Supplementary Material for: Systemic Therapy for Atopic Dermatitis in Children and Adolescents: A United States Expert Consensus

Atopic dermatitis (AD) is a chronic, type-2 mediated, inflammatory skin disease characterized by intense pruritus, disruption of skin barrier function, and immune dysregulation. Management strategies for AD are routinely determined based on disease severity. First-line treatment begins with basic skin care and topical anti-inflammatory medication, which is typically sufficient for the management of mild-to-moderate disease. For those patients with moderate-to-severe disease, systemic therapy is often required. This can involve off-label treatment with conventional immunosuppressant medications. However, this approach is limited by a lack of robust clinical trial data and safety concerns that necessitate close monitoring. The emergence of novel targeted biologics and small molecules to treat AD presents an opportunity to optimize AD management and patient outcomes by offering greater efficacy than traditional immunosuppressants and a favorable safety profile. As the treatment landscape shifts, clinicians can benefit from a standardized process of patient assessment and treatment, along with resources to help maintain contemporary knowledge of available therapeutic options. This United States (US)-based, expert-led consensus used a modified Delphi process to develop core recommendations for the use of systemic medications for the management of pediatric patients <18 years of age with moderate-to-severe AD.

特应性皮炎（Atopic dermatitis, AD）是一种由2型免疫介导的慢性炎症性皮肤病，以剧烈瘙痒、皮肤屏障功能受损及免疫失调为主要特征。特应性皮炎的治疗策略通常依据疾病严重程度制定：一线治疗以基础皮肤护理与局部抗炎药物（topical anti-inflammatory medication）为起始，该方案一般足以控制轻中度病情；对于中重度患者，则常需采用系统治疗（systemic therapy），其中可能涉及传统免疫抑制剂的超适应症用药（off-label treatment）。然而此类治疗方案因缺乏高质量临床试验数据，且存在需密切监测的安全隐患而应用受限。新型靶向生物制剂与小分子药物的问世，为优化特应性皮炎管理及改善患者结局提供了新契机——相较于传统免疫抑制剂，其疗效更优且安全性更佳。随着特应性皮炎治疗格局的转变，临床医师可通过标准化的患者评估与治疗流程，以及助力其及时掌握当前可用治疗方案的相关资源，提升诊疗水平。本项基于美国（United States, US）的专家主导共识研究采用改良德尔菲法（modified Delphi process），为18岁以下中度至重度特应性皮炎患儿的系统用药制定核心推荐意见。