Guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies

Dawn M. Davis, Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota.
Aaron M. Drucker, Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
Ali Alikhan, Department of Dermatology, Sutter Medical Foundation, Sacramento, California.
Lionel Bercovitch, Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
David E. Cohen, The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York City, New York.
Jennifer M. Darr, Department of Pediatrics, Pediatric Behavioral Health, National Jewish Health, Denver, Colorado.
Lawrence F. Eichenfield, Departments of Dermatology and Pediatrics, University of California San Diego and Rady Children's Hospital San Diego, San Diego, California.
Lindsy Frazer-Green, American Academy of Dermatology, Rosemont, Illinois. Electronic address: lfrazer-green@aad.org.
Amy S. Paller, Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Kathryn Schwarzenberger, Department of Dermatology, Oregon Health and Science University, Portland, Oregon.
Jonathan I. Silverberg, Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
Anne Marie Singh, Departments of Pediatrics, Dermatology and Medical Microbiology/Immunology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Peggy A. Wu, Department of Dermatology, University of California, Davis, Sacramento, California.
Robert Sidbury, Division of Dermatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington.

Document Type

Journal Article

Publication Date

11-3-2023

Journal

Journal of the American Academy of Dermatology

DOI

10.1016/j.jaad.2023.08.102

Keywords

JAK inhibitor; atopic dermatitis; azathioprine; biologic; cyclosporine; dupilumab; eczema; methotrexate; phototherapy

Abstract

BACKGROUND: For people with atopic dermatitis (AD) refractory to topical therapies, treatment with phototherapy and systemic therapies can be considered. Multiple biologic therapies and Janus kinase (JAK)inhibitors have been approved since 2014 to treat AD. These guidelines update the 2014 recommendations for management of AD with phototherapy and systemic therapies. OBJECTIVE: To provide evidence-based recommendations on the use of phototherapy and systemic therapies for AD in adults. METHODS: A multidisciplinary workgroup conducted a systematic review and applied the GRADE approach for assessing the certainty of evidence and formulating and grading recommendations. RESULTS: The workgroup developed 11 recommendations on the management of AD in adults with phototherapy and systemic agents, including biologics, oral JAK inhibitors, and other immunomodulatory medications. LIMITATIONS: Most randomized controlled trials of phototherapy and systemic therapies for AD are of short duration with subsequent extension studies, limiting comparative long-term efficacy and safety conclusions. CONCLUSIONS: We make strong recommendations for the use of dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib. We make conditional recommendations in favor of using phototherapy, azathioprine, cyclosporine, methotrexate, and mycophenolate, and against the use of systemic corticosteroids.

Department

Dermatology

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