Systemic treatments for atopic dermatitis in children and adolescents: Review of current practice and new treatments

Background: Atopic dermatitis (AD) is a prevalent pruritic chronic relapsing inflammatory skin condition that predominantly manifests before the age of 5 years. Physical, mental, and financial burdens of AD are substantial and can adversely reflect on patients, carers, and society. Objective: This article purpose is to review available systemic treatments for moderate-severe AD in children and adolescents and present the evidence behind it. Methods: A thorough search was performed on PubMed. Keywords used were systemic treatment, atopic dermatitis, moderate-severe, and children and adolescents, in addition to search for individual systemic agents. English-published data were utilized exclusively. Results and recommendations drawn from elected studies and guidelines are displayed in this review. Results: Treating patients with moderate-severe AD has proved to be challenging. Not long ago, the available systemic treatments were restricted to conventional immunosuppressants including ciclosporin and methotrexate among others. However, recent years have witnessed impressive advancement in the understanding of AD pathogenesis at the molecular level that resulted in the emergence of multiple promising targeted biologic therapy options including interleukin (IL)-4 and IL-13 inhibitors, IL-13 inhibitors, and JAK inhibitors. Conclusion: Although the new biologic agents have been proposed to be more effective and possibly safer than the traditionally used conventional wide-spectrum immunosuppressive agents for moderate-severe AD, head-to-head comparative studies are limited and long-term data to ascertain the safety of these biologic agents are lacking. Moreover, the cost of biologic agents is far greater than conventional immunosuppressant agents which could contribute to its limited availability in some institutions.