Systemic Treatment for Severe Atopic Dermatitis

Arch Immunol Ther Exp (Warsz). 2019 Apr;67(2):69-78. doi: 10.1007/s00005-018-0521-y. Epub 2018 Aug 22.


Atopic dermatitis (AD) is a chronic inflammatory, relapsing disease of the skin, characterized by intense pruritus, maculopapular or vesicular erythematous lesions and scaling, sometimes accompanied by oozing, crusts and/or lichenification that has a negative impact on patients' quality of life. Prevalence is higher in children, around 15%, and approximately 5% in adults. Before introducing systemic therapy, it is mandatory to review patients' adherence to the correct use of topical treatments (corticosteroids, calcineurin inhibitors or cresoborole) and/or phototherapy. Ensure that environmental measures are being taken care of, irritant or proven allergic substances are not in use and even if the diagnostic is correct. If all is being done and topical treatment with corticosteroid, emollients and phototherapy have not been sufficient to achieve a good control in AD of adults or children patients, it is time to consider systemic agents. Up to now, most of systemic treatments were based on immunosuppressive therapies, being cyclosporine A, the usually first choice for moderate-to-severe AD. Recently, biologic drugs have been developed and approved for AD, as dupilumab, and a whole new group of drugs is giving much hope for patients to have a better control of the disease with less side effects.

Keywords: Atopic dermatitis; Biologic agents; Immunosuppressive agents; Review; Systemic treatment.

Publication types

  • Review

MeSH terms

  • Administration, Intravenous
  • Adult
  • Antibodies, Monoclonal / therapeutic use*
  • Antibodies, Monoclonal, Humanized
  • Child
  • Cyclosporine / therapeutic use*
  • Dermatitis, Atopic / drug therapy*
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Immunotherapy / methods*
  • Quality of Life
  • Receptors, Interleukin-4 / immunology
  • Skin / pathology*


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Immunosuppressive Agents
  • Receptors, Interleukin-4
  • dupilumab
  • Cyclosporine