• There is reasonable RCT evidence to support the use of systemic immunosuppressive therapies such as oral corticosteroids and ciclosporin.
• Both of these therapies are associated with significant side-effects which limit their short-to-medium-term use for major disease flares, with return to conventional topical treatment inbetween such flares.
• Photochemotherapy has consistently been shown to benefit atopic dermatitis, but is limited by the long-term risk of skin cancer after many treatments.
• The use of other common treatments such as azathioprine are not currently supported by RCT evidence.
• There is need for longer term studies of systemic immunosuppressive treatment for atopic dermatitis to evaluate long-term safety and whether use of these agents alters the natural history of the disease.
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