What are the diagnostic criteria and management guidelines for atopic dermatitis according to the Australian guidelines and the Royal Australian College of General Practitioners (RACGP)?

From the Guidelines

Atopic dermatitis management should prioritize a stepped approach to treatment, focusing on regular use of emollients and topical corticosteroids for mild cases, with consideration of phototherapy or systemic immunosuppressants for moderate-to-severe cases, as recommended by recent guidelines 1. The cornerstone of therapy for mild atopic dermatitis is the regular use of emollients (moisturizers) applied at least twice daily, even when the skin appears normal, to maintain the skin barrier. First-line pharmacological treatment involves topical corticosteroids (TCS) of appropriate potency for the affected area - mild potency (e.g., hydrocortisone 1%) for the face and flexures, and moderate potency (e.g., betamethasone valerate 0.02-0.05%) for the body. Some key points to consider in the management of atopic dermatitis include:

• Apply TCS once daily to active eczema until the inflammation resolves, typically within 1-2 weeks.
• For maintenance, consider proactive therapy with twice-weekly TCS to prevent flares.
• Topical calcineurin inhibitors (tacrolimus, pimecrolimus) are alternatives for sensitive areas or when TCS are contraindicated.
• For moderate-to-severe cases unresponsive to topical therapy, consider phototherapy or systemic immunosuppressants like cyclosporine (3-5 mg/kg/day), methotrexate (10-25 mg weekly), or azathioprine (1-3 mg/kg/day), as supported by the updated guidelines 1.
• Dupilumab, a biologic agent, is reserved for severe cases (initial dose 600mg followed by 300mg every two weeks).
• Antihistamines may help with sleep disturbance but don't directly treat the eczema.
• Addressing triggers (allergens, irritants, stress), regular bathing with mild soap-free cleansers, and wet dressings during flares are important non-pharmacological measures.
• Patient education about the chronic, relapsing nature of the condition and proper application techniques for medications is essential for successful management, as emphasized in the recent guidelines 1.

From the Research

Diagnostic Criteria and Management Guidelines for Atopic Dermatitis

The diagnostic criteria and management guidelines for atopic dermatitis according to the Australian guidelines and the Royal Australian College of General Practitioners (RACGP) are as follows:

• Atopic dermatitis is a disease characterized by relapsing eczema with pruritus as a primary lesion 2
• The objectives of therapy for atopic dermatitis are to reduce skin inflammation and pruritus, restore skin barrier function, and improve quality of life (QoL) 3
• Management involves drug and non-drug treatments to clear the skin, including:
  • Moisturizers to improve the condition of the skin 4
  • Topical corticosteroids as the main drug treatment, with the choice of corticosteroid depending on the site of the atopic dermatitis 4, 5
  • Topical calcineurin inhibitors for sensitive sites such as the face where potent topical corticosteroids are potentially harmful 4
  • Adjunctive treatments such as bleach baths, wet dressings, and antihistamines to relieve itch 4
  • Phototherapy for adults with inadequate response to treatment 4
  • Systemic treatment, including immunosuppressants such as ciclosporin, and biologics such as dupilumab and upadacitinib for severe chronic atopic dermatitis 2, 4

Treatment Options

Treatment options for atopic dermatitis can be classified as:

• Moisturizing and basic care 3
• Topical therapy, including topical corticosteroids and topical calcineurin inhibitors 3, 4
• Phototherapy 3, 4
• Systemic therapy, including oral cyclosporine, subcutaneous injections of biologics, and oral Janus kinase inhibitors 2