Basic treatment
for all patients

Daily use of emollients + Hygiene
Guideline

Associated measures + Comorbidity screening
Guideline

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Treatment of the flare-up

Infant	Children & Adults
Topical corticosteroids
	Topical calcineurin inhibitors
	High-strength topical corticosteroids with wet wrap

Infant	Topical corticosteroids
Children & Adults	Topical corticosteroids or Topical calcineurin inhibitors or High-strength topical corticosteroids with wet wrap

Proactive treatment
in cases of frequent recurrences

Infant	Children & Adults
Topical corticosteroids
	Topical calcineurin inhibitors

Infant	Topical corticosteroids
Children & Adults	Topical corticosteroids or Topical calcineurin inhibitors

Treatment of infections

Impetiginization & Viral Infection
Guideline

Systemic treatment

Indications
Guideline

The decision to initiate systemic treatment and the choice of this treatment must take into account the patient’s opinion (shared medical decision):

• Atopic dermatitis poorly controlled (high severity score and/or major impact on quality of life) despite appropriate and well-conducted local treatment.
• OR
• Patient’s inability to perform appropriate local treatment (+/- care by a registered nurse in hospital or at home)
• OR
• Quantity of topical corticosteroids required for long-term disease control > 4 tubes of 30 grams of high-strength topical corticosteroids/month in adults

Options
in the absence of contraindications¹

Cyclosporine
≥ 6 months	≥ 2 yo	≥ 12 yo	≥ 16 yo, Adults
× (peut-on ajouter une précision courte ici ?)			Cyclosporine2
OR
Biotherapies
≥ 6 months	≥ 2 yo	≥ 12 yo	≥ 16 yo, Adults
Dupilumab		Dupilumab or Lebrikizumab or Tralokinumab
OR
JAK Inhibitors3
≥ 6 months	≥ 2 yo	≥ 12 yo	≥ 16 yo, Adults
×	Baricitinib4	Abrocitinib or Baricitinib4 or Upadacinitib

Cyclosporine
≥ 6 months	×
≥ 2 yo
≥ 12 yo
≥ 16 yo, Adults	Cyclosporine2
OR
Biotherapies
≥ 6 months	Dupilumab
≥ 2 yo
≥ 12 yo	Dupilumab or Lebrikizumab or Tralokinumab
≥ 16 yo, Adults
OR
JAK Inhibitors3
≥ 6 months	×
≥ 2 yo	Baricitinib4
≥ 12 yo	Abrocitinib or Baricitinib4 or Upadacinitib
≥ 16 yo, Adults

Alternative options
in the absence of contraindications

Methotrexate off-label	Narrow-spectrum UVB phototherapy according to phototype

Special situations

Severe involvement predominantly of the hands

Pregnant woman

Adult > 65 yo

• ¹ Systemic corticosteroids are not recommended (either for treating flare-ups or for maintenance therapy).
• ² Cyclosporine: In adults, the HAS (French National Authority for Health) recommends biologics and JAK inhibitors as second-line treatments after failure, intolerance, or contraindication to cyclosporine. However, given the benefit/risk ratio of cyclosporine and current data on biologics and JAK inhibitors, the working group believes that reimbursed access as first-line treatment would be desirable.
• ³ JAK inhibitors: ANSM recommendations (2023): They should only be used for chronic inflammatory diseases when no suitable therapeutic alternatives exist in patients: aged 65 years and over; current or former smokers; or those with other cardiovascular or malignant tumor risk factors.
  JAK inhibitors should be used with caution in patients with venous thromboembolic risk factors other than those listed above. Dosage recommendations are adjusted for certain patient groups with risk factors.
  Prescribers should discuss the risks associated with the use of these treatments with patients.
• ⁴ Reimbursed only for adults at the time the recommendations were written.