Advanced Systemic Treatments in Patients with Moderate-to-Severe Atopic Dermatitis: Key Learnings from Physicians Practicing in Nine Asian Countries and Territories.
Antirheumatic agents
Asia
Atopic
Biologics
Dermatitis
Janus kinase inhibitors
Journal
Dermatology and therapy
ISSN: 2193-8210
Titre abrégé: Dermatol Ther (Heidelb)
Pays: Switzerland
ID NLM: 101590450
Informations de publication
Date de publication:
28 Sep 2024
28 Sep 2024
Historique:
received:
09
08
2024
accepted:
13
09
2024
medline:
28
9
2024
pubmed:
28
9
2024
entrez:
28
9
2024
Statut:
aheadofprint
Résumé
Rapid progress made in the management of atopic dermatitis (AD) in recent years and the differences in patient journey between Asian and non-Asian populations call for a review of current atopic dermatitis landscape in Asia. A roundtable meeting with nine regional dermatological experts was held in June 2023 to discuss the optimal management approaches for moderate-to-severe AD, focusing on the use of advanced therapies. Disease burden on patients' quality of life, treatment adherence, and financial constraints were identified as major concerns when managing patients with moderate-to-severe AD in parts of Asia. It was agreed that the Hanifin and Rajka's criteria or the UK Working Party's Diagnostic Criteria for Atopic Dermatitis can be used to guide the clinical diagnosis of AD. Meanwhile, patient-reported outcome scales including the Dermatology Life Quality Index and Atopic Dermatitis Control Tool can be used alongside depression monitoring scales to monitor treatment outcomes in patients with AD, allowing a better understanding for individualized treatment. When managing moderate-to-severe AD, phototherapy should be attempted after failure with topical treatments, followed by conventional disease-modifying antirheumatic drugs and, subsequently, biologics or Janus kinase inhibitors. Systemic corticosteroids can be used as short-term therapy for acute flares. Although these advanced treatments are known to be effective, physicians have to take into consideration safety concerns and limitations when prescribing these treatments. Treatments in AD have evolved and its management varies country by country. Unique challenges across Asian countries necessitate a different management approach in Asian patients with AD.
Identifiants
pubmed: 39340696
doi: 10.1007/s13555-024-01278-x
pii: 10.1007/s13555-024-01278-x
doi:
Types de publication
Letter
Langues
eng
Informations de copyright
© 2024. The Author(s).
Références
Nutten S. Atopic dermatitis: global epidemiology and risk factors. Ann Nutr Metab. 2015;66(Suppl 1):8–16.
pubmed: 25925336
doi: 10.1159/000370220
Mallol J, Crane J, von Mutius E, Odhiambo J, Keil U, Stewart A, et al. The International Study of Asthma and Allergies in Childhood (ISAAC) phase three: a global synthesis. Allergol Immunopathol (Madr). 2013;41:73–85.
pubmed: 22771150
doi: 10.1016/j.aller.2012.03.001
Odhiambo JA, Williams HC, Clayton TO, Robertson CF, Asher MI, ISAAC Phase Three Study Group. Global variations in prevalence of eczema symptoms in children from ISAAC phase three. J Allergy Clin Immunol. 2009;124:1251–8 (e23).
pubmed: 20004783
doi: 10.1016/j.jaci.2009.10.009
Hadi HA, Tarmizi AI, Khalid KA, Gajdács M, Aslam A, Jamshed S. The epidemiology and global burden of atopic dermatitis: a narrative review. Life (Basel). 2021;11:936.
pubmed: 34575085
Maspero J, De Paula Motta Rubini N, Zhang J, Sanclemente G, Amador JR, El Sayed MH, et al. Epidemiology of adult patients with atopic dermatitis in AWARE 1: a second international survey. World Allergy Organ J. 2023;16: 100724.
pubmed: 37033301
pmcid: 10074250
doi: 10.1016/j.waojou.2022.100724
Gabriel MT, Lim HG, Gulmatico-Flores Z, Adasa GU, Lavadia MAM, Villafuerte LL et al. Guidelines for the management of atopic dermatitis: a literature review and consensus statement of the Philippine Dermatological Society. J Philipp Dermatol Soc 2020;35–58.
Lim JJ, Lim YYE, Ng JY, Malipeddi P, Ng YT, Teo WY, et al. An update on the prevalence, chronicity, and severity of atopic dermatitis and the associated epidemiological risk factors in the Singapore/Malaysia Chinese young adult population: a detailed description of the Singapore/Malaysia Cross-Sectional Genetics Epidemiology Study (SMCGES) cohort. World Allergy Organ J. 2022;15: 100722.
pubmed: 36438192
pmcid: 9678778
doi: 10.1016/j.waojou.2022.100722
Noda S, Suárez-Fariñas M, Ungar B, Kim SJ, de Guzman SC, Xu H, et al. The Asian atopic dermatitis phenotype combines features of atopic dermatitis and psoriasis with increased TH17 polarization. J Allergy Clin Immunol. 2015;136:1254–64.
pubmed: 26428954
doi: 10.1016/j.jaci.2015.08.015
Kaufman BP, Guttman-Yassky E, Alexis AF. Atopic dermatitis in diverse racial and ethnic groups – variations in epidemiology, genetics, clinical presentation and treatment. Exp Dermatol. 2018;27:340–57.
pubmed: 29457272
doi: 10.1111/exd.13514
Brown SJ, McLean WH. One remarkable molecule: filaggrin. J Invest Dermatol. 2012;132:751–62.
pubmed: 22158554
doi: 10.1038/jid.2011.393
Wu W, Chan TC, Chu C. Asian type atopic dermatitis. CosmoDerma. 2022;2:48.
doi: 10.25259/CSDM_47_2022
Cheng J, Wu JJ, Han G. Epidemiology and characterization of atopic dermatitis in East Asian populations: a systematic review. Dermatol Ther (Heidelb). 2021;11:707–17.
pubmed: 33835410
doi: 10.1007/s13555-021-00516-w
Malaysian Health Technology Assessment Section, Medical Development Division, Ministry of Health Malaysia. Management of atopic eczema [Internet]. Malaysia: Malaysian Health Technology Assessment Section, Medical Development Division, Ministry of Health Malaysia; 2018. Available from: https://www.moh.gov.my/moh/resources/Penerbitan/CPG/Skin%20Condition/CPG%20Management%20of%20Atopic%20Eczema.pdf .
Tay YK, Chan YC, Chandran NS, Ho MS, Koh MJ, Lim YL, et al. Guidelines for the management of atopic dermatitis in Singapore. Ann Acad Med Singap. 2016;45:439–50.
pubmed: 27832218
doi: 10.47102/annals-acadmedsg.V45N10p439
Chan TC, Wu NL, Wong LS, Cho YT, Yang CY, Yu Y, et al. Taiwanese Dermatological Association consensus for the management of atopic dermatitis: a 2020 update. J Formos Med Assoc. 2021;120:429–42.
pubmed: 32564976
doi: 10.1016/j.jfma.2020.06.008
Kulthanan K, Tuchinda P, Nitiyarom R, Chunharas A, Chantaphakul H, Aunhachoke K, et al. Clinical practice guidelines for the diagnosis and management of atopic dermatitis. Asian Pac J Allergy Immunol. 2021;39:145–55.
pubmed: 34246205
Rajagopalan M, De A, Godse K, Krupa Shankar DS, Zawar V, Sharma N, et al. Guidelines on management of atopic dermatitis in India: an evidence-based review and an expert consensus. Indian J Dermatol. 2019;64:166–81.
pubmed: 31148854
pmcid: 6537677
doi: 10.4103/ijd.IJD_683_18
Saeki H, Ohya Y, Furuta J, Arakawa H, Ichiyama S, Katsunuma T, et al. English version of clinical practice guidelines for the management of atopic dermatitis 2021. J Dermatol. 2022;49:e315–75.
pubmed: 35996152
Lee JH, Kim JE, Park GH, Bae JM, Byun JY, Shin MK, et al. Consensus update for systemic treatment of atopic dermatitis. Ann Dermatol. 2021;33:497–514.
pubmed: 34858001
pmcid: 8577915
doi: 10.5021/ad.2021.33.6.497
Chow S, Seow CS, Dizon MV, Godse K, Foong H, Chan V, et al. A clinician’s reference guide for the management of atopic dermatitis in Asians. Asia Pac Allergy. 2018;8: e41.
pubmed: 30402408
pmcid: 6209602
doi: 10.5415/apallergy.2018.8.e41
Wollenberg A, Kinberger M, Arents B, Aszodi N, Avila Valle G, Barbarot S, et al. European guideline (EuroGuiDerm) on atopic eczema: part I—systemic therapy. J Eur Acad Dermatol Venereol. 2022;36:1409–31.
pubmed: 35980214
doi: 10.1111/jdv.18345
Wollenberg A, Kinberger M, Arents B, Aszodi N, Avila Valle G, Barbarot S, et al. European guideline (EuroGuiDerm) on atopic eczema—part II: non-systemic treatments and treatment recommendations for special AE patient populations. J Eur Acad Dermatol Venereol. 2022;36:1904–26.
pubmed: 36056736
doi: 10.1111/jdv.18429
Huang J, Choo YJ, Smith HE, Apfelbacher C. Quality of life in atopic dermatitis in Asian countries: a systematic review. Arch Dermatol Res. 2022;314:445–62.
pubmed: 34086064
doi: 10.1007/s00403-021-02246-7
Chan TC, Lin YC, Cho YT, Tang CH, Chu CY. Impact of atopic dermatitis on work and activity impairment in Taiwan. Acta Derm Venereol. 2021;101: adv00556.
pubmed: 34490471
doi: 10.2340/00015555-3918
Lim VZ, Ho RC, Tee SI, Ho MS, Pan JY, Lim YL, et al. Anxiety and depression in patients with atopic dermatitis in a Southeast Asian tertiary dermatological centre. Ann Acad Med Singap. 2016;45:451–5.
pubmed: 27832219
doi: 10.47102/annals-acadmedsg.V45N10p451
Sandhu JK, Wu KK, Bui TL, Armstrong AW. Association between atopic dermatitis and suicidality: a systematic review and meta-analysis. JAMA Dermatol. 2019;155:178–87.
pubmed: 30540348
doi: 10.1001/jamadermatol.2018.4566
Cho YT, Hsieh WT, Chan TC, Tang CH, Chu CY. Increased prevalence of many comorbidities in patients with atopic dermatitis: a population-based cohort study in Taiwan. JAAD Int. 2020;1:50–8.
pubmed: 34409322
pmcid: 8362251
doi: 10.1016/j.jdin.2020.05.002
Hsu CJ, Shen D, Chan TC, Cho YT, Tang CH, Chu CY. Correlation between anxiety and depression risk and atopic dermatitis severity in Taiwan: a cross-sectional study. JAAD Int. 2022;7:22–30.
pubmed: 35243405
pmcid: 8873920
doi: 10.1016/j.jdin.2021.12.008
Simpson EL, Bieber T, Eckert L, et al. Patient burden of moderate to severe atopic dermatitis (AD): insights from a phase 2b clinical trial of dupilumab in adults. J Am Acad Dermatol. 2016;74:491–8.
pubmed: 26777100
doi: 10.1016/j.jaad.2015.10.043
Kwatra SG, Gruben D, Fung S, DiBonaventura M. Psychosocial comorbidities and health status among adults with moderate-to-severe atopic dermatitis: a 2017 US National Health and Wellness Survey analysis. Adv Ther. 2021;38:1627–37.
pubmed: 33555555
pmcid: 7932976
doi: 10.1007/s12325-021-01630-z
Andersen L, Nyeland ME, Nyberg F. Increasing severity of atopic dermatitis is associated with a negative impact on work productivity among adults with atopic dermatitis in France, Germany, the U.K. and the U.S.A. Br J Dermatol. 2020;182:1007–16.
pubmed: 31260080
doi: 10.1111/bjd.18296
Eichenfield LF, Kusari A, Han AM, Barbarot S, Deleuran M, Lio P, et al. Therapeutic education in atopic dermatitis: a position paper from the International Eczema Council. JAAD Int. 2021;3:8–13.
pubmed: 34409365
pmcid: 8361897
doi: 10.1016/j.jdin.2021.01.001
Gori N, Chiricozzi A, Marsili F, Ferrucci SM, Amerio P, Battarra V, et al. National information campaign revealed disease characteristic and burden in adult patients suffering from atopic dermatitis. J Clin Med. 2022;11:5204.
pubmed: 36079131
pmcid: 9457191
doi: 10.3390/jcm11175204
Seale L, Gaulding JV, Porto D, Prabhakar D, Kerr H. Implementation of a psychodermatology clinic at a major health system in Detroit. Int J Womens Dermatol. 2018;4:227–9.
pubmed: 30627622
pmcid: 6322150
doi: 10.1016/j.ijwd.2018.05.002
Fritzsche K, Ott J, Zschocke I, Scheib P, Burger T, Augustin M. Psychosomatic liaison service in dermatology. Need for psychotherapeutic interventions and their realization. Dermatology. 2001;203:27–31.
pubmed: 11549796
doi: 10.1159/000051699
Orion E, Feldman B, Ronni W, Orit BA. A psychodermatology clinic: The concept, the format, and our observations from Israel. Am J Clin Dermatol. 2012;13:97–101.
pubmed: 22251230
doi: 10.2165/11630950-000000000-00000
Shenoi SD, Prabhu S, Nirmal B, Petrolwala S. Our experience in a psychodermatology liaison clinic at Manipal, India. Indian J Dermatol. 2013;58:53–5.
pubmed: 23372214
pmcid: 3555374
doi: 10.4103/0019-5154.105310
Weigandt WA, Schardt Y, Bruch A, Herr R, Goebeler M, Benecke J, et al. Impact of an eHealth smartphone app on quality of life and clinical outcome of patients with hand and foot eczema: prospective randomized controlled intervention study. JMIR Mhealth Uhealth. 2023;11: e38506.
pubmed: 36881465
pmcid: 10031439
doi: 10.2196/38506
Rijsbergen M, Niemeyer-van der Kolk T, Rijneveld R, Pinckaers JHFM, Meshcheriakov I, Bouwes Bavinck JN, et al. Mobile e-diary application facilitates the monitoring of patient-reported outcomes and a high treatment adherence for clinical trials in dermatology. J Eur Acad Dermatol Venereol. 2020;34:633–9.
pubmed: 31419338
doi: 10.1111/jdv.15872
Furue M, Onozuka D, Takeuchi S, Murota H, Sugaya M, Masuda K, et al. Poor adherence to oral and topical medication in 3096 dermatological patients as assessed by the Morisky Medication Adherence Scale-8. Br J Dermatol. 2015;172:272–5.
pubmed: 25154923
doi: 10.1111/bjd.13377
Torrelo A, Ortiz J, Alomar A, Ros S, Pedrosa E, Cuervo J. Health-related quality of life, patient satisfaction, and adherence to treatment in patients with moderate or severe atopic dermatitis on maintenance therapy: the CONDA-SAT study. Actas Dermosifiliogr. 2013;104:409–17.
pubmed: 23665434
doi: 10.1016/j.ad.2012.12.003
Ee S, Tay YK, Chu CY, Hon KLE, Leong KF, Wananukul S. A study on the knowledge, attitudes, and practices of Asian dermatologists in the management of atopic dermatitis. Dermatol Sin. 2020;38:67–80.
doi: 10.4103/ds.ds_31_19
Nickles MA, Coale AT, Henderson WJA, Brown KE, Morrell DS, Nieman EL. Steroid phobia on social media platforms. Pediatr Dermatol. 2023;40:479–82.
pubmed: 36815409
doi: 10.1111/pde.15269
Noorlaily MN, Baba R. Topical corticosteroid phobia among atopic eczema patients and their caregivers: survey in two dermatology outpatient clinics in Malaysia. Malays J Dermatol. 2015;35:2–5.
Eicher L, Knop M, Aszodi N, Senner S, French LE, Wollenberg A. A systematic review of factors influencing treatment adherence in chronic inflammatory skin disease—strategies for optimizing treatment outcome. J Eur Acad Dermatol Venereol. 2019;33:2253–63.
pubmed: 31454113
doi: 10.1111/jdv.15913
James M, Roy A, Antony E, George S. Impact of patient counseling on treatment adherence behavior and quality of life in maintenance hemodialysis patients. Saudi J Kidney Dis Transpl. 2021;32:1382–7.
pubmed: 35532708
Kolios AGA, Hueber AJ, Michetti P, Mrowietz U, Mustak-Blagusz M, Sator PG, et al. ALIGNed on adherence: subanalysis of adherence in immune-mediated inflammatory diseases in the DACH region of the global ALIGN study. J Eur Acad Dermatol Venereol. 2019;33:234–41.
pubmed: 29998520
doi: 10.1111/jdv.15179
Kew CH, Ahmad Basir KF, Low DW, Loh KC. Breaking through the steroid stigma: a single-centre study on topical corticosteroid perception and adherence in dermatology patients and caregivers. Med J Malaysia. 2023;78:437–44.
pubmed: 37518909
Nathan AD, Shankar PR, Sreeramareddy CT. Topical corticosteroid counselling among Malaysian community pharmacists: a qualitative interview study. BMC Prim Care. 2023;24:119.
pubmed: 37231354
pmcid: 10211295
doi: 10.1186/s12875-023-02071-z
Tan S, Phan P, Law JY, Choi E, Chandran NS. Qualitative analysis of topical corticosteroid concerns, topical steroid addiction and withdrawal in dermatological patients. BMJ Open. 2022;12: e060867.
pubmed: 35296492
pmcid: 8928312
doi: 10.1136/bmjopen-2022-060867
van Os-Medendorp H, Deprez E, Maes N, Ryan S, Jackson K, Winders T, et al. The role of the nurse in the care and management of patients with atopic dermatitis. BMC Nurs. 2020;19:102.
pubmed: 33292229
pmcid: 7640616
doi: 10.1186/s12912-020-00494-y
Courtenay M, Carey N. Nurse-led care in dermatology: a review of the literature. Br J Dermatol. 2006;154:1–6.
pubmed: 16403087
doi: 10.1111/j.1365-2133.2005.06979.x
Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI)—a simple practical measure for routine clinical use. Clin Exp Dermatol. 1994;19:210–6.
pubmed: 8033378
doi: 10.1111/j.1365-2230.1994.tb01167.x
Pariser DM, Simpson EL, Gadkari A, Bieber T, Margolis DJ, Brown M, et al. Evaluating patient-perceived control of atopic dermatitis: design, validation, and scoring of the Atopic Dermatitis Control Tool (ADCT). Curr Med Res Opin. 2020;36:367–76.
pubmed: 31778083
doi: 10.1080/03007995.2019.1699516
De Bruin-Weller M, Biedermann T, Bissonnette R, Deleuran M, Foley P, Girolomoni G, et al. Treat-to-target in atopic dermatitis: an international consensus on a set of core decision points for systemic therapies. Acta Derm Venereol. 2021;101: adv00402.
pubmed: 33491094
doi: 10.2340/00015555-3751
Hsieh BJ, Shen D, Hsu CJ, Chan TC, Cho YT, Tang CH, et al. The impact of atopic dermatitis on health-related quality of life in Taiwan. J Formos Med Assoc. 2022;121:269–77.
pubmed: 33849750
doi: 10.1016/j.jfma.2021.03.024
Tan WF, Voo SYM, Sulaiman N, Robinson S. Psychosocial burden of patients with atopic dermatitis at two tertiary referral centres in Malaysia. Med J Malaysia. 2021;76:643–52.
pubmed: 34508369
Hosoya K, Komachi T, Masaki K, Suzaki I, Saeki H, Kanda N, et al. Barrier factors of adherence to dupilumab self-injection for severe allergic disease: a non-interventional open-label study. Patient Prefer Adherence. 2023;17:861–72.
pubmed: 37009430
pmcid: 10064874
doi: 10.2147/PPA.S389865
Aubert-Wastiaux H, Moret L, Le Rhun A, Fontenoy AM, Nguyen JM, Leux C, et al. Topical corticosteroid phobia in atopic dermatitis: a study of its nature, origins and frequency. Br J Dermatol. 2011;165:808–14.
pubmed: 21671892
doi: 10.1111/j.1365-2133.2011.10449.x
Stalder JF, Aubert H, Anthoine E, Moret L, Barbarot S, Futamura M, et al. Topical corticosteroid phobia in atopic dermatitis: international feasibility study of the TOPICOP score. Allergy. 2017;72:1713–9.
pubmed: 28439896
doi: 10.1111/all.13189
Lee EM, Cho YT, Chan TC, Shen D, Chu CY, Tang CH. Economic burden of atopic dermatitis in Taiwan. Acta Derm Venereol. 2023;103: adv00866.
pubmed: 36789754
doi: 10.2340/actadv.v103.4556
Azmi S, Goh A. Household expenditure on pediatric atopic dermatitis across 12 countries in the Asia Pacific region. Value Health. 2013;16: PA243.
doi: 10.1016/j.jval.2013.03.1235
Handa S, Jain N, Narang T. Cost of care of atopic dermatitis in India. Indian J Dermatol. 2015;60:213.
pubmed: 25814734
pmcid: 4372938
Hanifin JM, Rajka G. Diagnostic features of atopic eczema. Acta Derm Venereol (Stockh). 1980;92:44–7.
doi: 10.2340/00015555924447
Williams HC, Burney PG, Pembroke AC, Hay RJ. The U.K. Working Party’s Diagnostic Criteria for atopic dermatitis. III. Independent hospital validation. Br J Dermatol. 1994;131:406–16.
pubmed: 7918017
doi: 10.1111/j.1365-2133.1994.tb08532.x
Chopra R, Vakharia PP, Sacotte R, Patel N, Immaneni S, White T, et al. Severity strata for Eczema Area and Severity Index (EASI), modified EASI, Scoring Atopic Dermatitis (SCORAD), objective SCORAD, Atopic Dermatitis Severity Index and body surface area in adolescents and adults with atopic dermatitis. Br J Dermatol. 2017;177:1316–21.
pubmed: 28485036
doi: 10.1111/bjd.15641
Eichenfield LF, Lucky AW, Boguniewicz M, Langley RGB, Cherill R, Marshall K, et al. Safety and efficacy of pimecrolimus (ASM 981) cream 1% in the treatment of mild and moderate atopic dermatitis in children and adolescents. J Am Acad Dermatol. 2002;46:495–504.
pubmed: 11907497
doi: 10.1067/mjd.2002.122187
University of Nottingham. POEM – Patient Oriented Eczema Measure. Available from: https://www.nottingham.ac.uk/research/groups/cebd/resources/poem.aspx .
Yosipovitch G, Reaney M, Mastey V, Eckert L, Abbé A, Nelson L, et al. Peak Pruritus Numerical Rating Scale: psychometric validation and responder definition for assessing itch in moderate-to-severe atopic dermatitis. Br J Dermatol. 2019;181:761–9.
pubmed: 30729499
pmcid: 6850643
doi: 10.1111/bjd.17744
Kim JE, Shin MK, Park GH, Lee UH, Lee JH, Han TY, et al. 2019 Consensus Korean Diagnostic Guidelines to define severity classification and treatment refractoriness for atopic dermatitis: objective and subjective assessment of severity. Ann Dermatol. 2019;31:654–61.
pubmed: 33911665
pmcid: 7992600
doi: 10.5021/ad.2019.31.6.654
Cheng CM, Hsu JW, Huang KL, Bai YM, Su TP, Li CT, et al. Risk of developing major depressive disorder and anxiety disorders among adolescents and adults with atopic dermatitis: a nationwide longitudinal study. J Affect Disord. 2015;178:60–5.
pubmed: 25795537
doi: 10.1016/j.jad.2015.02.025
McIntyre R, Kennedy S, Bagby RM, Bakish D. Assessing full remission. J Psychiatry Neurosci. 2002;27:235–9.
pubmed: 12174732
pmcid: 161657
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62.
pubmed: 14399272
pmcid: 495331
doi: 10.1136/jnnp.23.1.56
Williams JB. Standardizing the hamilton depression rating scale: past, present, and future. Eur Arch Psychiatry Clin Neurosci. 2001;251(Suppl 2):II6–12.
pubmed: 11824839
doi: 10.1007/BF03035120
Drucker AM, Eyerich K, de Bruin-Weller MS, Thyssen JP, Spuls PI, Irvine AD, et al. Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement. Br J Dermatol. 2018;178:768–75.
pubmed: 28865094
pmcid: 5901393
doi: 10.1111/bjd.15928
Wollenberg A, Barbarot S, Bieber T, Christen-Zaech S, Deleuran M, Fink-Wagner A, et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part II. J Eur Acad Dermatol Venereol. 2018;32:850–78.
pubmed: 29878606
doi: 10.1111/jdv.14888
Yao TC, Wang IJ, Sun HL, Ou LS, Yu HH, Wang L, et al. Taiwan guidelines for the diagnosis and management of pediatric atopic dermatitis: consensus statement of the Taiwan Academy of Pediatric Allergy, Asthma and Immunology. J Microbiol Immunol Infect. 2022;55:561–72.
pubmed: 35487815
doi: 10.1016/j.jmii.2022.03.004
Wollenberg A, Barbarot S, Bieber T, Christen-Zaech S, Deleuran M, Fink-Wagner A, et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I. J Eur Acad Dermatol Venereol. 2018;32:657–82.
pubmed: 29676534
doi: 10.1111/jdv.14891
Teng Y, Zhong H, Yang X, Tao X, Fan Y. Current and emerging therapies for atopic dermatitis in the elderly. Clin Interv Aging. 2023;18:1641–52.
pubmed: 37810952
pmcid: 10558003
doi: 10.2147/CIA.S426044
Wu CY, Lu YY, Lu CC, Su YF, Tsai TH, Wu CH. Osteoporosis in adult patients with atopic dermatitis: a nationwide population-based study. PLoS One. 2017;12: e0171667.
pubmed: 28207767
pmcid: 5313211
doi: 10.1371/journal.pone.0171667
Vestergaard C, Wollenberg A, Barbarot S, Christen-Zaech S, Deleuran M, Spuls P, et al. European task force on atopic dermatitis position paper: treatment of parental atopic dermatitis during preconception, pregnancy and lactation period. J Eur Acad Dermatol Venereol. 2019;33:1644–59.
pubmed: 31231864
doi: 10.1111/jdv.15709
Simpson EL, Lacour JP, Spelman L, Galimberti R, Eichenfield LF, Bissonnette R, et al. Baricitinib in patients with moderate-to-severe atopic dermatitis and inadequate response to topical corticosteroids: results from two randomized monotherapy phase III trials. Br J Dermatol. 2020;183:242–55.
pubmed: 31995838
doi: 10.1111/bjd.18898
Simpson EL, Sinclair R, Forman S, Wollenberg A, Aschoff R, Cork M, et al. Efficacy and safety of abrocitinib in adults and adolescents with moderate-to-severe atopic dermatitis (JADE MONO-1): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial. Lancet. 2020;396:255–66.
pubmed: 32711801
doi: 10.1016/S0140-6736(20)30732-7
Guttman-Yassky E, Teixeira HD, Simpson EL, Papp KA, Pangan AL, Blauvelt A, et al. Once-daily upadacitinib versus placebo in adolescents and adults with moderate-to-severe atopic dermatitis (measure up 1 and measure up 2): results from two replicate double-blind, randomised controlled phase 3 trials. Lancet. 2021;397:2151–68.
pubmed: 34023008
doi: 10.1016/S0140-6736(21)00588-2
Armstrong A, Blauvelt A, Simpson EL, Smith CH, Herranz P, Kataoka Y, et al. Continued treatment with dupilumab is associated with improved efficacy in adults with moderate-to-severe atopic dermatitis not achieving optimal responses with short-term treatment. Dermatol Ther (Heidelb). 2022;12:195–202.
pubmed: 34897582
doi: 10.1007/s13555-021-00643-4
Simpson EL, Bieber T, Guttman-Yassky E, Beck LA, Blauvelt A, Cork MJ, et al. Two phase 3 trials of dupilumab versus placebo in atopic dermatitis. N Engl J Med. 2016;375:2335–48.
pubmed: 27690741
doi: 10.1056/NEJMoa1610020
Heddle RJ, Soothill JF, Bulpitt CJ, Atherton DJ. Combined oral and nasal beclomethasone diproprionate in children with atopic eczema: a randomised controlled trial. Br Med J (Clin Res Ed). 1984;289:651–4.
pubmed: 6434024
doi: 10.1136/bmj.289.6446.651
La Rosa M, Musarra I, Ranno C, Maiello N, Negri L, Miraglia del Guidice JM, et al. A randomized, double-blind, placebo-controlled crossover trial of systemic flunisolide in the treatment of children with severe atopic dermatitis. Curr Ther Res. 1995;56:720–6.
doi: 10.1016/0011-393X(95)85143-7
Schmitt J, Schäkel K, Fölster-Holst R, Bauer A, Oertel R, Augustin M, et al. Prednisolone vs ciclosporin for severe adult eczema. An investigator-initiated double-blind placebo-controlled multicentre trial. Br J Dermatol. 2010;162:661–8.
pubmed: 19863501
doi: 10.1111/j.1365-2133.2009.09561.x
Wollenberg A, Christen-Zäch S, Taieb A, Paul C, Thyssen JP, de Bruin-Weller M, et al. ETFAD/EADV Eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children. J Eur Acad Dermatol Venereol. 2020;34:2717–44.
pubmed: 33205485
doi: 10.1111/jdv.16892
Patrizi A, Raone B, Ravaioli GM. Management of atopic dermatitis: safety and efficacy of phototherapy. Clin Cosmet Investig Dermatol. 2015;8:511–20.
pubmed: 26491366
pmcid: 4599569
doi: 10.2147/CCID.S87987
Nakamura M, Farahnik B, Bhutani T. Recent advances in phototherapy for psoriasis. F1000Res 2016;5:F1000 Faculty Rev-1684.
Torres AE, Lyons AB, Hamzavi IH, Lim HW. Role of phototherapy in the era of biologics. J Am Acad Dermatol. 2021;84:479–85.
pubmed: 32339702
doi: 10.1016/j.jaad.2020.04.095
Tzaneva S, Seeber A, Schwaiger M, Hönigsmann H, Tanew A. High-dose versus medium-dose UVA1 phototherapy for patients with severe generalized atopic dermatitis. J Am Acad Dermatol. 2001;45:503–7.
pubmed: 11568738
doi: 10.1067/mjd.2001.114743
Kowalzick L, Kleinheinz A, Weichenthal M, Neuber K, Köhler I, Grosch J, et al. Low dose versus medium dose UV-A1 treatment in severe atopic eczema. Acta Derm Venereol. 1995;75:43–5.
pubmed: 7538257
doi: 10.2340/00015555754345
Reynolds NJ, Franklin V, Gray JC, Diffey BL, Farr PM. Narrow-band ultraviolet B and broad-band ultraviolet A phototherapy in adult atopic eczema: a randomised controlled trial. Lancet. 2001;357:2012–6.
pubmed: 11438134
doi: 10.1016/S0140-6736(00)05114-X
Roekevisch E, Spuls PI, Kuester D, Limpens J, Schmitt J. Efficacy and safety of systemic treatments for moderate-to-severe atopic dermatitis: a systematic review. J Allergy Clin Immunol. 2014;133:429–38.
pubmed: 24269258
doi: 10.1016/j.jaci.2013.07.049
Drucker AM, Ellis AG, Bohdanowicz M, Mashayekhi S, Yiu ZZN, Rochwerg B, et al. Systemic immunomodulatory treatments for patients with atopic dermatitis: a systematic review and network meta-analysis. JAMA Dermatol. 2020;156:659–67.
pubmed: 32320001
doi: 10.1001/jamadermatol.2020.0796
Wang CW, Chi MH, Tsai TF, Yu KH, Kao HW, Chen HC, et al. Implementation of NUDT15 genotyping to prevent azathioprine-induced leukopenia for patients with autoimmune disorders in Chinese population. Clin Pharmacol Ther. 2022;112:1079–87.
pubmed: 35869597
pmcid: 9804440
doi: 10.1002/cpt.2716
Zhou X, Cheng L, Wang Y, Gou H, Ju K, Lan TJ, et al. Effect of NUDT15 polymorphisms on early hematological safety of low-dose azathioprine in Chinese patients with pemphigus vulgaris: a prospective cohort study. J Dermatol. 2022;49:402–10.
pubmed: 34866237
doi: 10.1111/1346-8138.16265
Zhang F, Amat G, Tang Y, Chen R, Tian X, Hu W, et al. NUDT15 genetic variants in Chinese Han, Uighur, Kirghiz, and Dai nationalities. Front Pediatr. 2022;10: 832363.
pubmed: 35498806
pmcid: 9047856
doi: 10.3389/fped.2022.832363
Kim SY, Shin JH, Park JS, Kang SY, Nam TS, Kim JK, et al. NUDT15 p.R139C variant is common and strongly associated with azathioprine-induced early leukopenia and severe alopecia in Korean patients with various neurological diseases. J Neurol Sci. 2017;378:64–8.
pubmed: 28566182
doi: 10.1016/j.jns.2017.04.041
Lee YJ, Hwang EH, Park JH, Shin JH, Kang B, Kim SY. NUDT15 variant is the most common variant associated with thiopurine-induced early leukopenia and alopecia in Korean pediatric patients with Crohn’s disease. Eur J Gastroenterol Hepatol. 2016;28:475–8.
pubmed: 26735160
doi: 10.1097/MEG.0000000000000564
Banerjee R, Ravikanth VV, Pal P, Bale G, Avanthi US, Goren I, et al. NUDT15 C415T variant compared with TPMT genotyping in predicting azathioprine-induced leucopenia: prospective analysis of 1014 inflammatory bowel disease patients in India. Aliment Pharmacol Ther. 2020;52:1683–94.
pubmed: 33111378
doi: 10.1111/apt.16137
Zhao Y, Wu L, Lu Q, Gao X, Zhu X, Yao X, et al. The efficacy and safety of dupilumab in Chinese patients with moderate-to-severe atopic dermatitis: a randomized, double-blind, placebo-controlled study. Br J Dermatol. 2022;186:633–41.
pubmed: 34358343
doi: 10.1111/bjd.20690
Wechsler ME, Klion AD, Paggiaro P, Nair P, Staumont-Salle D, Radwan A, et al. Effect of dupilumab on blood eosinophil counts in patients with asthma, chronic rhinosinusitis with nasal polyps, atopic dermatitis, or eosinophilic esophagitis. J Allergy Clin Immunol Pract. 2022;10:2695–709.
pubmed: 35636689
doi: 10.1016/j.jaip.2022.05.019
Worm M, Simpson EL, Thaçi D, Bissonnette R, Lacour JP, Beissert S, et al. Efficacy and safety of multiple dupilumab dose regimens after initial successful treatment in patients with atopic dermatitis: a randomized clinical trial. JAMA Dermatol. 2020;156:131–43.
pubmed: 31876900
doi: 10.1001/jamadermatol.2019.3617
Bieber T, Simpson EL, Silverberg JI, Thaçi D, Paul C, Pink AE, et al. Abrocitinib versus placebo or dupilumab for atopic dermatitis. N Engl J Med. 2021;384:1101–12.
pubmed: 33761207
doi: 10.1056/NEJMoa2019380
Reich K, Thyssen JP, Blauvelt A, Eyerich K, Soong W, Rice ZP, et al. Efficacy and safety of abrocitinib versus dupilumab in adults with moderate-to-severe atopic dermatitis: a randomised, double-blind, multicentre phase 3 trial. Lancet. 2022;400:273–82.
pubmed: 35871814
doi: 10.1016/S0140-6736(22)01199-0
Liu B, Song X, Liao S, Luan T, Zhao Z. Comparison of efficacy of baricitinib and dupilumab in the treatment of Chinese moderate-to-severe atopic dermatitis: a retrospective study. Int Arch Allergy Immunol. 2023;184:966–74.
pubmed: 37245505
doi: 10.1159/000530394
Guttman-Yassky E, Thaçi D, Pangan AL, Hong HCH, Papp KA, Reich K, et al. Upadacitinib in adults with moderate to severe atopic dermatitis: 16-week results from a randomized, placebo-controlled trial. J Allergy Clin Immunol. 2020;145:877–84.
pubmed: 31786154
doi: 10.1016/j.jaci.2019.11.025
Hagino T, Saeki H, Kanda N. The efficacy and safety of upadacitinib treatment for moderate to severe atopic dermatitis in real-world practice in Japan. J Dermatol. 2022;49:1158–67.
pubmed: 35986480
doi: 10.1111/1346-8138.16549
Simpson EL, Papp KA, Blauvelt A, Chu CY, Hong HCH, Katoh N, et al. Efficacy and safety of upadacitinib in patients with moderate to severe atopic dermatitis: analysis of follow-up data from the Measure Up 1 and Measure Up 2 randomized clinical trials. JAMA Dermatol. 2022;158:404–13.
pubmed: 35262646
pmcid: 8908226
doi: 10.1001/jamadermatol.2022.0029
Blauvelt A, Teixeira HD, Simpson EL, Costanzo A, de Bruin-Weller M, Barbarot S, et al. Efficacy and safety of upadacitinib vs dupilumab in adults with moderate-to-severe atopic dermatitis: a randomized clinical trial. JAMA Dermatol. 2021;157:1047–55.
pubmed: 34347860
pmcid: 8340015
doi: 10.1001/jamadermatol.2021.3023
Wan H, Jia H, Xia T, Zhang D. Comparative efficacy and safety of abrocitinib, baricitinib, and upadacitinib for moderate-to-severe atopic dermatitis: a network meta-analysis. Dermatol Ther. 2022;35: e15636.
pubmed: 35703351
pmcid: 9541568
doi: 10.1111/dth.15636
Cox D, Mohr DC. Managing difficulties with adherence to injectable medications due to blood, injection, and injury phobia and self-injection anxiety. Am J Drug Deliv. 2003;1:215–21.
doi: 10.2165/00137696-200301030-00005
van den Bemt BJF, Gettings L, Domańska B, Bruggraber R, Mountian I, Kristensen LE. A portfolio of biologic self-injection devices in rheumatology: how patient involvement in device design can improve treatment experience. Drug Deliv. 2019;26:384–92.
pubmed: 30905213
pmcid: 6442222
doi: 10.1080/10717544.2019.1587043
Yang N, Chen L, Shao J, Jiang F, Liu J, Li Z. Dupilumab with concomitant Janus kinase inhibitor: a novel treatment strategy for atopic dermatitis with poor response to dupilumab. Br J Dermatol. 2022;187:828–30.
pubmed: 35822461
doi: 10.1111/bjd.21776
Peterson DM, Vesely MD. Remission of severe atopic dermatitis with dupilumab and rescue tofacitinib therapy. JAAD Case Rep. 2021;10:4–7.
pubmed: 33728367
pmcid: 7935686
doi: 10.1016/j.jdcr.2021.01.020
Wang F, Trier AM, Li F, Kim S, Chen Z, Chai JN, et al. A basophil-neuronal axis promotes itch. Cell. 2021;184:422-440.e17.
pubmed: 33450207
pmcid: 7878015
doi: 10.1016/j.cell.2020.12.033
Jutel M, Agache I, Bonini S, Burks AW, Calderon M, Canonica W, et al. International consensus on allergy immunotherapy. J Allergy Clin Immunol. 2015;136:556–68.
pubmed: 26162571
doi: 10.1016/j.jaci.2015.04.047
Shi ZF, Song TB, Xie J, Yan YQ, Du YP. The traditional Chinese medicine and relevant treatment for the efficacy and safety of atopic dermatitis: a systematic review and meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med. 2017;2017:6026434.
pubmed: 28713436
pmcid: 5497608
doi: 10.1155/2017/6026434
Zhao Q, Guo R, Fan Z, Hu L, Hu Z, Liu Y. Medical conditions and preference of traditional Chinese medicine: results from the China Healthcare Improvement Evaluation Survey. Patient Prefer Adherence. 2023;17:227–37.
pubmed: 36718438
pmcid: 9883991
doi: 10.2147/PPA.S398644
Lee KS, Song JH, Rha YH, Choi SH. Vitamin D deficiency as a risk factor of a topic dermatitis in Korean female adolescents. J Allergy Clin Immunol. 2015;135: AB262.
doi: 10.1016/j.jaci.2014.12.1798
Palmer DJ. Vitamin D and the development of atopic eczema. J Clin Med. 2015;4:1036–50.
pubmed: 26239464
pmcid: 4470215
doi: 10.3390/jcm4051036
David TJ, Waddington E, Stanton RH. Nutritional hazards of elimination diets in children with atopic eczema. Arch Dis Child. 1984;59:323–5.
pubmed: 6721557
pmcid: 1628678
doi: 10.1136/adc.59.4.323
Bath-Hextall F, Delamere FM, Williams HC. Dietary exclusions for established atopic eczema. Cochrane Database Syst Rev. 2008;2008: CD005203.
pubmed: 18254073
pmcid: 6885041
Kaimal S, Thappa DM. Diet in dermatology: revisited. Indian J Dermatol Venereol Leprol. 2010;76:103–15.
pubmed: 20228538
doi: 10.4103/0378-6323.60540
Taibanguay N, Chaiamnuay S, Asavatanabodee P, Narongroeknawin P. Effect of patient education on medication adherence of patients with rheumatoid arthritis: a randomized controlled trial. Patient Prefer Adherence. 2019;13:119–29.
pubmed: 30666095
pmcid: 6333161
doi: 10.2147/PPA.S192008
Reddy S, Ananthakrishnan S, Garg A. A prospective observational study evaluating hypothalamic-pituitary-adrenal axis alteration and efficacy of intramuscular triamcinolone acetonide for steroid-responsive dermatologic disease. J Am Acad Dermatol. 2013;69:226–31.
pubmed: 23545370
doi: 10.1016/j.jaad.2013.02.005
Paller AS, Siegfried EC, Thaçi D, et al. Efficacy and safety of dupilumab with concomitant topical corticosteroids in children 6 to 11 years old with severe atopic dermatitis: a randomized, double-blinded, placebo-controlled phase 3 trial. J Am Acad Dermatol. 2020;83:1282–93.
pubmed: 32574587
doi: 10.1016/j.jaad.2020.06.054
Biswas T, Magalhaes RJS, Townsend N, Das SK, Mamun A. Double burden of underweight and overweight among women in South and Southeast Asia: a systematic review and meta-analysis. Adv Nutr. 2020;11:128–43.
pubmed: 31634389
doi: 10.1093/advances/nmz078
Mak KK, Tan SH. Underweight problems in Asian children and adolescents. Eur J Pediatr. 2012;171:779–85.
pubmed: 22350280
doi: 10.1007/s00431-012-1685-9
Ziehfreund S, Tizek L, Hangel N, Fritzsche MC, Weidinger S, Smith C, et al. Requirements and expectations of high-quality biomarkers for atopic dermatitis and psoriasis in 2021-a two-round Delphi survey among international experts. J Eur Acad Dermatol Venereol. 2022;36:1467–76.
pubmed: 35470457
doi: 10.1111/jdv.18178
Mastraftsi S, Vrioni G, Bakakis M, Nicolaidou E, Rigopoulos D, Stratigos AJ, et al. Atopic dermatitis: striving for reliable biomarkers. J Clin Med. 2022;11:4639.
pubmed: 36012878
pmcid: 9410433
doi: 10.3390/jcm11164639
Maintz L, Bieber T, Simpson HD, Demessant-Flavigny A-L. From skin barrier dysfunction to systemic impact of atopic dermatitis: implications for a precision approach in dermocosmetics and medicine. J Pers Med. 2022;12:893.
pubmed: 35743678
pmcid: 9225544
doi: 10.3390/jpm12060893
Leong K, Ong TWY, Foong YW, Wong YP, Lim W, Liew HM, et al. Multidisciplinary management of chronic atopic dermatitis in children and adolescents: a prospective pilot study. J Dermatol Treat. 2022;33:822–8.
doi: 10.1080/09546634.2020.1782321
Resnick SD, Hornung R, Konrad TR. A comparison of dermatologists and generalists. Management of childhood atopic dermatitis. Arch Dermatol. 1996;132:1047–52.
pubmed: 8795544
doi: 10.1001/archderm.1996.03890330061011
Eichenfield LF, Boguniewicz M, Simpson EL, Russell JJ, Block JK, Feldman SR, et al. Translating atopic dermatitis management guidelines into practice for primary care providers. Pediatrics. 2015;136:554–65.
pubmed: 26240216
doi: 10.1542/peds.2014-3678
Rübsam ML, Esch M, Baum E, Bösner S. Diagnosing skin disease in primary care: a qualitative study of GPs’ approaches. Fam Pract. 2015;32:591–5.
pubmed: 26160890
doi: 10.1093/fampra/cmv056
Moreno G, Tran H, Chia AL, Lim A, Shumack S. Prospective study to assess general practitioners’ dermatological diagnostic skills in a referral setting. Australas J Dermatol. 2007;48:77–82.
pubmed: 17535192
doi: 10.1111/j.1440-0960.2007.00340.x
Le Roux E, Powell K, Banks JP, Ridd MJ. GPs’ experiences of diagnosing and managing childhood eczema: a qualitative study in primary care. Br J Gen Pract. 2018;68:e73–80.
pubmed: 29335327
pmcid: 5774966
doi: 10.3399/bjgp18X694529