Systemic agents indicated for moderate to severe dz when optimized topical tx and or photo tx don t adequately control dz or when dz severity substantially impacts QOL 1 3 4 Strongly recommend dupilumab tralokinumab 1 4 abrocitinib baricitinib upadacitini

<b>Systemic agents</b> indicated for <i>moderate to severe</i> dz when optimized topical tx and/or photo-tx don’t adequately control dz, or when dz severity substantially impacts QOL.^1,3,4<br>
<li style="margin-left:1em"><b>Strongly recommend:</b> dupilumab, tralokinumab,^1,4 abrocitinib, baricitinib, upadacitinib.⁴
<li style="margin-left:1em"><b>Conditionally recommend:</b> cyclosporine modified,^1,4 MTX, mycophenolate mofetil, azathioprine,⁴ abrocitinib, baricitinib, upadacitinib.¹</li>
<li style="margin-left:1em"><b>Conditionally recommend <i>against</i>:</b> MTX, mycophenolate mofetil, azathioprine.¹
<li style="margin-left:1em"><b>Insufficient data:</b> systemic abx, PO antihistamines, montelukast, apremilast, ustekinumab, IVIG, interferon-γ, omalizumab, TNF-α inhibitors, systemic calcineurin inhibitors (other than cyclosporine), mepolizumab.⁴</li>
<li style="margin-left:1em"><b>Avoid systemic steroids;</b> consider only for acute, severe exacerbations or as short-term bridge tx to other systemic, steroid-sparing tx.⁴</li>
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