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Design and created by Guideline Central in participation with the American Academy of Dermatology.

Management Of Atopic Dermatitis in Adults with Phototherapy and Systemic Therapies

American Academy of Dermatology

Publication Date: Jun 17, 2025

Page Last Updated: May 5, 2026

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Grading of Recommendations, Assessment, Development, and Evaluation (GRADE)-Based Recommendations

Implications for:	Strong Recommendation (S)	Conditional Recommendation (C)
Patients	Most individuals in this situation would want the recommended course of action, and only a small proportion would not.	The majority of individuals in this situation would want the suggested course of action, but many would not.
Clinicians	Most individuals should receive the intervention. Adherence to this recommendation according to the guideline could be used as a quality criterion or performance indicator. Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences.	Recognize that different choices will be appropriate for individual patients and that you must help each patient arrive at a management decision consistent with his or her values and preferences. Decision aids may be useful in helping individuals to make decisions consistent with their values and preferences.
Policy	The recommendation can be adopted as policy in most situations.	Policymaking will require substantial debate and involvement of various stakeholders.

Certainty in the Evidence
High	H	Low	L
Moderate	M	Very Low	VL

Source: Grading of Recommendations Assessment, Development and Evaluation Working Group (Schunemann HJ et al. Am J Respir Crit Care Med. 2006;174:605-14. Guyatt GH et al. BMJ 2008;336:924-6).

Document Overview

Document Title: Management Of Atopic Dermatitis in Adults With Phototherapy And Systemic Therapies

Authoring Society: American Academy of Dermatology

Document Publication Date: Jun 17, 2025

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: www.jaad.org/article/S0190-9622(23)02878-5/fulltext

Source Citation: Davis DMR, Frazer-Green L, Alikhan A, Bercovitch L, Cohen DE, Darr JM, Drucker AM, Eichenfield LF, Paller AS, Schwarzenberger K, Silverberg JI, Singh AM, Wu PA, Sidbury R. Focused update: Guidelines of care for the management of atopic dermatitis in adults. J Am Acad Dermatol. 2025 Jun 17:S0190-9622(25)02125-5. doi: 10.1016/j.jaad.2025.05.1386. Epub ahead of print. PMID: 40531067.

Dawn M.R. Davis, Aaron M. Drucker, Ali Alikhan, Lionel Bercovitch, David E. Cohen, Jennifer M. Darr, Lawrence F. Eichenfield, Lindsy Frazer-Green, Amy S. Paller, Kathryn Schwarzenberger, Jonathan I. Silverberg, Anne Marie Singh, Peggy A. Wu, Robert Sidbury,
Guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies, Journal of the American Academy of Dermatology, 2023, ISSN 0190-9622, https://doi.org/10.1016/j.jaad.2023.08.102

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Document Scope, Criteria, and Use Cases

Document Objectives: To provide evidence-based recommendations on the use of phototherapy and systemic therapies for AD in adults. For most people with atopic dermatitis (AD), emollients and prescription topical therapies are sufficient to achieve AD control. In contrast, people with more severe or widespread AD, people with substantially impaired quality of life (QOL), and individuals whose AD is refractory to optimized topical therapy may consider the use of phototherapy or systemic therapies to improve disease control and QOL.¹ Systemic therapies considered in these guidelines include oral medications

Scope: Management, Treatment

Diseases/Conditions (MeSH)

D003876 - Dermatitis, Atopic

Keywords: Dupilumab, Tralokinumab, atopic dermatitis, eczema, phototherapy

Target Patient Population: Adult patients with atopic dermatitis (eczema)

Target Provider Population: Dermatologists, allergists/immunologists, primary care providers, and other clinicians caring for adult patients with atopic dermatitis

Inclusion Criteria: Male, Female, Adolescent, Adult, Child, Older Adult

Health Care Settings: Ambulatory, Outpatient

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Number of Source Documents: 74

Literature Search Start Date: Saturday, November 1, 2003

Literature Search End Date: Thursday, November 1, 2012

Includes peer/external review process?: Yes

Includes public comment process?: No

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: No

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Medication	Dose	Notes
Dupilumab (Dupixent)	600 mg then 300 mg SC every 2 wk	Pediatric and adolescent dosing will differ. Please see the product package insert for details.
Tralokinumab (Adbry)	600 mg then 300 mg SC every 2 wk	Dose reduction to 300 mg every 4 weeks may be considered after 16 weeks if an adequate response is achieved.
Upadacitinib (Rinvoq)	15 or 30 mg PO daily	It is recommended to start at 15 mg daily and increase if needed.
Abrocitinib (Cibinqo)	100 or 200 mg PO daily	It is recommended to start at 100 mg daily and increase if needed.
Baricitinib (Olumiant)	2 or 4 mg PO daily	Off-label in the US; approved for use for AD in Europe.
Methotrexate	10-25 mg PO or SC weekly	Once control is achieved, the dose may be lowered to the lowest possible effective dose.
Azathioprine	2.5-5 mg/kg PO daily	Thiopurine methyltransferase genotype or enzyme activity should be checked before treatment initiation and the dose lowered, or the medication not started, depending on the results.
Cyclosporine	3 to 5 mg/kg PO daily	It is suggested to start at the higher end of the dosing range and decrease the dose once control is achieved. Use is generally limited to 1 year. Prescribers should be aware of whether the modified or nonmodified form of cyclosporine is being dispensed as this can alter bioavailability, efficacy, and safety.
Mycophenolate mofetil	Up to 3000 mg PO daily, divided BID	For mycophenolate sodium/acid, 360 mg is equivalent to 500 mg of mycophenolate mofetil.

Management Of Atopic Dermatitis in Adults with Phototherapy and Systemic Therapies

Summary of Recommendations

From 2025 Focused Update

Phototherapy

Biologics

JAK inhibitors

Antimetabolite

Immunosuppressants

Medication dosing table for use in adults

Adults with atopic dermatitis

Video

Grading of Recommendations, Assessment, Development, and Evaluation (GRADE)-Based Recommendations

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology