Treat‐to‐target in dermatology: A scoping review and International Eczema Council survey on the approach in atopic dermatitis

Abstract

Treat‐to‐Target (T2T) is a pragmatic therapeutic strategy being gradually introduced into dermatology after adoption in several other clinical areas. Atopic dermatitis (AD), one of the most common inflammatory skin diseases, may also benefit from this structured and practical therapeutic approach. We aimed to evaluate existing data regarding the T2T approach in dermatology, with a specific focus on AD, as well as the views of International Eczema Council (IEC) members on the potential application of a T2T approach to AD management. To do so, we systematically searched for peer‐reviewed publications on the T2T approach for any skin disease in the PubMed and Scopus databases up to February 2022 and conducted a survey among IEC members regarding various components to potentially include in a T2T approach in AD.We identified 21 relevant T2T‐related reports in dermatology, of which 14 related to psoriasis, five to AD, one for juvenile dermatomyositis and one for urticaria. In the IEC member survey, respondents proposed treatable traits (with itch, disease severity, and sleep problems getting the highest scores), relevant comorbidities (with asthma being selected most commonly, followed by anxiety and depression in adults), recommended specialists that should define the approach in AD (dermatologists, allergists, and primary care physicians were most commonly selected in adults), and applicable assessment tools (both physician‐ and patient‐reported), in both adult and pediatric patients, for potential future utilization of the T2T approach in AD.In conclusion, while the T2T approach may become a useful tool to simplify therapeutic goals and AD management, its foundation in AD is only starting to build. A multidisciplinary approach, including a wide range of stakeholders, including patients, is needed to further define the essential components needed to utilize T2T in AD.

Characterization of High and Low IFNG-Expressing Subgroups in Atopic Dermatitis

“…Additionally, in line with our findings in the high IFNG AD group, Th1/type 1-associated cytokines were identified in the adult- compared to the pediatric-onset AD cohort, in chronic compared to acute AD, and in intrinsic compared to extrinsic AD [ 38 , 39 , 40 , 41 ]. Furthermore, the PCA of the low IFNG AD group revealed less separation between the lesional and non-lesional transcriptome in comparison to the high IFNG group, which might be explained by a strong alteration of healthy skin in extrinsic AD [ 42 , 43 , 44 ]. Moreover, in the low IFNG AD group, a significant reduction was observed in lipid production (glycerolipid metabolic process), a hallmark of the impaired barrier characteristic of extrinsic AD [ 41 , 45 , 46 ].…”

A Multidisciplinary Approach Is Beneficial in Atopic Dermatitis

“…Studies show that treat-to-target approach could simplify the management and raise the bar of the therapeutic goals in the disease [ 41 ]. Moreover, such strategy has the potential to optimise short- and long-term patient outcomes, although studies that investigate this possibility are still ongoing [ 42 ].…”

“…In the case of AD, the multidisciplinary teams must be coordinated by a dermatologist, as only specialists from this clinical speciality have the skills needed to diagnose AD, which is a skin condition, and define the patient’s treatment targets [ 3 , 41 ]. The work of a multidisciplinary team has to result in an agreed treatment plan, avoid contradictory advice and lead to better control of AD and its co-morbidities.…”