Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Dermatology, Unit Pediatric Dermatology, SKIN Research Group, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
J Eur Acad Dermatol Venereol. 2022 Nov;36(11):2153-2165. doi: 10.1111/jdv.18410. Epub 2022 Jul 19.
Paediatric atopic dermatitis (AD) can be burdensome, affecting mental health and impairing quality of life for children and caregivers. Comprehensive guidelines exist for managing paediatric AD, but practical guidance on using systemic therapy is limited, particularly for new therapies including biologics and Janus kinase (JAK) inhibitors, recently approved for various ages in this indication.
This expert consensus aimed to provide practical recommendations within this advancing field to enhance clinical decision-making on the use of these and other systemics for children and adolescents aged ≥2 years with moderate-to-severe AD.
Nineteen physicians from Northern Europe were selected for their expertise in managing childhood AD. Using a two-round Delphi process, they reached full or partial consensus on 37 statements.
Systemic therapy is recommended for children aged ≥2 years with a clear clinical diagnosis of severe AD and persistent disease uncontrolled after optimizing non-systemic therapy. Systemic therapy should achieve long-term disease control and reduce short-term interventions. Recommended are cyclosporine A for short-term use (all ages) and dupilumab or methotrexate for long-term use (ages ≥6 years). Consensus was not reached on the best long-term systemics for children aged 2-6 years, although new systemic therapies will likely become favourable: New biologics and JAK inhibitors will soon be approved for this age group, and more trial and real-world data will become available.
This article makes practical recommendations on the use of systemic AD treatments for children and adolescents, to supplement international and regional guidelines. It considers the systemic medication that was available for children and adolescents with moderate-to-severe AD at the time this consensus project was done: azathioprine, cyclosporine A, dupilumab, methotrexate, mycophenolate mofetil and oral glucocorticosteroids. We focus on the geographically similar Northern European countries, whose healthcare systems, local preferences for AD management and reimbursement structures nonetheless differ significantly.
儿科特应性皮炎（AD）可能会给儿童及其照顾者带来沉重负担，影响心理健康和生活质量。目前有管理儿科 AD 的综合指南，但关于系统治疗的实用指导有限，尤其是对于新的治疗方法，包括生物制剂和 Janus 激酶（JAK）抑制剂，最近在该适应证的各种年龄段均已获批。
本专家共识旨在为这一不断发展的领域提供实用建议，以增强在≥2 岁中重度 AD 儿童中使用这些药物和其他系统药物的临床决策。
从北欧选择了 19 名在管理儿童 AD 方面具有专业知识的医生。他们通过两轮 Delphi 流程，就 37 项声明达成了完全或部分共识。
对于明确诊断为严重 AD 且在优化非系统治疗后疾病仍未得到控制的≥2 岁儿童，建议采用系统治疗。系统治疗应实现长期疾病控制并减少短期干预。推荐环孢素 A 短期使用（所有年龄段），以及度普利尤单抗或甲氨蝶呤长期使用（≥6 岁）。对于 2-6 岁儿童，最佳长期系统治疗药物尚未达成共识，但新的系统治疗药物可能更具优势：新的生物制剂和 JAK 抑制剂即将获批用于该年龄组，并且将有更多的临床试验和真实世界数据。
本文针对儿童和青少年 AD 系统治疗药物的使用提出了实用建议，以补充国际和地区指南。本共识项目考虑了当时可用于中重度 AD 儿童和青少年的系统药物：阿扎胞苷、环孢素 A、度普利尤单抗、甲氨蝶呤、霉酚酸酯和口服糖皮质激素。我们专注于地理上相似的北欧国家，这些国家的医疗保健系统、AD 管理的本地偏好和报销结构存在显著差异。
