When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council

Eric L. Simpson*, Marjolein Bruin-Weller, Carsten Flohr, Michael R. Ardern-Jones, Sebastien Barbarot, Mette Deleuran, Thomas Bieber, Christian Vestergaard, Sara J. Brown, Michael J. Cork, Aaron M. Drucker, Lawrence F. Eichenfield, Regina Foelster-Holst, Emma Guttman-Yassky, Audrey Nosbaum, Nick J. Reynolds, Jonathan I. Silverberg, Jochen Schmitt, Marieke M.B. Seyger, Phyllis I. SpulsJean Francois Stalder, John C. Su, Roberto Takaoka, Claudia Traidl-Hoffmann, Jacob P. Thyssen, Jorien van der Schaft, Andreas Wollenberg, Alan D. Irvine, Amy S. Paller

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

173 Scopus citations


Background: Although most patients with atopic dermatitis (AD) are effectively managed with topical medication, a significant minority require systemic therapy. Guidelines for decision making about advancement to systemic therapy are lacking. Objective: To guide those considering use of systemic therapy in AD and provide a framework for evaluation before making this therapeutic decision with the patient. Methods: A subgroup of the International Eczema Council determined aspects to consider before prescribing systemic therapy. Topics were assigned to expert reviewers who performed a topic-specific literature review, referred to guidelines when available, and provided interpretation and expert opinion. Results: We recommend a systematic and holistic approach to assess patients with severe signs and symptoms of AD and impact on quality of life before systemic therapy. Steps taken before commencing systemic therapy include considering alternate or concomitant diagnoses, avoiding trigger factors, optimizing topical therapy, ensuring adequate patient/caregiver education, treating coexistent infection, assessing the impact on quality of life, and considering phototherapy. Limitations: Our work is a consensus statement, not a systematic review. Conclusion: The decision to start systemic medication should include assessment of severity and quality of life while considering the individual's general health status, psychologic needs, and personal attitudes toward systemic therapies.

Original languageEnglish (US)
Pages (from-to)623-633
Number of pages11
JournalJournal of the American Academy of Dermatology
Issue number4
StatePublished - Oct 2017


  • atopic dermatitis
  • azathioprine
  • biologic
  • consensus statement
  • cyclosporine
  • eczema
  • methotrexate
  • quality of life
  • systemic therapy

ASJC Scopus subject areas

  • Dermatology


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