Management of Moderate to Severe Atopic Dermatitis in Adults

Atopic dermatitis is a chronic inflammatory skin condition characterized by relapsing pruritic, scaly, erythematous papules and plaques frequently associated with superinfection. It is one of the most common skin diseases affecting 10%-20% of children and 1%-3% of adults, and it is a significant cause of morbidity, quality-of-life impairment and health-care costs. Although many patients can be treated satisfactorily with topical medications and phototherapy, a smaller subset requires more aggressive systemic therapies to control skin inflammation, reduce symptoms, prevent flares, and improve quality of life. Besides, severe atopic dermatitis has a profound effect on many aspects of the patient's life, and a combination of topical and systemic treatment is often required to control the disease, after ensuring all treatment failure causes are adequately excluded. Despite the available classical options, effective and safe treatments for patients with moderate-to-severe atopic dermatitis are limited due to toxicity and side effects. This article reviews the use and the scientific evidence of these medications in the treatment of adult moderate to severe atopic dermatitis, as well as several promising targeted therapies currently in development.