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Systemic Agents for Severe Atopic Dermatitis in Children

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Abstract

Atopic dermatitis (AD), or eczema, is a chronic inflammatory skin condition characterized by relapsing pruritic, scaly, erythematous papules and plaques frequently associated with superinfection. The lifelong prevalence of AD is over 20 % in affluent countries. When a child with severe AD is not responding to optimized topical therapy including phototherapy, and relevant triggers cannot be identified or avoided, systemic therapy should be considered. If studies show early aggressive intervention can prevent one from advancing along the atopic march, and relevant triggers such as food allergies cannot be either identified or avoided, systemic therapy may also play a prophylactic role. Though the majority of evidence exists in adult populations, four systemic non-specific immunosuppressive or immunomodulatory drugs have demonstrated efficacy in AD and are used in most patients requiring this level of intervention regardless of age: cyclosporine, mycophenolate mofetil, methotrexate, and azathioprine. This article reviews the use of these medications as well as several promising targeted therapies currently in development including dupilumab and apremilast. We briefly cover several other systemic interventions that have been studied in children with atopic dermatitis.

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Authors and Affiliations

  1. Dermatology Division, Seattle Children’s Hospital, University of Washington School of Medicine, 2480 Birch Ave N #1105, Seattle, WA, 98109, USA

    Eliza R. Notaro

  2. Dermatology Division, Seattle Children’s Hospital, OC.9.835-Dermatology, 4800 Sand Point Way NE, Seattle, WA, 98105, USA

    Robert Sidbury

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Correspondence to Robert Sidbury.

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E. Notaro and R. Sidbury declare no relevant conflicts of interest. No sources of funding were used to support the writing of this manuscript.

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Notaro, E.R., Sidbury, R. Systemic Agents for Severe Atopic Dermatitis in Children. Pediatr Drugs 17, 449–457 (2015). https://doi.org/10.1007/s40272-015-0150-4

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