Management of severe atopic dermatitis refractory to topical treatment in infants and children

JAK: Janus kinase; NBUVB: narrowband ultraviolet B; TCI: topical calcineurin inhibitor; TCS: topical corticosteroid.

• Poor adherence/incorrect use of medications
• Steroid phobia
• Continued exposure to environmental triggers
• Superimposed infection
• Incorrect diagnosis

¶ We define frequent flare-ups as those that require daily TCS therapy for more than 14 days per month (ie, continuous topical therapy is required for more than half the time). A prolonged flare-free interval is a period of at least 3 months in which the dermatitis is controlled without treatment or with only intermittent use of TCS or TCI.

Δ Children <6 months are not candidates for systemic therapies but can be considered for systemic therapies if the atopic dermatitis is still uncontrolled once they are >6 months.

◊ For discussion of cyclosporine dosing and monitoring, refer to UpToDate content on severe refractory atopic dermatitis.