More Study of Systemic Therapies for Atopic Dermatitis Needed in Patients With Comorbidities

Doctor looking uncertain
Expert treatment recommendations for patients with atopic dermatitis and comorbidities are reviewed.

A scoping review and survey found limited data regarding the use of systemic therapy for atopic dermatitis (AD) among populations with comorbidities; data on expert opinions about appropriate treatment medications was also lacking. These findings were published in Dermatitis.

Publication databases were searched through September 2020 for studies of AD in patients with HIV, viral hepatitis B or C, liver disease, renal disease, or malignancy. Systemic treatment for AD was defined as azathioprine, cyclosporine, dupilumab, methotrexate, mycophenolate, or systemic corticosteroids.

The study authors also performed an International Eczema Council (IEC) survey. An electronic survey was sent to 103 IEC councilors and associates on September 1, 2020. The members were asked which systemic agent they would consider prescribing to specific patient populations and to rank which therapies they thought should be first-, second-, and third-line options.

For the review, a total of 25 studies met the inclusion criteria. The most evaluated drug was dupilumab (n=15) and the most evaluated populations were patients with HIV (n=9) and malignancy (n=9). In general, most reports of dupilumab reported favorable outcomes, such as a reduction of itching, without harmful effects to the underlying disorder.

For the IEC survey, 64.1% of members responded. Participants were from Europe (n=31), North America (n=23), Asia (n=9), Africa (n=1), Australia (n=1), and South America (n=1).

The most common response was for dupilumab as the systemic treatment respondents would consider prescribing to these populations. Stratified by population, dupilumab was least likely to be considered as first-line for 30-year-olds who were not concerned with childbearing (46.2%) and the population most likely to be considered for first-line dupilumab was patients with significant liver disease (76.7%).

For second-line therapies, 32.8% to 48.1% of respondents would consider cyclosporine for 30-year-olds who were not concerned with childbearing, patients with significant kidney disease, and those with chronic hepatitis B and/or C. Between 25.5% to 28.1% would consider methotrexate for older (³65 years) adults, patients with significant kidney impairment, a history of malignancy, or HIV.

Most clinicians thought no treatment option was an appropriate third-line therapy, although mycophenolate was recommended for older adults by 23.3% and methotrexate for 30-year-olds who were not concerned with childbearing by 33.3% of those who participated in the survey.

This review was limited by the paucity of data about systemic treatment for AD among patients with comorbidities, it was noted.

The study authors concluded, “As more biologic and other targeted agents are approved, there will be more options to use for older patients and those with comorbidities.” They continued, “Ideally, clinical trial inclusion criteria can be broadened to include such patients, but in the absence of that, high-quality observational data are needed. Ongoing AD registries will be instrumental in providing data on the safety of both new and older systemic agents for special populations of adults with AD, and observational studies should specifically aim to include older patients and those with comorbidities.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Drucker AM, Lam M, Flohr C,et al. Systemic therapy for atopic dermatitis in older adults and adults with comorbidities: a scoping review and international eczema council survey.Dermatitis. Published online March 12, 2022. doi:10.1097/DER.0000000000000845