Guidelines of care for the management of atopic dermatitis in pediatric patients (AAD)

Focused update: Guidelines of care for the management of atopic dermatitis in adults - American Academy of Dermatology (AAD)

Background: Pediatric atopic dermatitis (AD) is a common, chronic inflammatory skin disorder that significantly impacts the quality of life of affected children and their families. Multiple therapies were approved to treat AD in children and adolescents since publication of the AAD's 2014 AD guidelines.

Objective: To provide evidence-based recommendations on the use of topical therapies, phototherapy, and systemic therapies for AD in children and adolescents.

Methods: A multidisciplinary workgroup conducted a systematic review and applied the GRADE approach for assessing the certainty of evidence and formulating and grading recommendations.

Results: The workgroup developed 27 evidence-based recommendations on the medical management of pediatric AD.

Limitations: This analysis is based on the best available evidence at the time it was conducted. Most randomized controlled trials of therapies for AD are of short duration limiting long-term efficacy and safety conclusions.

Conclusions: We make strong recommendations for the use of moisturizers, topical calcineurin inhibitors, topical corticosteroids, crisaborole ointment, roflumilast cream, ruxolitinib cream, tapinarof cream, dupilumab, tralokinumab, lebrikizumab, nemolizumab with concomitant topical therapy, upadacitinib, abrocitinib, and baricitinib in the treatment of pediatric AD. We make conditional recommendations in favor of bathing, bleach baths, wet dressings, phototherapy, methotrexate, mycophenolate mofetil, azathioprine, and cyclosporine. We conditionally recommend against the use of topical antimicrobials, PUVA phototherapy, and strongly recommend against systemic corticosteroids.


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