Expert consensus on the systemic treatment of atopic dermatitis in special populations

Abstract

With the increasing number of options for the treatment of moderate-to-severe atopic dermatitis, clinicians need guidance on a practical approach to selecting a systemic agent for specific patient populations. We convened an expert panel consisting of 12 members to conduct a literature review and summarize relevant data related to six scenarios of clinical interest: comorbid asthma, ocular surface disease, history of cancer, past and ongoing infections of interest (including herpes simplex virus, herpes zoster, hepatitis B, and tuberculosis), pregnancy and lactation, and the elderly. We performed a literature search and examined each clinical scenario with | 1143 ADAM et al.

Dupilumab-Associated Lymphoid Reactions in Patients With Atopic Dermatitis

“…So, as dupilumab treatment might reveal a misdiagnosed MF, histopathologic evaluation including IHC is advised in specific patients (eg, late-onset AD, nonatopic elderly with an atypical and/or severe [progressive] presentation). [24][25][26]…”

“…We hypothesize that these benign LRs may evolve into CTCL if dupilumab treatment is not permanently stopped. So, as dupilumab treatment might reveal a misdiagnosed MF, histopathologic evaluation including IHC is advised in specific patients (eg, late-onset AD, nonatopic elderly with an atypical and/or severe [progressive] presentation) …”

How to Understand Personalized Medicine in Atopic Dermatitis Nowadays?

“…The next important point is how fast/early and how widely to commence treatment to stop the disease and comorbidities, and how long to continue treatment. For example, in the case of dupilumab, it is the only drug with a proven efficacy in asthma and AD; therefore, this treatment may be preferred for patients presenting with a coexistence of these two diseases [105]. Furthermore, dupilumab has the most data supporting its use in elderly populations [105].…”

“…For example, in the case of dupilumab, it is the only drug with a proven efficacy in asthma and AD; therefore, this treatment may be preferred for patients presenting with a coexistence of these two diseases [105]. Furthermore, dupilumab has the most data supporting its use in elderly populations [105]. Should we also search for clinical or immunological markers to indicate the AD subgroup that may potentially need short-term or long-term treatment?…”

Switching from dupilumab to tralokinumab in patients with atopic dermatitis due to inefficacy or side effects

“…11 Nevertheless, based on experts' opinion and the mechanism of advanced therapy, there are some Commentary Switching from dupilumab to tralokinumab circumstances in which switching from dupilumab to tralokinumab might be a safer option, such as cases of cancer, hepatitis B virus infection, untreated latent tuberculosis, and elderly. 3,12 On the other hand, dupilumab related side effects like conjunctivitis, H-N dermatitis, or psoriasiform eruptions are believed to be caused by the inhibition of Th2 and the skew to Th1 and Th17. These changes hamper the proliferation of goblet cells and induce the colonization of demodex leading to conjunctivitis, H-N dermatitis, and psoriasiform lesions.…”