University of Oulu

de Graaf, M., Janmohamed, S.R., Schuttelaar, M.L.A., Agner, T., Alfonso, J.H., De Schepper, S., Deleuran, M., Despontin, K., Elenius, V., Ghislain, P.-.-D., Huilaja, L., Johansson, E.K., Kvenshagen, B.K., Mandelin, J.M., Olset, H., Svensson, A., van Tuyll van Serooskerken, A.M., Thyssen, J.P. and Vestergaard, C. (2022), Systemic treatment of children and adolescents with atopic dermatitis aged ≥2 years: a Delphi consensus project mapping expert opinion in Northern Europe. J Eur Acad Dermatol Venereol, 36: 2153-2165.

Systemic treatment of children and adolescents with atopic dermatitis aged ≥2 years : a Delphi consensus project mapping expert opinion in Northern Europe

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Author: de Graaf, M.1; Janmohamed, S.R.2; Schuttelaar, M.L.A.3;
Organizations: 1Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, Wilhelmina Children’s Hospital,University Medical Center Utrecht, Utrecht, The Netherlands
2Department of Dermatology, Unit Pediatric Dermatology, SKIN Research Group, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
3Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
4Department of Dermatology and Venereology, Bispebjerg Hospital, Copenhagen, Denmark
5Department of Dermatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
6Department of Dermatology, Gent University Hospital, Gent, Belgium
7Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
8Department of Dermatology and Venereology, CHU UCL Namur, Namur, Belgium
9Department of Pediatrics, Turku University Hospital, Turku, Finland
10Department of Dermatology, UCL St-Luc, Louvain University, Brussels, Belgium
11PEDEGO Research Unit, University of Oulu, Oulu, Finland
12Department of Dermatology and Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
13Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
14Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
15Department of Paediatrics, Østfold Hospital, Grålum, Norway
16Department of Dermatology, Helsinki University Central Hospital, Helsinki, Finland
17Department of Dermatology, Haukeland University Hospital, Bergen, Norway
18Department of Dermatology and Venereology, Malmö University Hospital, Malmö, Sweden
19HagaZiekenhuis/Juliana Kinderziekenhuis, The Hague, The Netherlands
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
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Language: English
Published: John Wiley & Sons, 2022
Publish Date: 2023-06-19


Background: 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.

Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

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Series: Journal of the European Academy of Dermatology and Venereology
ISSN: 0926-9959
ISSN-E: 1468-3083
ISSN-L: 0926-9959
Volume: 36
Issue: 11
Pages: 2153 - 2165
DOI: 10.1111/jdv.18410
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
Funding: This Delphi project was funded by Sanofi Genzyme. The expert panel was invited by the study sponsor but remained independent, having not been appointed by any national dermatological society or regulatory authority from any of the respective countries.
Copyright information: © 2022 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.DOI: 10.1111/jdv.18410JEADV