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Treatment resistant atopic dermatitis: challenges and solutions

Authors Johnson BB, Franco AI, Beck LA, Prezzano JC

Received 10 December 2018

Accepted for publication 11 February 2019

Published 21 March 2019 Volume 2019:12 Pages 181—192

DOI https://doi.org/10.2147/CCID.S163814

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Ms Justinn Cochran

Peer reviewer comments 2

Editor who approved publication: Dr Jeffrey Weinberg


Brian B Johnson, Abigail I Franco, Lisa A Beck, James C Prezzano

Department of Dermatology, University of Rochester Medical Center, Rochester, NY 14642, USA

Abstract: Atopic dermatitis (AD) is a common, chronic, relapsing–remitting inflammatory disease that can be challenging to treat. Patients with mild disease are usually managed well with good skin care practices including moisturization and appropriate bathing along with intermittent use of topical therapies such as topical corticosteroids and/or topical calcineurin inhibitors during flares. Patients with frequent flares may benefit from proactive application of topical therapies twice a week to the most troublesome areas. Patients with severe disease often present significant treatment challenges. Systemic therapies are usually required for severe AD but have varying degrees of success and can be associated with side-effect profiles that require counseling and close monitoring. Phototherapy has been shown to have success in treating moderate-to-severe AD, but several factors can limit its utility and efficacy including cost and access. New therapies are in development targeting specific pathways relevant for AD. Dupilumab was the first biologic treatment approved in North America, Europe, and Japan for adults with moderate-to-severe AD. Although this treatment can lead to rapid improvement in the majority of patients, there are inadequate responders. In this review, we discuss the clinical challenges and treatment options for moderate-to-severe refractory AD.

Keywords: atopic dermatitis, eczema, treatment resistance, topical therapy, systemic therapy, biologics

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