A Treatment Algorithm for Moderate to Severe Atopic Dermatitis in Adults

Area of Science:

• Dermatology
• Immunology
• Clinical Medicine

Background:

• Atopic dermatitis (AD) is a prevalent chronic inflammatory skin condition.
• A significant portion of adult AD patients (10%) exhibit inadequate response to topical therapies, necessitating advanced treatments like phototherapy or systemic agents.
• Current treatment options for severe, refractory AD are limited.

Purpose of the Study:

• To establish a patient-centered framework for identifying and managing adult atopic dermatitis (AD) patients requiring systemic therapy.
• To develop practical clinical criteria for selecting candidates for systemic treatment.
• To propose an evidence-based algorithm for guiding treatment decisions in moderate to severe AD.

Main Methods:

• A consensus-based approach was employed, involving a working group of experienced AD clinicians.
• A systematic review of current evidence on the identification and management of moderate to severe AD was conducted.
• Development of a clinical algorithm incorporating patient and clinician-relevant factors.

Main Results:

• A practical set of clinical criteria was proposed for identifying adult AD patients suitable for systemic treatment, based on topical therapy response and four easily measurable clinical indicators.
• A framework for evaluating systemic treatments was suggested, considering both clinician and patient perspectives.
• A treatment algorithm was developed to guide the management pathway for moderate to severe adult AD.

Conclusions:

• Adults with moderate to severe AD refractory to topical treatments have limited safe and effective therapeutic choices.
• A structured clinical algorithm can aid in optimizing treatment decisions for this patient population.
• The proposed framework supports a more personalized and effective approach to managing severe atopic dermatitis.