Fast Five Quiz: Severe Atopic Dermatitis in Adults

William D. James, MD


September 09, 2020

Dupilumab is a monoclonal antibody that inhibits interleukin (IL)-4 and IL-13 signaling by blocking the shared alpha chain of the IL-4 receptor. It has been shown to be effective in the treatment of moderate to severe atopic dermatitis, and it is indicated for the treatment of moderate to severe atopic dermatitis that is not adequately controlled with topical prescription therapies, or when those therapies are contraindicated. Given its unprecedented efficacy, dupilumab is emerging as a first-line agent for the management of moderate to severe atopic dermatitis.

Newer options for the treatment of atopic dermatitis include topical calcineurin inhibitors. Tacrolimus is a topical calcineurin inhibitor that is indicated for the treatment of moderate to severe atopic dermatitis. Another topical calcineurin inhibitor, pimecrolimus, is used for mild to moderate disease.

Acute exacerbations of atopic dermatitis can be treated with a 7-day course of systemic steroids, but this is controversial. Most experts reserve oral prednisone (≥ 20 mg/d for 7 days) for patients with the most severe disease; however, the disease tends to quickly relapse upon discontinuation of the medication.

Crisaborole is a topical PDE-4 inhibitor. It has been shown to be an effective treatment for the management of mild to moderate atopic dermatitis, but it is not yet indicated for the treatment of more severe disease.

For additional information, refer to the Atopic Dermatitis Clinical Guideline of the AAD and the Consensus-based European Guidelines for Treatment of Atopic Eczema (Atopic Dermatitis) in Adults and Children: Part I and Part II.

Learn more about the treatment of atopic dermatitis, as well as novel and emerging therapies.


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