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Guidelines for Atopic Dermatitis

Read time: 15 mins
Last updated:17th May 2022
Published:27th Jul 2021

Learn more about the recommendations and available data for non-pharmacological and pharmacological treatment of atopic dermatitis.

  • Read about the consensus-based European guidelines
  • Find out about a stepwise approach to managing atopic dermatitis based on disease severity
  • Access summaries of the NICE, American Academy of Dermatology, Association of the Scientific Medical Societies in Germany and the Italian Society of Allergy and Pediatric Immunology guidelines published

Consensus-based European guidelines and position paper

In 2018, a joint interdisciplinary European project updated the 2012 guidelines and developed extensive consensus-based guidelines and recommendations for the management of atopic dermatitis. A collaboration between several dermatology, immunology and allergy societies (consisting of the European Dermatology Forum (EDF), the European Academy of Dermatology and Venereology (EADV), the European Academy of Allergy and Clinical Immunology (EAACI), the European Task Force on Atopic Dermatitis (ETFAD), European Federation of Allergy and Airways Diseases Patients’ Associations (EFA), the European Society for Dermatology and Psychiatry (ESDaP), the European Society of Pediatric Dermatology (ESPD), Global Allergy and Asthma European Network (GA2LEN) and the European Union of Medical Specialists (UEMS)), it was decided that the guidelines should focus on therapeutic regimens rather than clinical entity, diagnosis or pathophysiology. Consensus was formed over a series of meetings between 2015 and 2017 and all recommendations required at least a 75% approval among the panel members1.

The guidelines provide a thorough overview of the available data for non-pharmacological and pharmacological therapies that are currently available or have shown promise in ongoing clinical trials. In addition, the consensus guidelines offer treatment recommendations for adult and child patients with different atopic dermatitis severities1.

The second part of the guidelines discusses the use of antimicrobial therapy, systemic treatments, allergen-specific immunotherapy, complementary medicine, psychosomatic counselling and educational interventions2.

AD_Fig25 T4 fig1. 2021.png

Figure 1: Treatment recommendations for adult and child patients with atopic dermatitis (adapted from1).

Most recently the EFTAD/EADV Eczema task force published the 4th edition of the position paper on the diagnosis and treatment of AD in adults and children. Like previous versions it provides information on the experience, opinion, and recommendations of the EFTAD on the treatment and management options for AD in view of the updated guidelines.

Publication: https://onlinelibrary.wiley.com/doi/full/10.1111/jdv.16892

Stepwise approach to management

In 2013, Leung offered a stepwise approach to managing atopic dermatitis based on disease severity.3

AD_Fig26__95FAC80D-F143-4991-B4965F9962CEC520.png

Figure 2: A stepwise approach to managing atopic dermatitis (adapted from3).

National Institute for Health and Care Excellence

The National Institute for Health and Care Excellence (NICE) in the UK have developed interactive treatment and management guidelines based on their published recommendations. The guidelines from 2007 also offer recommendations on issues such as transitioning from child to adult services and when patients should be referred (National Institute for Health and Care Excellence), and were last updated in March, 2021.

Additional to the guidelines, a technology appraisal guidance was also published in 2018 for the use of dupilumab for treating moderate-to-severe AD. NICE guidelines are currently being developed for JAK inhibitor use in atopic dermatitis, with an expected publication date of late 2022.

NICE eczema guidelines

Technology appraisal guidance

American Academy of Dermatology (AAD)

The AAD 2014 atopic dermatitis clinical guideline is commonly used by physicians both inside and outside of the USA. It contains four specific sections covering diagnosis and assessment, topical therapy, phototherapy and systemic agents, and disease flares and adjunctive therapy. In 2021 the AAD announced they are working on a series of updated guidelines that will supersede the 2014 edition. The first update published in 2022 includes a guideline on comorbidities associated with atopic dermatitis.

Publication

Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V., AWMF)

The AMWF is an association that brings together 178 scientific societies in Germany from all branches of medicine. In 2015, it published guidelines for eczema (neurodermatitis in Germany) at a classification of S2k (moderate, consensus-based). A review in March 2018 found the guidelines (in German and English) remained up-to-date and the validity was extended to end March 2020 (www.awmf.org).

Publication

Italian Society of Allergy and Pediatric Immunology (Società Italiana di Allergologia e Immunologia Pediatrica; SIAIP)

In 2015, SIAIP published Italian consensus guidelines on the clinical management of paediatric atopic dermatitis.

Publication

Consensus by seven Italian Societies on the diagnosis and management of moderate-to-severe atopic dermatitis

In 2021 a consensus was published by the Italian Society of Dermatology and Venereology (SIDeMaST), the Italian Association of Hospital Dermatologists and Public Health (ADOI), the Italian Association of Hospital and Territorial Allergists and Immunologists (AAIITO), the Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC), Italian Society of Allergy and Pediatric Immunology (SIAIP), the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA), and the Italian Society of Pediatric Dermatology (SIDerP). The seven societies used a modified Delphi procedure to reach a consensus by 59 Italian experts on the management of AD. This included 20 statements covering 5 areas on adolescent AD, including disease complexity, burden and social impact, diagnosis and definition of severity, current treatments and new biologic therapies.

Publication

References

  1. Wollenberg A, Barbarot S, Bieber T, Christen-Zaech S, Deleuran M, Fink-Wagner A, et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I. J Eur Acad Dermatology Venereol. 2018;32(5):657–682.
  2. Wollenberg A, Barbarot S, Bieber T, Christen-Zaech S, Deleuran M, Fink-Wagner A, et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part II. J Eur Acad Dermatology Venereol. 2018;32(6):850–878.
  3. Leung DYM. New insights into atopic dermatitis: Role of skin barrier and immune dysregulation. Allergol Int. 2013;62(2):151–161.
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