Systemic Therapy for Atopic Dermatitis in Children and Adolescents: A US Expert Consensus

Dermatology. 2024;240(5-6):897-909. doi: 10.1159/000540920. Epub 2024 Oct 15.

Abstract

Atopic dermatitis (AD) is a chronic, type-2 mediated, inflammatory skin disease characterized by intense pruritus, disruption of skin barrier function, and immune dysregulation. Management strategies for AD are routinely determined based on disease severity. First-line treatment begins with basic skin care and topical anti-inflammatory medication, which is typically sufficient for the management of mild-to-moderate disease. For those patients with moderate-to-severe disease, systemic therapy is often required. This can involve off-label treatment with conventional immunosuppressant medications. However, this approach is limited by a lack of robust clinical trial data and safety concerns that necessitate close monitoring. The emergence of novel targeted biologics and small molecules to treat AD presents an opportunity to optimize AD management and patient outcomes by offering greater efficacy than traditional immunosuppressants and a favorable safety profile. As the treatment landscape shifts, clinicians can benefit from a standardized process of patient assessment and treatment, along with resources to help maintain contemporary knowledge of available therapeutic options. This US-based, expert-led consensus used a modified Delphi process to develop core recommendations for the use of systemic medications for the management of pediatric patients <18 years of age with moderate-to-severe AD.

Keywords: Alternative systemic therapy; Conventional systemic therapy; Pediatric atopic dermatitis; Systemic therapy; Topical therapy.

Publication types

  • Consensus Development Conference
  • Practice Guideline

MeSH terms

  • Adolescent
  • Child
  • Consensus*
  • Delphi Technique
  • Dermatitis, Atopic* / drug therapy
  • Dermatologic Agents / therapeutic use
  • Humans
  • Immunosuppressive Agents* / therapeutic use
  • Severity of Illness Index
  • United States

Substances

  • Immunosuppressive Agents
  • Dermatologic Agents

Grants and funding

The consensus development was funded by Sanofi and Regeneron. Sanofi and Regeneron had no role in the development of the consensus recommendations; collection, management, analysis, and interpretation of the literature; and preparation, review, or approval of the manuscript. The authors received no financial compensation for the development and publication of this article. Medical writing support was provided by Lucid Group and funded by Sanofi, Cambridge MA, USA and Regeneron, in accordance with Good Publication Practice 2022 (GPP 2022) guidelines.