, Michael R.⁵  Barbarot, Sebastien⁶  Deleuran, Mette⁷  Bieber, Thomas^8,9  Vestergaard, Christian⁷  Brown, Sara J.^10,11  Cork, Michael J.¹²  Drucker, Aaron M.¹³  Eichenfield, Lawrence F.^14,15,16  Foelster-Holst, Regina¹⁷  Guttman-Yassky, Emma¹⁸  Nosbaum, Audrey¹⁹  Reynolds, Nick J.^20,21  Silverberg, Jonathan I.^22,23,24,25  Schmitt, Jochen²⁶  Seyger, Marieke M. B.²⁷  Spuls, Phyllis I.²⁸  Stalder, Jean-Francois⁶  Su, John C.^29,30,31  Takaoka, Roberto³²  Traidl-Hoffmann, Claudia^33,34,35  Thyssen, Jacob P.³⁶  van der Schaft, Jorien³⁷  Wollenberg, Andreas³⁸  Irvine, Alan D.³⁹  Paller, Amy S.^{22,23,24,25,40} 

[1] Oregon Hlth & Sci Univ, Dept Dermatol, Portland, OR 97201 USA

[2] Univ Med Ctr Utrecht, Natl Expertise Ctr Atop Dermatitis, Dept Dermatol & Allergol, Utrecht, Netherlands

[3] Guys & St Thomas Natl Hlth Serv Fdn Trust, Unit Population Based Dermatol Res, St Johns Inst Dermatol, London, England

[4] Kings Coll London, London, England

[5] Univ Southampton, Fac Med, Clin Expt Sci, Southampton SO9 5NH, Hants, England

[6] Nantes Univ Hosp, Dept Dermatol, Nantes, France

[7] Aarhus Univ Hosp, Dept Dermatol, Aarhus, Denmark

[8] Univ Bonn, Dept Dermatol & Allergy, Bonn, Germany

[9] Christine Kuhne Ctr Allergy Res & Educ, Davos, Switzerland

[10] Univ Dundee, Skin Res Grp, Sch Med, Dundee, Scotland

[11] Ninewells Hosp & Med Sch, Dept Dermatol, Dundee, Scotland

[12] Univ Sheffield, Sheffield Dermatol Res Dept Infect Immun & Cardio, Sheffield, S Yorkshire, England

[13] Brown Univ, Dept Dermatol, Alpert Med Sch, Providence, RI 02912 USA

[14] Univ Calif San Diego, Dept Dermatol, San Diego, CA 92103 USA

[15] Univ Calif San Diego, Dept Pediat, San Diego, CA 92103 USA

[16] Rady Childrens Hosp, San Diego, CA USA

[17] Univ Schleswig Holstein, Dermatol Venereol & Allergol, Kiel, Germany

[18] Mt Sinai Med Ctr, Icahn Sch Med, New York, NY 10029 USA

[19] Hosp Civiles Lyon, Dept Allergy & Clin Immunol, Univ Hosp Lyon Sud, Lyon, France

[20] Newcastle Univ, Inst Cellular Med, Newcastle Upon Tyne, Tyne & Wear, England

[21] Royal Victoria Infirm, Newcastle Dermatol, Newcastle Upon Tyne, Tyne & Wear, England

[22] Northwestern Univ, Dept Dermatol, Feinberg Sch Med, 676 N St Clair,Suite 1600, Chicago, IL 60611 USA

[23] Northwestern Univ, Dept Prevent Med, Feinberg Sch Med, Chicago, IL 60611 USA

[24] Northwestern Univ, Dept Med Social Sci, Feinberg Sch Med, Chicago, IL 60611 USA

[25] Northwestern Univ, Dept Pediat, Feinberg Sch Med, Chicago, IL 60611 USA

[26] Tech Univ Dresden, Ctr Evidence Based Healthcare, Dresden, Germany

[27] Radboud Univ Nijmegen, Dept Dermatol, Med Ctr, Nijmegen, Netherlands

[28] Acad Med Ctr, Dept Dermatol, Amsterdam, Netherlands

[29] Monash Univ, Dept Dermatol, Eastern Hlth, Clayton, Vic, Australia

[30] Monash Univ, Dept Pediat, Eastern Hlth, Clayton, Vic, Australia

[31] Univ Melbourne, Murdoch Childrens Res Inst, Melbourne, Vic, Australia

[32] Univ Sao Paulo, Dept Dermatol, Sch Med, Sao Paulo, Brazil

[33] Tech Univ Munich, UNIKA T, Inst Environm Med, Munich, Germany

[34] German Res Ctr Environm Hlth GmbH, Helmholtz Zentrum Munchen, Munich, Germany

[35] Christine Kuhne Ctr Allergy Res & Educ, CK CARE, Davos, Switzerland

[36] Univ Copenhagen, Dept Dermatol & Allergy, Herlev Gentofte Hosp, Hellerup, Denmark

[37] Univ Med Ctr Utrech, Dept Dermatol & Allergol, Utrecht, Netherlands

[38] Ludwig Maximilian Univ Munich, Dept Dermatol & Allergy, Munich, Germany

[39] Our Ladys Childrens Hosp, Trinity Coll Dublin, Natl Childrens Res Ctr, Paediat Dermatol, Dublin, Ireland

[40] Ann & Robert H Lurie Childrens Hosp Chicago, Chicago, IL 60611 USA

关键词: atopic dermatitis;    azathioprine;    biologic;    consensus statement;    cyclosporine;    eczema;    methotrexate;    quality of life;    systemic therapy;   

DOI  :  10.1016/j.jaad.2017.06.042

来源: Elsevier

【 摘 要 】

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.

【 授权许可】

Free