Allergy, Asthma & Respiratory Disease

The Korean Academy of Asthma, Allergy and Clinical Immunology (대한천식알레르기학회)
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Update of systemic treatments in severe/recalcitrant atopic dermatitis: Consensus document of the KAAACI working group on atopic dermatitis

난치 아토피피부염 전신 치료에 관한 전문가 의견서 업데이트

  • Myongsoon Sung (Department of Pediatrics, Soonchunhyang University Gumi Hospital) ;
  • Young-Il Koh (Division of Allergy, Asthma, and Clinical Immunology, Department of Internal Medicine, Chonnam National University Medical School) ;
  • Mi-Ae Kim (Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University) ;
  • Hyunjung Kim (Department of Dermatology, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine) ;
  • Jung Im Na (Department of Dermatology, Seoul National University Bundang Hospital) ;
  • Dong-Ho Nahm (Department of Dermatology, Seoul National University College of Medicine) ;
  • Taek Ki Min (Department of Allergy and Clinical Immunology, Ajou University School of Medicine) ;
  • Yang Park (Department of Pediatrics, Soonchunhyang University Hospital) ;
  • Dong Hun Lee (Department of Pediatrics, Jangheung Integrative Medical Hospital, Wonkwang University School of Medicine) ;
  • Mi-Hee Lee (Department of Pediatrics, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • So-Yeon Lee (PHI Digital Healthcare) ;
  • Youngsoo Lee (Department of Dermatology, Seoul National University College of Medicine) ;
  • Chong Hyun Won (Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hye Yung Yum (Department of Pediatrics, Seoul Medical Center) ;
  • Mira Choi (Department of Dermatology, Inje University Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Eung Ho Choi (Department of Dermatology, Yonsei University Wonju College of Medicine) ;
  • Woo Kyung Kim (Department of Pediatrics, Inje University Seoul Paik Hospital, Inje University College of Medicine) ;
  • KAAACI Work Group Report on the Treatment of Severe/Recalcitrant Atopic Dermatitis (KAAACI Work Group Report on the Treatment of Severe/Recalcitrant Atopic Dermatitis)
  • 성명순 (순천향대학교 구미병원 소아청소년과) ;
  • 고영일 (전남대학교 의과대학 내과학교실) ;
  • 김미애 (차의과학대학교 분당차병원 호흡기알레르기내과) ;
  • 김현정 (충남대학교 의과대학 세종충남대학교병원 피부과) ;
  • 나정임 (분당서울대학교병원 피부과) ;
  • 남동호 (서울대학교 의과대학 피부과학교실) ;
  • 민택기 (아주대학교 의과대학 알레르기내과학교실) ;
  • 박양 (순천향대학교 서울병원 소아청소년과) ;
  • 이동훈 (원광대학교 의과대학 장흥통합의료병원 소아청소년과) ;
  • 이미희 (가톨릭대학교 성빈센트병원 소아청소년과) ;
  • 이소연 (파이디지털헬스케어) ;
  • 이영수 (서울대학교 의과대학 피부과학교실) ;
  • 원종훈 (울산대학교 의과대학 서울아산병원 피부과) ;
  • 염혜영 (서울의료원 소아청소년과) ;
  • 최미라 (인제대학교 의과대학 일산백병원 피부과) ;
  • 최응호 (연세대학교 원주의과대학 피부과학교실) ;
  • 김우경 (인제대학교 의과대학 서울백병원 소아청소년과) ;
  • 난치성아토피피부염 연구팀 (난치성아토피피부염 연구팀)
  • Received : 2023.09.06
  • Accepted : 2023.11.20
  • Published : 2024.04.30
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Abstract

Atopic dermatitis (AD) is the most prevalent inflammatory skin condition, with approximately 80% of cases originating in childhood and some emerging in adulthood. In South Korea, the estimated prevalence of AD ranges between 10% and 20% in children and 1% and 3% in adults. Severe/recalcitrant AD manifests as a chronic, relapsing skin disorder, persisting with uncontrolled symptoms even after topical steroid treatment. Corticosteroids and systemic immunosuppression, conventionally the standard care for difficult-to-treat diseases, cause numerous undesirable side effects. When AD persists despite topical steroid application, systemic therapies like cyclosporine or systemic steroids become the second treatment strategy. The desire for targeted treatments, along with an enhanced understanding of AD's pathophysiology, has spurred novel therapeutic development. Recent advances introduce novel systemic options, such as biological agents and small-molecule therapy, tailored to treat severe or recalcitrant AD. Notably, dupilumab, a monoclonal antibody inhibiting interleukin 4 and 13, marked a transformative breakthrough upon gaining approval from the U.S. Food and Drug Administration (FDA) in 2017, leading to a paradigm shift in the systemic treatment of AD. Furthermore, both dupilumab and Janus kinase inhibitors, including baricitinib, abrocitinib, and tofacitinib, now approved by the Korean FDA, have established their applicability in clinical practice. These innovative therapeutic agents have demonstrated favorable clinical outcomes, effectively addressing moderate to severe AD with fewer side reactions than those associated with previous systemic immunosuppressants. This review summarizes the latest advancements and evidence regarding systemic treatments for AD, including newly approved drugs in Korea.

Keywords

References

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