STEPWISE MANAGEMENT OF ATOPIC DERMATITIS IN CHILDREN AND ADULTS: A SYSTEMATIC REVIEW OF THE CLINICAL EVIDENCE. SYSTEMATIC REVIEW
Keywords:
atopic dermatitis; eczema; stepped therapy; children; adults; PRISMA 2020; biologic therapies; JAK inhibitorsAbstract
DOI: https://doi.org/10.46296/yc.v10i18.0823
Abstract
Introduction: Atopic dermatitis is a chronic, recurrent, and heterogeneous inflammatory dermatosis that requires a stepwise approach to treatment based on severity, extent, age, clinical phenotype, and previous response. Objective: To synthesize the current clinical evidence on the stepwise treatment of atopic dermatitis in children and adults. Methods: A qualitative systematic review was conducted, reported according to PRISMA 2020 guidelines. PubMed/MEDLINE was searched, and targeted manual searches of relevant guidelines and references were performed up to March 16, 2026. Evidence-based guidelines, systematic reviews, network meta-analyses, randomized controlled trials, and long-term extension studies focused on emollients, topical corticosteroids, calcineurin inhibitors, crisaborole, topical ruxolitinib, phototherapy, dupilumab, tralokinumab, abrocitinib, baricitinib, upadacitinib, and conventional systemic immunomodulatory therapies were included. Results: Of 51 initial records, 45 were screened after removing duplicates; 35 full texts were appraised, and 29 studies were integrated into the qualitative synthesis. The evidence supports that all patients should begin treatment with therapy education, intensive hydration, and trigger control. In mild disease, topical corticosteroids remain the mainstay of rescue therapy, and calcineurin inhibitors, crisaborole, or ruxolitinib are steroid-sparing alternatives in sensitive areas or localized mild to moderate disease. In moderate or recurrent disease, proactive therapy with topical corticosteroids or calcineurin inhibitors, wet-wrap therapy, and narrowband UVB phototherapy are validated options. In moderate to severe refractory disease, dupilumab and tralokinumab show a favorable benefit-risk profile; oral JAK inhibitors offer rapid responses and, in some scenarios, greater efficacy, although with a greater safety burden. Conventional systemic therapies retain a selective role, while systemic corticosteroids should not be used routinely. Conclusions: The most consistent stepwise approach begins with universal basic therapy, intensifies topical treatment according to disease activity, and reserves targeted systemic therapies for moderate to severe or refractory cases. Dupilumab is the systemic option with the most robust pediatric and adult support, while JAK inhibitors are effective alternatives in selected adolescents and adults under close monitoring..
Keywords: atopic dermatitis; eczema; stepped therapy; children; adults; PRISMA 2020; biologic therapies; JAK inhibitors.
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