Management

New Guidelines Recommend Use of JAK, PDE-4 Inhibitors for Managing Atopic Dermatitis

Jessica Ganga
01/25/2023

The American Academy of Dermatology has released an updated set of guidelines for the management and treatment of atopic dermatitis (AD) to reflect new evidence that supports the best ways to manage AD since the release of its 2014 guidelines.1,2

“Atopic dermatitis is the most common type of eczema, and it can interfere with a person’s daily life without proper treatment,” said board-certified dermatologist Robert Sidbury, MD, MPH, FAAD, co-chair of the AAD’s Atopic Dermatitis Guideline Workgroup, in a press release.3 “The guidelines provide evidence-based recommendations for dermatologists to use in caring for their adult atopic dermatitis patients with topical treatments, which have come a long way since the guidelines were last revised in 2014. This update reflects the latest advances in topical medications that are now available to help adults with atopic dermatitis.”

In the updated set of guidelines, the authors build upon the previous guidelines and provide recommendations for a variety of treatments that apply to patients’ individual needs.

The guidelines strongly recommend:

  • Moisturizers, which help relieve inflammation and potentially reduce itch caused by AD;
  • topical calcineurin inhibitors (TCI) (pimecrolimus 1% cream and tacrolimus 0.03% or 0.1% ointment) as a safe and effective treatment option for inflammation, itching, and AD flare-ups;
  • topical corticosteroids (TCS), a common first-line treatment, to decrease inflammation and provide itching relief;
  • phosphodiesterase-4 inhibitors (crisaborole ointment), which was FDA-approved for treating AD in 2016, as an alternative to TCIs and TCS due to its ability to decrease inflammation and reduce itching; and
  • janus kinase inhibitors (ruxolitinib cream) as a short-term treatment for patients with mild to moderate AD aged 12 years and older.

The guidelines also gave conditional recommendations for bathing and wet wrap therapy, which can be used to help soothe the skin and may be appropriate depending on patient factors. Both options are used in conjunction with the strongly recommended therapies.

Further, the guidelines conditionally recommend against the use of topical antimicrobials, antiseptics, and antihistamines as there is a low certainty of evidence regarding the efficacy of these treatments.

The group of authors did note a limitation with their guideline citing the fact that their review only included English-language randomized trials. They acknowledged that studies published in other languages were excluded and may have contained relevant long-term follow-up data.

 

References:

  1. Sidbury R, Alikhan A, Bercovitch L, et al. Guidelines of care for the management of atopic dermatitis in adults with topical therapies. J Am Acad Dermatol. Published online January 11, 2023. doi:10.1016/j.jaad.2022.12.029
  2. Eichenfield LF, Tom WL, Berger TG, et al. Guidelines of care for the management of atopic dermatitis. J Am Acad Dermatol. 2014;71(1):116-132. doi:10.1016/j.jaad.2014.03.023
  3. American Academy of Dermatology issues updated guidelines for the management of atopic dermatitis in adults with topical therapies. News release. American Academy of Dermatology Association; January 11, 2023. Accessed January 25, 2023. https://www.aad.org/news/updated-atopic-dermatitis-guidelines-topical-therapies