Consensus Guidelines for the Treatment of Atopic Dermatitis in Korea (Part II): Systemic Treatment

Kim, Jung Eun; Kim, Hyun Jeong; Lew, Bark Lynn; Lee, Kyung Ho; Hong, Soon-Tae; Jang, Yong Hyun; Park, Kui Young; Seo, Seong Jun; Bae, Jung Min; Choi, Eung Ho; Suhr, Ki Beom; Lee, Seung−Chul; Ko, Hyun Chang; Park, Young Lip; Son, Sang Wook; Seo, Young‐Joon; Lee, Yang Won; Cho, Sang Hyun; Park, Chun Wook; Roh, Joo Young

doi:10.5021/ad.2015.27.5.578

Cited by 53 publications

(60 citation statements)

References 78 publications

(127 reference statements)

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“…In clinical practice guidelines and position statements concerning the management of atopic dermatitis (AD), the use of systemic corticosteroids (CS), including prednisone, hydrocortisone and celestone, is generally discouraged, with use limited to special circumstances (Table ) . While systemic CS can lead to rapid clearing of AD, their side‐effect profile and the risk of severe rebound flares after discontinuation limit their use …”

Section: Approach To Systemic Corticosteroid (Cs) Use In Atopic Dermamentioning

confidence: 99%

Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement

et al. 2018

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SummaryBackgroundGuidelines discourage the use of systemic corticosteroids for atopic dermatitis (AD), but their use remains widespread.ObjectivesTo reach consensus among an international group of AD experts on the use of systemic corticosteroids for AD.MethodsA survey consisting of statements accompanied by visual analogue scales ranging from ‘strongly disagree’ to ‘neutral’ to ‘strongly agree’ was distributed to the International Eczema Council (IEC). Consensus was reached in agreement on a statement if < 30% of respondents marked to the left of ‘neutral’ towards ‘strongly disagree’.ResultsSixty of 77 (78%) IEC members participated. Consensus was reached on 12 statements, including that systemic corticosteroids should generally be avoided but can be used rarely for severe AD under certain circumstances, including a lack of other treatment options, as a bridge to other systemic therapies or phototherapy, during acute flares in need of immediate relief, in anticipation of a major life event or in the most severe cases. If used, treatment should be limited to the short term. Most respondents agreed that systemic corticosteroids should never be used in children, but consensus was not reached on that statement. The conclusions of our expert group are limited by a dearth of high‐quality published evidence. If more stringent consensus criteria were applied (e.g. requiring < 20% of respondents marking towards ‘strongly disagree’), consensus would have been reached on fewer statements.ConclusionsBased on expert opinion from the IEC, routine use of systemic corticosteroids for AD is generally discouraged and should be reserved for special circumstances.

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Section: Approach To Systemic Corticosteroid (Cs) Use In Atopic Dermamentioning

confidence: 99%

Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement

et al. 2018

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“…All guidelines either recommend against or do not mention the use of oral antivirals unless there are clinical signs of eczema herpeticum, coxsackium, or molluscum contagiosum infection. Several guidelines recommend antifungal treatment in cases of “head and neck” dermatitis from Malassezia infection, colonization, and hypersensitivity . Several guidelines also recommend obtaining a culture when infection is recurrent or resistant to treatment.…”

Section: Resultsmentioning

confidence: 99%

“…All but the South African guidelines recommend MTX when symptoms are refractory to cyclosporine . Generally, doses of 7.5‐25 mg/wk are recommended for adults, and doses of 0.2‐0.7 mg/kg/wk are recommended for pediatric patients …”

Section: Resultsmentioning

confidence: 99%

“…Mycophenolate mofetil (MMF), similar to azathioprine and methotrexate, is used off‐label to treat AD . Many guidelines recommend MMF as a second‐line therapy for refractory disease . The Asia‐Pacific, Korean, Taiwanese, South African, German, and European guidelines recommend up to 2 g/d in adult patients …”

Section: Resultsmentioning

confidence: 99%

“…Interferon‐gamma (IFN‐γ) is used off‐label for the treatment of AD . A few guidelines recommend exogenous IFN‐γ in severe cases refractory to other systemic therapies or phototherapy . Dosage recommendations are lacking.…”

Section: Resultsmentioning

confidence: 99%

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A comparison of international management guidelines for atopic dermatitis

LePoidevin

Lee

Shi

2018

Pediatric Dermatology

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Background/Objectives Atopic dermatitis (AD) is a chronic condition that is predominantly found in pediatric patients and commonly presents therapeutic challenges. The management of AD encompasses a variety of factors, and the pillars of optimal management revolve around skin barrier repair and antiinflammatory, antimicrobial, and antipruritic treatment. AD management guidelines exist in various geographic regions globally. The purpose of this review was to compare international guidelines to highlight the similarities and variances among populations and skin types. Comparisons were made for recommendations regarding moisturization, bathing, wet wrap therapy, topical corticosteroids, topical calcineurin inhibitors, antihistamines, antipruritics, antibiotics, systemic immunosuppressants, and biologics. Methods A literature search of the PubMed, EMBASE, and MEDLINE databases was performed for published guidelines in each geographic region. Inclusion criteria included publications available in English that were established by a dermatological association or group including dermatologists, pertained to the treatment of AD in humans, were the most recent guidelines available that were published between 2007 and 2018, and included comprehensive treatment recommendations. Results Publications from Europe, North America, Asia, the Asia‐Pacific region, Australia, and Africa were reviewed, encompassing 14 guidelines. Notable diversity exists across these guidelines regarding recommendations for moisturization and bathing, as well as topical and systemic therapies for AD. Conclusions Due to the heterogeneity of the disease and regional treatment accessibility, complete standardization of AD management guidelines may be difficult. Nevertheless, more consensus on management guidelines is needed, and recommendations should be updated as new treatment modalities become available.

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Association of Pediatric Atopic Dermatitis and Cataract Development and Surgery

et al. 2018

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IMPORTANCE There is a paucity of data addressing the risk of cataract development in pediatric patients with atopic dermatitis (AD). OBJECTIVE To investigate the association of AD with subsequent cataract development and cataract surgery in a Korean pediatric population. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective longitudinal cohort study used nationally representative data from the Korean National Health Insurance Service database from 2002 to 2013. Incident AD cases, consisting of patients younger than 20 years with AD and severe AD and were matched to 4 controls each using propensity score derived from age, sex, residential area, and household income.MAIN OUTCOMES AND MEASURES Incidence probabilities of cataract development and cataract surgery between the AD group and controls were compared using Kaplan-Meier methods and log-rank tests. Cox proportional hazard models were fitted for cataract and cataract surgery to determine the risk factors in the matched cohort. RESULTSOf 34 375 patients with incident AD (16 159 girls [47%]; mean [SD] age, 3.47 [4.96] years), there were 3734 severe AD cases (10.9%) with 137 500 matched controls. Development of cataracts was not different between the AD and control groups, (0.216% vs 0.227%; 95% CI, −0.041% to 0.063%; P = .32) or between the severe AD cohort and their controls (0.520% vs 0.276%; 95% CI, −0.073% to 0.561%; P = .06). Cataract surgery was performed more frequently in the AD cohort than in the control group (0.075% vs 0.041%; 95% CI, 0.017%-0.050%; P = .02) and in the severe AD cohort compared with their controls (0.221% vs 0.070%; 95% CI, 0.021%-0.279%; P = .03). Severe AD was associated with both development of cataract (adjusted hazard ratio, 1.94; 95% CI, 1.06-3.58, P = .03) and requirement for cataract surgery (adjusted hazard ratio, 5.48; 95% CI, 1.90-15.79, P = .002).CONCLUSIONS AND RELEVANCE Absolute risk of cataract was rare, with or without AD, even after 10 years of observation. However, our results suggest that pediatric patients with AD have an increased risk for cataracts requiring surgery and that disease severity may increase the risk for cataract development and cataract surgery. JAMA Ophthalmol. 2018;136(8):912-918.

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Consensus Guidelines for the Treatment of Atopic Dermatitis in Korea (Part II): Systemic Treatment

Cited by 53 publications

References 78 publications

Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement

Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement

A comparison of international management guidelines for atopic dermatitis

Association of Pediatric Atopic Dermatitis and Cataract Development and Surgery

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