ACAAI and AAAAI experts have published new guidelines for the diagnosis and treatment of atopic dermatitis in children and adults.
In patients with uncontrolled atopic dermatitis who are receiving moisturizers, the use of topical corticosteroids or topical calcineurin inhibitors is recommended. For mild to moderate disease, topical use of the PDE4 inhibitor crisaborole and the Janus kinase inhibitor ruxolitinib is possible.
Experts suggest applying moderate to potent topicals once a day instead of twice. However, it is not recommended to use local antimicrobial agents for atopic dermatitis without concomitant infection.
For patients with recurrent disease, prophylactic therapy with topical corticosteroids and topical calcineurin inhibitors is indicated.
In moderate to severe atopic dermatitis, bleaching baths are indicated as an additional therapy. For patients with mild disease, bleaching baths are not indicated.
People with moderate to severe atopic dermatitis can undergo allergy vaccination. It is not recommended to follow an elimination diet.
Dupilumab is recommended for patients older than six months with moderate atopic dermatitis that is resistant to treatment with potent local and systemic drugs, as well as people intolerant or unable to use them. Tralokinumab is indicated for patients 12 years of age and older. Adults and adolescents with moderate-to-severe atopic dermatitis, refractory disease, intolerance, or inability to use topical and systemic medications of moderate to high potency, including the above-mentioned biological agents, may be prescribed oral Janus kinase inhibitors after assessing the benefits and risks.
Experts do not recommend the use of baricitinib and suggest avoiding therapy with azathioprine, methotrexate, and mycophenolate mofetil. It is also recommended to avoid the use of systemic corticosteroids for atopic dermatitis.
It is possible to use cyclosporine in adults and adolescents with moderate atopic dermatitis, refractory disease, intolerance or inability to use topical and biologically active drugs of moderate and high activity.