From the Guidelines
The most effective approach to managing atopic dermatitis is a stepwise strategy that incorporates gentle skincare, utilization of anti-inflammatory medications, rescue therapy, and understanding triggers, as outlined in the recent American Academy of Dermatology guidelines 1.
Key Components of Atopic Dermatitis Management
- Gentle skincare: Using mild, fragrance-free cleansers and moisturizing at least twice daily with thick emollients like petroleum jelly or ceramide-containing creams.
- Utilization of anti-inflammatory medications: Topical corticosteroids, ranging from low potency like hydrocortisone 1% for the face to medium-high potency like triamcinolone 0.1% for the body, applied to affected areas twice daily for flares, or topical calcineurin inhibitors like tacrolimus or pimecrolimus for sensitive areas.
- Rescue therapy: Wet wrap therapy for severe flares, using damp gauze over topical medications, or systemic treatments like oral prednisone (short courses), dupilumab injections, or JAK inhibitors for severe cases, as recommended by the guidelines 1.
- Understanding triggers: Identifying and avoiding personal triggers such as certain fabrics, stress, allergens, or irritants.
Recent Guideline Recommendations
The American Academy of Dermatology guidelines 1 highlight new evidence that has emerged since the 2014 guidelines, further informing the management of atopic dermatitis with systemic therapies. Strong recommendations are made for the use of dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib, while conditional recommendations are made in favor of using phototherapy, azathioprine, cyclosporine, methotrexate, and mycophenolate, and against the use of systemic corticosteroids.
Decision-Making and Treatment
The decision to initiate these more advanced therapies should be made using shared decision-making between patients and clinicians, taking into account the severity of atopic dermatitis, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions 1. Most patients will use evidence-based topical therapies, including emollients and topical anti-inflammatory medications, concomitantly with phototherapy and systemic therapies.
From the Research
GURU of Atopic Dermatitis
There are no specific studies that directly mention the term "GURU" of atopic dermatitis. However, we can break down the management and treatment of atopic dermatitis into several key points:
- Assessment of disease severity: Should encompass both physician-rated measures and patient-reported outcomes 2
- Treatment options: Include topical corticosteroids, noncorticosteroid topical therapies (e.g., topical calcineurin inhibitors, topical phosphodiesterase-4 inhibitors, and topical Janus kinase inhibitors) 2, 3, 4, 5
- Lifestyle-based strategies: Trigger avoidance, moisturizers, and supportive measures can help reduce signs and symptoms of atopic dermatitis 2
- Choice of therapy: Should consider disease-, patient-, and treatment-related factors 2
- Topical calcineurin inhibitors: Provide a safe and effective alternative to topical corticosteroid use in the treatment of atopic dermatitis, especially in thin and sensitive skin areas 3, 4, 5
- Emerging therapies: Include targeted, systemic therapies such as dupilumab for moderate-to-severe atopic dermatitis 6