Atopic Dermatitis

Guidelines for primary care clinicians on monitoring and safety guidelines regarding Janus kinase and tyrosine kinase 2 inhibitors in the treatment of inflammatory skin conditions are often unclear. This review aims to provide the primary care physician with a review of clinically relevant and updated information regarding the monitoring and overall profile of these medications. To do so, a systematic review was conducted using the PubMed database and relevant Food and Drug Administration (FDA) approved drug inserts from manufacturers. Janus kinase and tyrosine kinase 2 inhibitors have recently gained FDA approval for the treatment of several inflammatory skin conditions including atopic dermatitis, plaque psoriasis, alopecia areata, and vitiligo. There is a known box warning associated with the Janus kinase inhibitors that create the need for monitoring and close follow-up while patients are undergoing these treatments. Although these medications are often prescribed by specialists, as their use becomes more prevalent and therapies continue to gain approval for the treatment of these commonly encountered conditions, it is important for the primary physician to be updated and aware of the current monitoring guidelines and safety profile for this class of medication. Both Janus kinase inhibitors and tyrosine kinase 2 inhibitors display significant efficacy in the treatment of their approved conditions and research continues to move forward with the approval of more medications from these classes.

Author/s:

Beard, Abigail, Trotter, Shannon C.

Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE– and Institute of Medicine–based recommendations

Alex Haga — Sun, 11 Aug 2024 18:08:48 +0000

Date Added:

August 11, 2024

Journal/Publication:

Ann Allergy Asthma Immunol

Publication Date:

December 17, 2023

Issue:

Volume:

132

Pages:

274-312

URL:

Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE– and Institute of Medicine–based recommendations

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.anai.2023.11.009

Keywords

allergy

asthma

Atopic Dermatitis

PMID (1):

38108679

MeSH

adrenal cortex hormones

Asthma*

Dermatitis

Atopic* / drug therapy

Eczema*

A 2023 updated guideline for management of patients with atopic dermatitis. James W. Mold, MD, MPH

Free full text

View

Background: Guidance addressing atopic dermatitis (AD) management, last issued in 2012 by the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force, requires updating as a result of new treatments and improved guideline and evidence synthesis methodology.

Objective: To produce evidence-based guidelines that support patients, clinicians, and other decision-makers in the optimal treatment of AD.

Methods: A multidisciplinary guideline panel consisting of patients and caregivers, AD experts (dermatology and allergy/immunology), primary care practitioners (family medicine, pediatrics, internal medicine), and allied health professionals (psychology, pharmacy, nursing) convened, prioritized equity, diversity, and inclusiveness, and implemented management strategies to minimize influence of conflicts of interest. The Evidence in Allergy Group supported guideline development by performing systematic evidence reviews, facilitating guideline processes, and holding focus groups with patient and family partners. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach informed rating the certainty of evidence and strength of recommendations. Evidence-to-decision frameworks, subjected to public comment, translated evidence to recommendations using trustworthy guideline principles.

Results: The panel agreed on 25 recommendations to gain and maintain control of AD for patients with mild, moderate, and severe AD. The eAppendix provides practical information and implementation considerations in 1-2 page patient-friendly handouts.

Conclusion: These evidence-based recommendations address optimal use of (1) topical treatments (barrier moisturization devices, corticosteroids, calcineurin inhibitors, PDE4 inhibitors [crisaborole], topical JAK inhibitors, occlusive [wet wrap] therapy, adjunctive antimicrobials, application frequency, maintenance therapy), (2) dilute bleach baths, (3) dietary avoidance/elimination, (4) allergen immunotherapy, and (5) systemic treatments (biologics/monoclonal antibodies, small molecule immunosuppressants [cyclosporine, methotrexate, azathioprine, mycophenolate, JAK inhibitors], and systemic corticosteroids) and UV phototherapy (light therapy).

Author/s:

AAAAI/ACAAI JTF Atopic Dermatitis Guideline Panel, Derek K Chu, Lynda Schneider, Rachel Netahe Asiniwasis, Mark Boguniewicz

Topical Therapies for Atopic Dermatitis

Rowan Hutchins — Sun, 12 Nov 2023 21:20:37 +0000

Date Added:

November 12, 2023

Journal/Publication:

JAMA

Publisher:

AMA

Publication Date:

October 27, 2023

URL:

Topical Therapies for Atopic Dermatitis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2023.17719

Keywords

Atopic Dermatitis

guidelines

allergy and clinical immunology

PMID (1):

37889498

MeSH

Dermatitis, Atopic

dermatology

Practice Guidelines as Topic / standards*

clinical decision-making

A summary of current topical treatment options for atopic dermatitis. James W. Mold, MD, MPH

Commercial full text (fees may apply)

View

Atopic dermatitis (AD) is a chronic inflammatory skin condition affecting approximately 10% of the US population. AD often occurs as a childhood disease in conjunction with allergies and asthma, but it can also persist into or arise de novo in adulthood. AD negatively affects quality of life, social interactions, and work productivity, with annual US health care costs exceeding $5.3 billion.1 The current guideline provides recommendations on the management of AD in adults with both nonpharmacologic and pharmacologic topical therapies

Author/s:

Amy Z. Xu, Jason T. Alexander

Acupuncture Treatment for Symptom Management in Atopic Dermatitis: A Study Protocol for a Randomized, Participant- and Assessor-Blind, Sham-Controlled Trial

Saige Blanchard — Wed, 05 May 2021 05:00:00 +0000

Date Added:

May 5, 2021

Journal/Publication:

Evidence-based Complementary and Alternative Medicine

Publication Date:

May 2, 2019

URL:

Acupuncture Treatment for Symptom Management in Atopic Dermatitis: A Study Protocol for a Randomized, Participant- and Assessor-Blind, Sham-Controlled Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

https://doi.org/10.1155/2019/1907578

Keywords

PMID (1):

31186656

MeSH

I would never have imagined that acupuncture could help patients with atopic dermatitis, but it looks like it can.

James W. Mold, MD, MPH

Free full text

View

Atopic dermatitis (AD) is a chronic inflammatory skin disease with persistent itching, which impairs quality of life (QoL). Although various conventional treatments for AD exist, patients with AD often seek complementary and alternative therapies when conventional therapy has failed to relieve their AD symptoms or has had adverse effects. Acupuncture treatment may relieve AD symptoms, but controlled trials are needed to confirm this. Following our pilot study, which found that acupuncture treatment improves AD symptoms in mild-to-moderate AD patients, we will assess the effect of acupuncture treatment for symptom relief of AD using a trial with a complemented protocol. This is a two-arm, randomized, participant- and assessor-blinded, sham-controlled trial. A total of 36 mild-to-moderate AD patients will be randomly assigned in a 1:1 ratio to receive eight sessions twice weekly of either verum acupuncture (VA) or nonpenetrating sham acupuncture (SA) over four weeks. The primary outcome measured will be the change in the total Scoring Atopic Dermatitis (SCORAD) score. Secondary outcomes will be (1) changes in AD symptoms, QoL, dyspepsia symptoms, and electroencephalography (EEG) between baseline and week 4 and (2) changes in AD symptoms and QoL at baseline and at weeks 2, 4, and 8. This study will assess acupuncture treatment for the alleviation of AD symptoms in patients with mild-to-moderate AD. This clinical trial gas been registered in Korean Clinical Trial Registry (registration number: KCT0002796; date of registration: April 13, 2018).

Author/s:

Park. J. G., Park, H.J., Chae, Y., Kim, Y., Lee, H., Kim, K.