Skill Checkup: An 11-Year-Old Girl With Severe Nighttime Itchiness

Diamant Thaçi, MD, PhD


April 14, 2022

Dupilumab, an injectable interleukin inhibitor, is approved as systemic therapy in patients ≥ 6 years of age with moderate to severe AD in whom topical prescription therapies are not sufficient or appropriate.

Though the majority of evidence exists in adult populations, four systemic nonspecific immunosuppressive or immunomodulatory drugs have demonstrated the efficacy in AD and are used in most patients, requiring this level of intervention regardless of age: cyclosporine, mycophenolate mofetil, methotrexate, and azathioprine.

Three JAK inhibitors, upadacitinib, abrocitinib, and baricitinib, have been approved for patients whose AD is not adequately controlled with other systemic treatments. Upadacitinib is approved for both adults and adolescents (≥ 12 years of age), whereas abrocitinib and baricitinib are approved only for adult use. None of these should be used in the 11-year-old girl in this case.

Phototherapy, especially narrow-band ultraviolet B and medium-dose ultraviolet A1, is recommended for both short- and long-term management of moderate to severe AD in children ≥ 12 years of age and adults. However, phototherapy is not typically recommended for infants or young children until they can dependably stand still in the unit and wear appropriate eye protection, per Johnson and colleagues.

Phototherapy can be used in conjunction with emollients and topical corticosteroids to reduce flareups.


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