Canadian consensus statements for using systemic therapies for atopic dermatitis

Atopic dermatitis is a chronic relapsing and remitting inflammatory skin disease, with several systemic options available for treatment. To help healthcare providers select appropriate therapy, a panel of experts recently released Canadian recommendations on the use of systemic therapies for moderate-to-severe atopic dermatitis.1 Earlier this year, a similar panel released Canadian guidelines on managing atopic dermatitis with topical therapies.2 The new guidance on systemic therapies was prepared by a panel of 14 experts, including 11 dermatologists from Canada and three from the United States. The group reviewed available literature on systemic therapies for atopic dermatitis and used this evidence, along with their clinical expertise and opinion, to draft a concise set of statements to guide Canadian healthcare providers on systemic treatments. The document addresses pathophysiology and treatment selection, systemic options available in Canada and considerations for key special populations.1 Systemic therapy for atopic dermatitis may be indicated to reduce symptoms, minimize flares and improve quality of life in patients with moderate-to-severe atopic dermatitis who do not respond to topical therapy.1 Key statements and treatment considerations on using systemic agents in moderate-to-severe atopic dermatitis:1Dupilumab is recommended for systemic-therapy-eligible patients with atopic dermatitis who are ≥ 6 months of age.Anti-interleukin-13 biologics (tralokinumab and lebrikizumab) are recommended for systemic-therapy-eligible patients with atopic dermatitis who are ≥ 12 years of age.Oral JAK1-selective inhibitors (abrocitinib and upadacitinib) are recommended for systemic-therapy-eligible patients ≥ 12 years of age with atopic dermatitis who have had an inadequate response to one other systemic (including biologic) therapy or when use of these therapies is inadvisable.The panel recommends against the use of systemic corticosteroids for systemic-therapy-eligible patients with atopic dermatitis, except for acute severe exacerbations and as short-term bridge therapy to other systemic corticosteroid-sparing therapy.The panel recommends against the use of mycophenolate mofetil and azathioprine for patients with atopic dermatitis, except when use of another systemic therapy is inadvisable for systemic-therapy-eligible adults.Cyclosporine is conditionally recommended with proper monitoring and limited-term use (< 1 year of continuous dosing) for systemic-therapy-eligible adults with atopic dermatitis. The panel recommends against use of cyclosporine in patients with contraindications, including renal impairment and uncontrolled hypertension.Methotrexate is conditionally recommended with proper monitoring for systemic-therapy-eligible adults with atopic dermatitis. The panel recommends against use of methotrexate in patients with contraindications to broad systemic immunosuppressants.The panel also identified several Canadian populations where atopic dermatitis treatment modifications should be considered: indigenous individuals (with elevated socioeconomic and geographic challenges); patients with skin-of-colour; patients with certain infectious diseases (e.g., untreated latent tuberculosis, hepatitis B); as well as children, older adults, and breastfeeding or pregnant patients. Details are presented in the document.1Overall, the recommendations are intended to encourage prescribers to reflect on their current management of patients with moderate-to-severe atopic dermatitis who are eligible for systemic therapy and to identify the appropriate treatment for any given individual. The various statements provide a framework for patient assessment, to assist with making informed and rational treatment decisions.1References:Purdy K, Gooderham M, Abu-Hilal M, et al. Supporting evidence and recommendations for the management of patients with systemic-eligible atopic dermatitis: A Canadian consensus document. JAAD Int 2025:24:31-49. (accessed November 20, 2025). Gooderham MJ, Hong HC, Lynde C, et al. Canadian consensus guidelines for the management of atopic dermatitis with topical therapies. Dermatol Ther 2025; published April 25, 2025 online ahead of print. (accessed November 20, 2025).

Canadian consensus statements for using systemic therapies for atopic dermatitis

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