Systemic Treatments for Atopic Dermatitis in Children and Adolescents: Review of Current Practice and New Treatments

Abstract

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease in children. The onset is before the age of 5 in at least 85% of patients. [1] It is often associated with other atopic conditions including asthma, allergic rhinoconjunctivitis, food allergies, and eosinophilic esophagitis. [1] AD has a substantial impact on patients and carers' physical and mental health. [2] Furthermore, AD imposes a significant economic burden on patients, families, and society. One systematic review estimated the average direct cost of AD to be 4,411 USD, while the average indirect cost to be 9,068 USD annually. [3] Most patients are appropriately managed with topical treatments including emollients, topical corticosteroids (TCS), and topical calcineurin inhibitors (TCI) and in areas with availability narrow-band phototherapy can be utilized. However, management of severe AD unresponsive to standard topical treatments can be challenging.Until recently, systemic treatments of AD were mainly restricted to broad-spectrum immunosuppressant agents, including ciclosporin, azathioprine, and methotrexate. However, since the approval of dupilumab in 2017, the landscape of AD dermatitis systemic treatment has remarkably expanded with the addition of other targeted agents in the field.