Consensus statement of the management of severe, difficult-to-treat atopic dermatitis in adults and adolescents in South Africa and the role of biologics

Abstract

The first biological agent for treatment of moderate-to-severe atopic dermatitis (AD), dupilumab, has recently been introduced to South Africa and guidance is required as to its place in therapy. Consequently, an expert panel was convened to reach consensus on 14 statements relevant to contemporary management of AD and the use of dupilumab. In summary, the objectives of therapy are to reduce skin inflammation and pruritus, restore skin-barrier function, avoid flares, and improve quality of life. Useful comprehensive scoring tools to assess severity of AD and guide decisions to step up from topical to systemic therapy (including to a biologic agent), include SCORing Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI) and Dermatology Life Quality Index (DLQI). In addition, a photographic record of pre-treatment and follow-up assessments is helpful. When systemic therapy is required, options include cyclosporin, which should be limited to short-term use, and off-label use of methotrexate. Systemic corticosteroids should be considered only in short courses for rescue therapy in the event of flares. New classes of medication for the treatment of moderateto- severe AD are in various stages of development. The two most prominent classes of new therapies are biologics and small molecules. Dupilumab is the first fully humanised monoclonal antibody (MAB) biologic approved for the treatment of moderate-to-severe AD. It is an effective and well-tolerated, long-term treatment and has a favourable safety profile.