Management Of Atopic Dermatitis: Prevention Of Disease Flares And Use Of Adjunctive Therapies And Approaches

Publication Date: December 1, 2014
Last Updated: March 14, 2022

Recommendations

Prevention of flares

Continued use of either topical corticosteroids (1-2 times/wk) or topical calcineurin inhibitors (2-3 times/wk) after disease stabilization, to previously involved skin, is recommended to reduce subsequent flares or relapses. (A)
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EDUCATIONAL INTERVENTIONS

Educational programs (ie, training programs and ‘‘eczema schools’’) are recommended as an adjunct to the conventional therapy of atopic dermatitis. (A)
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Video interventions can be recommended as an adjunct to conventional therapy. (B)
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Eczema workshops and nurse-led programs may be useful as an adjunct to conventional therapy. (B)
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Testing for coexisting allergic disease

Atopic dermatitis patients have an increased rate of environmental and food allergies, and physicians should assess for these conditions during history taking. If significant concerns for allergy are identified (ie, hives, urticaria, etc) assessment can be undertaken. Allergy testing independent of history is not recommended. (B)
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Patch testing should be considered in patients with atopic dermatitis who have persistent/recalcitrant disease and/ or a history or physical examination findings consistent with allergic contact dermatitis. (B)
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DIETARY INTERVENTIONS, COMPLEMENTARY THERAPIES, ENVIRONMENTAL MODIFICATIONS AND OTHER ALLERGEN-BASED INTERVENTIONS

Food elimination diets based solely on the findings of food allergy test results are not recommended for the management of AD. (B)
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If a patient has a true immunoglobulin E-mediated allergy, he or she should practice avoidance to prevent potential serious health sequelae. (A)
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Children <5 years of age with moderate to severe AD should be considered for food allergy evaluation for milk, egg, peanut,
wheat, and soy if at least 1 of the following is met: (A) persistent AD in spite of optimized treatment or (B) having a reliable
history of immediate reaction after ingestion of a specific food.
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The use of probiotics/prebiotics for the treatment of patients with established AD is not recommended because of inconsistent evidence. (B)
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There is inconsistent to no evidence to recommend the use of fish oils, evening primrose oil, borage oil, multivitamin supplements, zinc, vitamin D, vitamin E, and vitamins B12 and B6 for the treatment of AD. (B)
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There is limited evidence to support the routine use of house dust mite covers to treat patients with AD who are sensitized to dust mites. (B)
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The use of specific laundering techniques, such as double rinsing, detergents, or other laundry products cannot be recommended for AD treatment because of the lack of clinical studies. (C)
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There is limited evidence to support the use of specialized clothing fabrics in the treatment of AD. (B)
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In the general AD population, sublingual immunotherapy and injection immunotherapy are not recommended for the treatment of AD because of the small number of studies and conflicting conclusions. (B)
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Chinese herbal therapy has insufficient evidence for recommendation for AD treatment. (C)
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Massage therapy has insufficient evidence for recommendation for AD treatment. (B)
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The use of aromatherapy, naturopathy, hypnotherapy, acupressure, or autologous blood injections cannot be recommended for the treatment of AD at this time because of insufficient evidence. (B)
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Recommendation Grading

Overview

Title

Management Of Atopic Dermatitis: Prevention Of Disease Flares And Use Of Adjunctive Therapies And Approaches

Authoring Organization

American Academy of Dermatology

Publication Month/Year

December 1, 2014

Last Updated Month/Year

July 31, 2023

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Target Patient Population

Pediatric and adult patients with atopic dermatitis

Target Provider Population

All providers who treat patients with atopic dermatitis

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management, Treatment

Diseases/Conditions (MeSH)

D003876 - Dermatitis, Atopic

Keywords

atopic dermatitis, aeroallergens

Methodology

Number of Source Documents
157
Literature Search Start Date
November 1, 2003
Literature Search End Date
November 1, 2012