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J Allergy Clin Immunol Pract. 2017 Nov - Dec;5(6):1519-1531. doi: 10.1016/j.jaip.2017.08.005. Epub 2017 Sep 29.

Expert Perspectives on Management of Moderate-to-Severe Atopic Dermatitis: A Multidisciplinary Consensus Addressing Current and Emerging Therapies.

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Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, Denver, Colo. Electronic address:
Department of Dermatology, Skin of Color Center, Mount Sinai St Luke's and Mount Sinai West, New York, NY.
Department of Dermatology, University of Rochester Medical Center, Rochester, NY.
National Eczema Association, San Rafael, Calif.
Departments of Dermatology and Pediatrics, University of California, San Diego, Calif; Rady Children's Hospital San Diego, San Diego, Calif.
Section of Allergy and Clinical Immunology, Department of Medicine, NYU Winthrop-University Hospital, Mineola, NY.
Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY.
Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill.
Department of Dermatology, Eastern Virginia Medical School and Virginia Clinical Research, Inc, Norfolk, Va.
Departments of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Ill.


Atopic dermatitis (AD) is a common, chronic, relapsing, inflammatory skin disease that affects children and adults. Until recently, the only Food and Drug Administration-approved systemic treatment option for patients with moderate-to-severe AD was systemic steroids, which are not recommended by current guidelines and are commonly associated with disease rebound. Instead, clinicians choose from several off-label immunosuppressants, which can have serious adverse effects. A significant number of these patients go untreated. Research on the immunopathogenesis of AD has paved the way for new, targeted, systemic therapies for moderate-to-severe AD. In early 2017, the Food and Drug Administration approved dupilumab for adults with moderate-to-severe AD whose disease is not adequately controlled with topical therapies. Although the national guidelines can be very helpful to clinicians, the process for updating them does not allow for timely incorporation of novel therapies. A steering committee of AD experts, including dermatologists, allergists, and a patient advocacy group representative, developed recommendations on the basis of a literature review and expert opinion to help clinicians understand how new therapies fit into the current treatment paradigm and to provide practical recommendations for assessing AD severity, treatment response, and treatment failure.


Allergy; Atopic dermatitis; Diagnosis; Eczema; Recommendations; Treatment

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