Considerations When Using Systemic Treatments in Special Populations of Adults with Atopic Dermatitis

Conclusions

• Atopic dermatitis during pregnancy occurs commonly and often affects those without a prior history of the condition.
• Monitoring and discussing treatment options is essential for atopic dermatitis during pregnancy due to potential impacts on both mother and fetus.
• Phototherapy is generally considered safe for pregnant women and may be beneficial, though it should be administered with caution due to effects on folic acid levels.
• Cyclosporine shows promise in treating atopic dermatitis during pregnancy, but its use requires monitoring due to potential adverse outcomes.
• Biologics like dupilumab and tralokinumab have reassuring preclinical data regarding safety in pregnancy, though further clinical evidence is limited.
• JAK inhibitors are not recommended during pregnancy or lactation due to potential teratogenic effects, and should ideally be stopped at least a month before conception.
• Treatment of atopic dermatitis in HIV-positive patients should consider phototherapy and certain biologics, as some treatments show stable viral loads and CD4 counts.
• Infection risks associated with traditional systemic treatments must be carefully evaluated in patients with HIV, hepatitis, and other infections.
• Older adults may face unique treatment challenges due to comorbidities and changes in drug metabolism; therefore, treatment modalities should be individualized.
• There is limited clinical trial data for older adults with atopic dermatitis, necessitating caution due to potential adverse effects from treatments.