NEW YORK (Reuters Health) – Patients with severe signs and symptoms of atopic dermatitis should receive in-depth assessment before starting systemic medication, according to a new consensus statement from the International Eczema Council.
Dr. Eric L. Simpson from the Oregon Health and Science University, in Portland, and colleagues from an expert panel subgroup of the International Eczema Council developed guidelines and a framework for evaluating patients with severe atopic dermatitis.
The multinational panel met face-to-face to determine broad topic areas for clinicians to consider before prescribing systemic therapy. Experts were assigned subtopic areas pertaining to their individual expertise. They conducted literature reviews, referred to available guidelines, and then provided consensus interpretation and expert opinion.
The article was published in the Journal of The American Academy of Dermatology, online August 10.
According to the consensus recommendations, severity-based scoring systems alone cannot determine whether a patient with atopic dermatitis should start systemic therapy. Holistic assessment of disease severity, quality of life, and alternative and concomitant diagnoses is needed.
The experts also recommended a trial of intensive topical therapy, and that clinicians deliver adequate education to improve adherence to therapy.
Other recommendations included identifying and treating existing bacterial and viral infections, considering possible allergic triggers of the atopic dermatitis, and using phototherapy as second-line or adjuvant therapy in select patients with moderate-to-severe atopic dermatitis.
The authors note that if systemic treatment is warranted, the choice of agent should be based on existing patient comorbidities and baseline investigations; the patient’s age; expected pregnancy and family planning; and the patient’s previous clinical experience, including use of systemic drugs. They emphasized shared decision making, between clinician and patient, that vets individual agents’ risks and benefits.
The authors also noted the potential importance of emerging treatments, such as targeted immunomodulation with systemic biologic and small-molecule therapies, that may reduce safety risks and provide superior outcomes.
“Optimal management of atopic dermatitis hinges on patient education, identifying and avoiding triggers, and instituting appropriate topical and/or systemic therapy,” Dr. Sarina B. Elmariah, a board-certified dermatologist at Massachusetts General Hospital in Boston, told Reuters Health by email.
Dr. Elmariah, who was not one of the authors, said that although the consensus statement isn’t primary research, it reflects the collective opinions of many experts in managing atopic dermatitis. She specifically emphasized the importance of the recommendations about quality of life for patients, even those with limited skin-surface involvement; patient education to improve adherence to therapy; and the use of systemic immunotherapies, both old and new.
Dr. Elmariah said that the consensus statement does not aim to change patient management, per se, but simply offers general guidelines for dermatologists and other clinicians who care for affected patients.
“The key message,” she said, “is that physicians should use a systematic and holistic approach to evaluate the severity of disease and its impact on the quality of life of patients with atopic dermatitis.”
Dr. Elmariah noted that many of the authors are consultants, investigators, or both for manufacturers of atopic dermatitis treatments, but that the discussion and guidelines are nevertheless reasonable and unbiased.
Dr. Simpson did not respond to requests for comment.
SOURCE: http://bit.ly/2vRUxTe
J Am Acad Dermatol 2017.
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