Allergy Asthma Respir Dis.
2024 Apr;12(2):58-71. 10.4168/aard.2024.12.2.58.
Update of systemic treatments in severe/recalcitrant atopic dermatitis: Consensus document of the KAAACI working group on atopic dermatitis
- Sung M1
- Koh YI2
- Kim MA3
- Kim H4
- Na JI5
- Nahm DH6
- Min TK7
- Park Y8
- Lee DH9
- Lee MH10
- Lee SY11
- Lee Y6
- Won CH12
- Yum HY13
- Choi M14
- Choi EH15
- Kim WK
16 - for the KAAACI Work Group Report on the Treatment of Severe/Recalcitrant Atopic Dermatitis
- Affiliations
-
- 1Department of Pediatrics, Soonchunhyang University Gumi Hospital, Gumi, Korea
- 2Division of Allergy, Asthma, and Clinical Immunology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- 3Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
- 4Department of Dermatology, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Korea
- 5Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
- 6Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
- 7Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
- 8Department of Pediatrics, Soonchunhyang University Hospital, Seoul, Korea
- 9Department of Pediatrics, Jangheung Integrative Medical Hospital, Wonkwang University School of Medicine, Jangheung, Korea
- 10Department of Pediatrics, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
- 11PHI Digital Healthcare, Seoul, Korea
- 12Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- 13Department of Pediatrics, Seoul Medical Center, Seoul, Korea
- 14Department of Dermatology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
- 15Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
- 16Department of Pediatrics, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
- KMID: 2555656
- DOI: http://doi.org/10.4168/aard.2024.12.2.58
Abstract
- Atopic dermatitis (AD) is the most prevalent inflammatory skin condition, with approximately 80% of cases originating in childhood and some emerging in adulthood. In South Korea, the estimated prevalence of AD ranges between 10% and 20% in children and 1% and 3% in adults. Severe/recalcitrant AD manifests as a chronic, relapsing skin disorder, persisting with uncontrolled symptoms even after topical steroid treatment. Corticosteroids and systemic immunosuppression, conventionally the standard care for difficult-to-treat diseases, cause numerous undesirable side effects. When AD persists despite topical steroid application, systemic therapies like cyclosporine or systemic steroids become the second treatment strategy. The desire for targeted treatments, along with an enhanced understanding of AD’s pathophysiology, has spurred novel therapeutic development. Recent advances introduce novel systemic options, such as biological agents and small-molecule therapy, tailored to treat severe or recalcitrant AD. Notably, dupilumab, a monoclonal antibody inhibiting interleukin 4 and 13, marked a transformative breakthrough upon gaining approval from the U.S. Food and Drug Administration (FDA) in 2017, leading to a paradigm shift in the systemic treatment of AD. Furthermore, both dupilumab and Janus kinase inhibitors, including baricitinib, abrocitinib, and tofacitinib, now approved by the Korean FDA, have established their applicability in clinical practice. These innovative therapeutic agents have demonstrated favorable clinical outcomes, effectively addressing moderate to severe AD with fewer side reactions than those associated with previous systemic immunosuppressants. This review summarizes the latest advancements and evidence regarding systemic treatments for AD, including newly approved drugs in Korea.
