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Atopic dermatitis (AD) is a chronic, inflammatory skin disorder characterized by intense itching, erythema, and dry skin. It commonly affects children but can persist into or appear in adulthood, significantly impacting the quality of life. Effective management of AD is essential to alleviate symptoms, reduce flare-ups, and improve the patient’s overall well-being. This systematic review aims to evaluate the effectiveness, safety, and recent advancements in the medical treatment of AD. A comprehensive literature search was conducted across major databases, including PubMed, Cochrane Library, and Embase, from inception to 2023. Studies included randomized controlled trials, cohort studies, and meta-analyses focusing on various medical treatments for AD. Primary outcomes assessed were clinical efficacy, safety profile, and impact on quality of life. A total of 75 studies were included, covering various treatment modalities such as topical corticosteroids (TCS), calcineurin inhibitors, biologics, systemic immunosuppressants, and newer agents like Janus kinase (JAK) inhibitors.
Topical treatments, including TCS and calcineurin inhibitors (e.g., tacrolimus, pimecrolimus), remain the cornerstone for mild to moderate AD. TCS are effective in reducing inflammation and controlling flare-ups but can cause skin atrophy and hypothalamic-pituitary-adrenal (HPA) axis suppression with prolonged use. Calcineurin inhibitors serve as alternatives, particularly for sensitive skin areas, offering similar efficacy with a lower risk of skin thinning but with a higher incidence of local irritation. For moderate to severe cases, systemic immunosuppressants such as cyclosporine, methotrexate, and azathioprine are commonly used. Although effective, these agents have significant side effects, including nephrotoxicity, hepatotoxicity, and bone marrow suppression, necessitating careful monitoring. Biologics, particularly dupilumab, have revolutionized the treatment landscape for moderate to severe AD. As an interleukin-4 receptor alpha antagonist, dupilumab has demonstrated significant efficacy in reducing disease severity and pruritus, with a favorable safety profile primarily limited to conjunctivitis and injection site reactions. JAK inhibitors, such as upadacitinib and abrocitinib, represent a novel class of oral medications that have shown rapid and significant improvements in symptom control compared to placebo, providing a promising alternative for patients unresponsive to conventional therapies. However, their long-term safety remains a concern, with potential risks including infections, thromboembolic events, and cardiovascular issues.
Other treatments like antihistamines, though commonly used, show limited efficacy in pruritus control. Emerging therapies, including phosphodiesterase-4 inhibitors and microbiome-modulating treatments, are under investigation and show potential for future management strategies. The management of AD has evolved significantly, with biologics and JAK inhibitors offering new options for patients with moderate to severe disease unresponsive to traditional treatments. However, safety concerns necessitate a careful, individualized approach to therapy. Future research should focus on long-term safety data, optimizing treatment combinations, and exploring novel pathways to improve patient outcomes further
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