Severe atopic dermatitis: Therapeutic update

Background: Atopic dermatitis (AD) is a common inflammatory skin disorder with a multitude of highly characterized comorbidities that affect infants, children, and adults worldwide. Despite its high prevalence and health burden, our armamentarium to treat AD in its severe form has remained lacking. For decades, the only Food and Drug Administration approved systemic treatment options for AD had been limited to corticosteroids. Methods: We conducted a nonsystematic review of the new and emerging drugs for the treatment of AD. Results: The recent emergence of dupilumab, a monoclonal antibody that selectively inhibits the type 2 cytokines that are integral to the pathogenesis of AD has provided dermatologists and allergists with a safe and effective targeted therapy to manage patients with moderate-to-severe disease. Numerous other drugs, both topical and systemic, are currently in development for the treatment of AD and have shown promise in their early phase trials. These agents include monoclonal antibodies that target various mediators relevant for a type 2 immune response, small-molecule inhibitors that block signaling through the Janus kinase pathway, and other agents that are aimed at addressing the symptomatology of itch. Conclusion: When anticipating the successful development and release of these drugs in the near future, it will be imperative for providers to review the available data, including the efficacy and adverse effects profile of each agent to determine the best treatment approach for each individual patient with AD.