Considerations when using systemic treatments in special populations of adults with atopic dermatitis

Conclusions

• Atopic dermatitis is increasingly recognized as a systemic inflammatory condition affecting various populations, including pregnant women and older adults.
• Gold standard treatments like systemic medications are often not tested in specific populations such as pregnant women, older adults, and those with comorbidities.
• Phototherapy, particularly UVB, is generally safe and recommended for pregnant women with atopic dermatitis.
• Cyclosporine has substantial evidence supporting its use during pregnancy, whereas methotrexate and mycophenolate are contraindicated due to their teratogenicity.
• Limited data suggests that biologics are safe for use in pregnancy, but caution is advised due to potential effects on neonates.
• Systemic corticosteroids can be used in the short term during pregnancy to manage severe symptoms if benefits outweigh risks.
• For patients with infections like HIV and hepatitis, phototherapy is also a recommended treatment, while methotrexate is contraindicated due to the risk of opportunistic infections.
• Older adults present unique treatment challenges such as polypharmacy and cognitive decline, which necessitate careful medication management and monitoring.
• Clinical trials have not adequately included older adults, though initial safety data on biologics in this population appears reassuring.
• JAK inhibitors should be approached with caution in older adults due to potential risks identified in other populations, but there is no consistent evidence of increased risk of serious events in dermatology-specific trials.