Search

Background: The summarized guidelines update the 2014 recommendations for the management of AD with phototherapy and systemic therapies., Methods: A multidisciplinary workgroup conducted a systematic review and applied the GRADE approach for assessing the certainty of the evidence and formulating and grading recommendations., Results: The workgroup developed 11 recommendations on the management of AD in adults with phototherapy and systemic therapies, including biologics, oral Janus Kinase inhibitors, and other immunomodulatory medications., Conclusions: The evidence supported strong recommendations for the use of dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib and conditional recommendations in favor of using phototherapy, azathioprine, cyclosporine, methotrexate, and mycophenolate, and against the use of systemic corticosteroids., Competing Interests: Conflict of interest The American Academy of Dermatology (AAD) strives to produce clinical guidelines that reflect the best available evidence supplemented with the judgment of expert clinicians. Significant efforts are taken to minimize the potential for conflicts of interest to influence guideline content. The management of conflict of interest for this guideline complies with the Council of Medical Specialty Societies' Code of Interactions with Companies. Funding of guideline production by medical or pharmaceutical entities is prohibited, full disclosure is obtained and evaluated for all guideline contributors throughout the guideline development process, and recusal is used to manage identified relationships. The AAD conflict of interest policy summary may be viewed at www.aad.org., (Copyright © 2023 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: For people with atopic dermatitis (AD) refractory to topical therapies, treatment with phototherapy and systemic therapies can be considered. Multiple biologic therapies and Janus kinase (JAK)inhibitors have been approved since 2014 to treat AD. These guidelines update the 2014 recommendations for management of AD with phototherapy and systemic therapies., Objective: To provide evidence-based recommendations on the use of phototherapy and systemic therapies for AD in adults., Methods: A multidisciplinary workgroup conducted a systematic review and applied the GRADE approach for assessing the certainty of evidence and formulating and grading recommendations., Results: The workgroup developed 11 recommendations on the management of AD in adults with phototherapy and systemic agents, including biologics, oral JAK inhibitors, and other immunomodulatory medications., Limitations: Most randomized controlled trials of phototherapy and systemic therapies for AD are of short duration with subsequent extension studies, limiting comparative long-term efficacy and safety conclusions., Conclusions: We make strong recommendations for the use of dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib. We make conditional recommendations in favor of using phototherapy, azathioprine, cyclosporine, methotrexate, and mycophenolate, and against the use of systemic corticosteroids., Competing Interests: Conflicts of interest Dr Drucker receives research grants paid to his institution from the National Eczema Association, Eczema Society of Canada, Canadian Dermatology Foundation, Canadian Institutes for Health Research, US National Institutes of Health, and Physician Services Incorporated Foundation. Dr Cohen serves on the board of directors for Timber and Evommune receiving stock options and/or fees; as a consultant for Asana Biosciences, Ferndale Laboratories, Inc, Novartis, Facilitation of International Dermatology Education, Dermavant Sciences, Leo Pharma, Inc, UCB, and Cosmetic Ingredient Review receiving honoraria and/or stock options. Dr Eichenfield serves on the board of directors for Forte Biosciences and Verrica Pharmaceuticals, Inc, receiving honoraria and/or stock options; as an investigator for AbbVie, Arcutis, Dermavant, Galderma Laboratories, Pfizer, and Bausch receiving research grants, fees, and/or honoraria; as a consultant for AbbVie, Almirall, Arcutis, Asana, Dermavant, Eli Lilly, Galderma, Ichnos/Glenmark, Incyte, Janssen, Leo Pharma, Novartis, Ortho Dermatologics, Otsuka, Pfizer, Regeneron, and Sanofi Genzyme, honoraria; as an independent contractor for Elsevier, Inc receiving royalties. Dr Paller serves as a consultant for Abbvie, Abeona, Almirall, Amagma, Anaptysbio, Arena, Bausch, Bristol Myer Squibb, Dermavant, Dermira, Eli Lilly, Exicure, Forte, Leo, Lifemax, Novartis, Phoenix, Pierre Fabre, Pfizer, Rapt, Regeneron, Sanofi, Sol-Gel, UCB, and Venthera receiving honoraria; as an investigator for Anaptysbio, Eli Lilly, Incyte, Janssen, Krystal Bio, Lenus, Regeneron, and UCB receiving no compensation. Dr Schwarzenberger is the founder of Pretel, Inc and serves as a data safety monitoring board member for Pfizer, Inc receiving fees. Dr Sidbury serves as an advisory board member for Pfizer, Inc receiving honoraria; as a principal investigator for Regeneron receiving grants and research funding; as an investigator for Brickell Biotech, Inc, and Galderma USA receiving grants and research funding; as a consultant for Galderma Global and Microes receiving fees or no compensation. Dr Silverberg serves as an advisory board member for BioMX, Boehringer Ingelheim, RAPT Therapeutics, Celgene, Ortho Dermatologics, TARGET Pharma, AFYX Therapeutics, Corrona, Inc, Dermira, Pfizer, Inc, Leo Pharma, Inc, and Menlo Therapeutics receiving honoraria and/or fees; as an investigator for DS Pharma, TARGET Pharma, Kiniksa Pharmaceuticals, Ltd, Menlo Therapeutics, GlaxoSmithKline, AbbVie, Leo Pharma, Inc, and Regeneron receiving research funding, honoraria, or no compensation; as a consultant for AOBiome, Bluefin Biomedicine, Bodewell, BiomX, Inc, Galderma Research & Development, LLC, Arena Pharmaceuticals, Dermavant Sciences, Incyte Corporation, DS Biopharma, Sun Pharmaceutical Industries, Ltd, AnaptysBio, Asana Biosciences, LLC, Pfizer, Inc, Glenmark Generics, Inc, Sanofi, Kiniksa Pharmaceuticals, Ltd, GlaxoSmithKlein, Eli Lilly and Company, AbbVie, Regeneron, and Medimmune receiving honoraria or fees; as a speaker for the Fall Clinical Dermatology Conference, Maui Derm, and Regeneron receiving honoraria or fees. Dr Singh serves as an advisory board member for Incyte receiving honoraria. DR Wu is an author for UpToDate, Inc receiving honoraria. Dr Davis, Dr Alikhan, Dr Bercovitch, Athor Darr, and Dr Frazer-Green have no conflicts of interest to declare., (Copyright © 2023 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: New evidence has emerged since the 2014 guidelines that further informs the management of atopic dermatitis (AD) with topical therapies. These guidelines update the 2014 recommendations for management of AD with topical therapies., Objective: To provide evidence-based recommendations related to management of AD in adults using topical treatments., Methods: A multidisciplinary workgroup conducted a systematic review and applied the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach for assessing the certainty of evidence and formulating and grading recommendations., Results: The workgroup developed 12 recommendations on the management of AD in adults with topical therapies, including nonprescription agents and prescription topical corticosteroids (TCS), calcineurin inhibitors (TCIs), Janus kinase (JAK) inhibitors, phosphodiesterase-4 inhibitors (PDE-4), antimicrobials, and antihistamines., Limitations: The pragmatic decision to limit the literature review to English-language randomized trials may have excluded data published in other languages and relevant long-term follow-up data., Conclusions: Strong recommendations are made for the use of moisturizers, TCIs, TCS, and topical PDE-4 and JAK inhibitors. Conditional recommendations are made for the use of bathing and wet wrap therapy and against the use of topical antimicrobials, antiseptics, and antihistamines., Competing Interests: Conflicts of interest David E. Cohen∗, MD, MPH serves on the board of directors for Timber and Evommune receiving stock options and/or fees and as a consultant for Asana Biosciences, Ferndale Laboratories, Inc, Novartis, Facilitation of International Dermatology Education, Dermavant Sciences, Leo Pharma, Inc, UCB, and Cosmetic Ingredient Review receiving honoraria and/or stock options. Lawrence F. Eichenfield∗, MD serves on the board of directors for Forte Biosciences and Verrica Pharmaceuticals, Inc, receiving honoraria and/or stock options; as an investigator for Abbvie, Arcutis, Dermavant, Galderma Laboratories, Pfizer, and Bausch, receiving research grants, fees, and/or honoraria; as a consultant for Abbvie, Almirall, Arcutis, Asana, Dermavant, Eli Lilly, Galderma, Ichnos/Glenmark, Incyte, Janssen, Leo Pharma, Novartis, Ortho Dermatologics, Otsuka, Pfizer, Regeneron, and Sanofi Genzyme, honoraria; and as an independent contractor for Elsevier, Inc receiving royalties. Amy S. Paller∗, MD serves as a consultant for Abbvie, Abeona, Almirall, Amagma, Anaptysbio, Arena, Bausch, Bristol Myer Squibb, Dermavant, Dermira, Eli Lilly, Exicure, Forte, Leo, Lifemax, Novartis, Phoenix, Pierre Fabre, Pfizer, Rapt, Regeneron, Sanofi, Sol-Gel, UCB, and Venthera receiving honoraria; and as an investigator for Anaptysbio, Eli Lilly, Incyte, Janssen, Krystal Bio, Lenus, Regeneron, and UCB receiving no compensation. Kathryn Schwarzenberger, MD is the founder of Pretel, Inc and serves as a data safety monitoring board member for Pfizer, Inc receiving fees. Robert Sidbury∗, MD serves as an advisory board member for Pfizer, Inc receiving honoraria; as a principal investigator for Regeneron receiving grants and research funding; as an investigator for Brickell Biotech, Inc, and Galderma USA receiving grants and research funding; and as a consultant for Galderma Global and Microes receiving fees or no compensation. Jonathan I. Silverberg∗, MD, PhD, MPH serves as an advisory board memberfor BioMX, Boehringer Ingelheim, RAPT Therapeutics, Celgene, Ortho Dermatologics, TARGET Pharma, AFYX Therapeutics, Corrona, Inc, Dermira, Pfizer, Inc, Leo Pharma, Inc, and Menlo Therapeutics receiving honoraria and/or fees; as an investigator for DS Pharma, TARGET Pharma, Kiniksa Pharmaceuticals, Ltd, Menlo Therapeutics, GlaxoSmithKline, AbbVie, Leo Pharma, Inc, and Regeneron receiving research funding, honoraria, or no compensation; as a consultant for AOBiome, Bluefin Biomedicine, Bodewell, BiomX, Inc, Galderma Research & Development, LLC., Arena Pharmaceuticals, Dermavant Sciences, Incyte Corporation, DS Biopharma, Sun Pharmaceutical Industries, Ltd, AnaptysBio, Asana Biosciences, LLC., Pfizer, Inc, Glenmark Generics, Inc, Sanofi, Kiniksa Pharmaceuticals, Ltd, GlaxoSmithKlein, Eli Lilly and Company, AbbVie, Regeneron, and Medimmune receiving honoraria or fees; and as a speaker for the Fall Clinical Dermatology Conference, Maui Derm, and Regeneron receiving honoraria or fees. Anne Marie Singh, MD as a consultant for Abbvie. Peggy Wu, MD serves as an author for UpToDate, Inc receiving honoraria. Drs. Alikhan, Bercovitch, Davis, and Frazer-Green, and Jennifer M. Darr, LCSW have no relationships to disclose., (Copyright © 2023 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

These guidelines update the 2014 recommendations for management of atopic dermatitis in adults with topical therapies. A multidisciplinary workgroup employed best practices for guideline development, including a systematic review of the evidence and application of the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of the evidence and formulating and grading recommendations. The evidence on atopic dermatitis treatment supported strong recommendations for the use of nonprescription moisturizers, topical calcineurin inhibitors, topical corticosteroids, and topical PDE-4 and JAK inhibitors. Conditional recommendations are made for the use of bathing and wet wrap therapy and against the use of topical antimicrobials, antiseptics, and antihistamines., Competing Interests: Conflict of Interest The American Academy of Dermatology (AAD) strives to produce clinical guidelines that reflect the best available evidence supplemented with the judgment of expert clinicians. Significant efforts are taken to minimize the potential for conflicts of interest to influence guideline content. The management of conflict of interest for this guideline complies with the Council of Medical Specialty Societies' Code of Interactions with Companies. Funding of guideline production by medical or pharmaceutical entities is prohibited, full disclosure is obtained and evaluated for all guideline contributors throughout the guideline development process, and recusal is used to manage identified relationships. The AAD conflict of interest policy summary may be viewed at www.aad.org., (Copyright © 2023 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Studies found associations between atopic dermatitis (AD) and various comorbidities., Objective: To appraise evidence of the association between AD and comorbidities among adults., Methods: Our multidisciplinary work group conducted a systematic review of the association between AD and selected comorbidities. We applied the Grading of Recommendations, Assessment, Development, and Evaluation for prognosis approach for assessing the certainty of the evidence, providing statements of association based on the available evidence., Results: Analysis of the evidence resulted in 32 statements. Clear evidence of the association of AD in adults and select allergic, atopic, immune-mediated mental health and bone health conditions and skin infections was identified. There is some evidence supporting an association between AD and substance use, attention deficit hyperactivity disorder, and elements of metabolic syndrome. Evidence suggests a small association with various cardiovascular conditions. The association between AD in adults and autism spectrum disorders, myocardial infarction, stroke, and metabolic syndrome is inconclusive., Limitations: This analysis is based on the best available evidence at the time it was conducted. This guideline does not make recommendations for screening or management of comorbidities in adults with AD., Conclusions: Clinicians should be aware of comorbidities associated with AD. Further research is needed to determine whether screening or management of comorbidities is beneficial for adults with AD., (Copyright © 2022 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)