Atopic Dermatitis Systemic Treatment Guidelines for Adult Patients

Published online November 7, 2023, the American Academy of Dermatology (AAD) provided an update to the management of atopic dermatitis for those 18 years or older with refractory disease who qualify for phototherapy or systemic therapy. This is the first update provided by the AAD since 2014.

The multidisciplinary workgroup conducted a systematic review and applied the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach for assessing the certainty of evidence and formulating and grading recommendations. Providing a strength of recommendation with the certainty of evidence and its implications for topical, systemic, and phototherapy.

For systemic treatments for adult patients with moderate to severe atopic dermatitis, a strong recommendation was given for the FDA-approved biologic medications dupilumab, tralokinumab, and for the FDA-approved JAK-inhibitors (JAKi) upadacitinib, abrocitinib, and baricitinib (not currently approved for atopic dermatitis in the USA, but approved in other countries). A thorough work-up with lab monitoring is recommended, as is discussion of risks of potential side effects and pregnancy avoidance with the JAKi class of medications.

Antimetabolites and immunosuppressants were given conditional recommendation based on low or very low certainty evidence. Medications in this class include the older systemic therapies cyclosporine, methotrexate, azathioprine, and mycophenolate, none of which are FDA-approved to treat uncontrolled moderate to severe atopic dermatitis and require screening for infections, lab monitoring, and pregnancy avoidance.

With these new guidelines, providers have clear treatment recommendations for treating moderate to severe atopic dermatitis in adults, which include evidence supporting new treatments over conventional, older immunosuppressants.

Reference:

Guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies, Davis, Dawn M.R. et al. Journal of the American Academy of Dermatology, Volume 90, Issue 2, e43 - e56

Justin Love MPAS, PA-C resides in the blue zone of Loma Linda CA. He works for Loma Linda University Department of Dermatology. In his spare time, he enjoys any ocean-related activities and spending time with his family.

Victoria Garcia-Albea, BSN, MSN, RN, PNP, DCNP, is a medical dermatology nurse practitioner at Lahey Clinic in Burlington, MA. She is the director of the Lahey Clinic Dermatology NP Training Program. She spends most of her free time with her husband and two school-aged boys, and volunteers at her public library.