AAD
Author: Willhemenia Loremipsum Special session: Lorem ipsum dolor sit amet Category: Lorem ipsum View all results

Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.

  • Presentation

Practical Considerations for Systemic Treatment of Atopic Dermatitis in Adults

Description

The discussion focuses on practical considerations for systemic treatment of atopic dermatitis (AD) in adults. Physicians are advised to engage in thorough discussions with patients regarding the benefits and risks of prescribed medications, including managing side effects and documenting them properly. Emphasis is placed on the importance of considering each patient's comorbidities without being overly restrictive. The presenter discusses various treatments, including traditional immunosuppressants like cyclosporine and methotrexate, highlighting their effectiveness, potential adverse effects, and necessary monitoring protocols. Concerns such as the risk of eczema herpeticum, potential osteoporotic effects due to chronic inflammation or steroid use, and monitoring blood pressure and kidney function are also addressed. The emerging use of biologics like dupilumab and Janus kinase inhibitors is highlighted, with discussions around their risks and monitoring requirements. Key risks involve infection rates, potential side effects like conjunctivitis and lymphoid reactions, and the importance of considering patient demographics in treatment decisions. Physicians are encouraged to treat aggressively to alleviate patient suffering while balancing risks carefully, ensuring a tailored approach to managing AD.

View more

Conclusions

  • Counsel patients on the common and serious side effects of systemic medications for atopic dermatitis, considering individual circumstances.
  • Baseline comorbidities should be considered, but do not overly restrict treatment options based on these.
  • Not all adverse events (AEs) necessitate stopping a medication; clinical judgment is key.
  • Monitor patients' lab results and clinical parameters based on individual risk rather than a one-size-fits-all approach.
  • Systemic corticosteroids should be reserved for acute exacerbations and not used as long-term therapy for atopic dermatitis.
  • Patients with atopic dermatitis are at increased risk for eczema herpeticum and require careful monitoring to avoid severe consequences.
  • Traditional immunosuppressants like cyclosporine and methotrexate should be closely monitored for specific adverse reactions, including liver toxicity.
  • Biologics and JAK inhibitors have favorable safety profiles, though vigilance is required to recognize rare events.
  • Older patients may have increased risks for serious complications; a cautious approach to dosing in this population is advised.
  • Effective treatment of atopic dermatitis can significantly improve patient quality of life, and aggressive management is often necessary.
  • 1. Traidl S, et al. TREATgermany Study Group. High recurrence rate of eczema herpeticum in moderate/severe atopic dermatitis -TREATgermany registry analysis. J Dtsch Dermatol Ges. 2023 Dec;21(12):1490-1498. Epub 2023 Oct 9. PMID: 37814394.
  • 2. Gao L, et al. Targeted deep sequencing identifies rare loss-of-function variants in IFNGR1 for risk of atopic dermatitis complicated by eczema herpeticum. J Allergy Clin Immunol. 2015 Dec;136(6):1591-1600. doi: 10.1016/j.jaci.2015.06.047.
  • 3. Davis DMR, et al. Guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies. J Am Acad Dermatol. 2024 Feb;90(2):e43-e56. doi: 10.1016/j.jaad.2023.08.102. Epub 2023 Nov 7. PMID: 37943240.
  • 4. Wu D, et al. Bone mineral density, osteopenia, osteoporosis, and fracture risk in patients with atopic dermatitis: a systematic review and meta-analysis. Ann Transl Med. 2021 Jan;9(1):40. PMC7859773.
  • 5. Sharma M, et al. Human germline heterozygous gain-of-function STAT6 variants cause severe allergic disease. J Exp Med. 2023 May.
  • 6. Sidbury R, et al. American Academy of Dermatology. Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol. 2014 Aug;71(2):327-49.
  • 7. Drucker AM, et al. Systemic Immunomodulatory Treatments for Patients With Atopic Dermatitis: A Systematic Review and Network Meta-analysis. JAMA Dermatol. 2020 Jun 1;156(6):659-667.
  • 8. Dawson JK, et al. Does methotrexate cause progressive fibrotic interstitial lung disease? A systematic review. Rheumatol Int. 2021 Jun;41(6):1055-1064. doi: 10.1007/s00296-020-04773-4. Epub 2021 Jan 29. PMID: 33515067; PMCID: PMC8079289.
  • 9. Hajar T, et al. Low-dose methotrexate in dermatology: the utility of serological monitoring in a real-world cohort. J Dermatolog Treat. 2022 Jun;33(4):2161-2167.
  • 10. Mickevicius T, et al. Dupilumab-Induced, Tralokinumab-Induced, and Belantamab Mafodotin-Induced Adverse Ocular Events-Incidence, Etiology, and Management. Cornea 42(4):p 507-519, April 2023.
  • 11. Schneeweiss MC, et al. Joint pain in patients with atopic dermatitis receiving treatment with dupilumab: A US nationwide cohort study. J Am Acad Dermatol. 2024 Jan;90(1):134-137. PMID: 37604229.
  • 12. Boesjes CM, et al. Dupilumab-Associated Lymphoid Reactions in Patients With Atopic Dermatitis. JAMA Dermatol. 2023 Nov 1;159(11):1240-1247. doi: 10.1001/jamadermatol.2023.3849. PMID: 37851456; PMCID: PMC10585590.
  • 13. Ytterberg SR, et al. Cardiovascular and Cancer Risk with Tofacitinib in Rheumatoid Arthritis. N Engl J Med. 2022 Jan 27;386(4):316-326.