Updated guidelines released for management of atopic dermatitis

In updated guidelines issued by the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology, and published online Dec. 17 in the Annals of Allergy, Asthma & Immunology, recommendations are presented for gaining and maintaining control of atopic dermatitis (AD).

Derek K. Chu, M.D., Ph.D., from McMaster University in Hamilton, Ontario, Canada, and colleagues agreed upon 25 recommendations to gain and maintain control of mild, moderate, and severe AD. The recommendations addressed optimal use of topical treatments, dilute bleach baths, dietary avoidance/elimination, allergen immunotherapy, and systemic treatments.

Changes in this update included guidance on shared decision-making and factors to consider for each of the recommendations. For patients with uncontrolled AD despite moisturizer use, use of topical corticosteroids or topical calcineurin inhibitors (TCIs) is recommended. The safety of TCIs is highlighted with typical use once or twice daily. Once-daily dosing of topical medications can be considered. Crisaborole 2 percent ointment is suggested for mild-to-moderate AD; for patients with mild-to-moderate AD refractory to moisturization alone, there is a suggestion against adding topical Janus kinase inhibitors. For AD alone with no infection, there is a suggestion against use of topical antimicrobials. Bleach baths are suggested as an additive therapy for patients with AD with moderate-to-severe disease, but not for those with mild AD. Elimination diets are not suggested for AD. For moderate-to-severe AD, allergen immunotherapy is suggested.

"The guidelines emphasize, in addition to standards of trustworthiness, the third principle of evidence-based medicine: that evidence alone is never enough; that patient values and preferences are crucial to arriving at optimal recommendations," Chu said in a statement.

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