AAD Issues Updated Guidelines for the Management of Atopic Dermatitis in Adults with Topical Therapies

The American Academy of Dermatology (AAD) has published updated guidelines of care for the management of atopic dermatitis in adults with topical therapies in the Journal of the American Academy of Dermatology. This is the second in a series of updated guidelines the AAD is producing on the condition.

The updates were developed by a workgroup of 12 physicians—including 11 dermatologists, an allergist/pediatrician—and one patient representative.

“Atopic dermatitis is the most common type of eczema, and it can interfere with a person’s daily life without proper treatment,” board-certified dermatologist Robert Sidbury, MD, MPH, FAAD, co-chair of the AAD’s Atopic Dermatitis Guideline Workgroup, said in a news release. “The guidelines provide evidence-based recommendations for dermatologists to use in caring for their adult atopic dermatitis patients with topical treatments, which have come a long way since the guidelines were last revised in 2014. This update reflects the latest advances in topical medications that are now available to help adults with atopic dermatitis.”

The Atopic Dermatitis Workgroup developed 11 recommendations on how to manage atopic dermatitis in adults with topical therapies. The workgroup provided new recommendations for non-prescription methods as well as prescription treatments.

Strong recommendations were made for the use of the following:

• Moisturizers help to relieve patients’ dry, cracked skin, decrease inflammation, and reduce the severity of and increase the time between flare-ups.
• Topical calcineurin inhibitors (pimecrolimus 1% cream and tacrolimus 0.03% or 0.1% ointment) reduce patients’ inflammation and itching, as well as decrease their flare-ups.
• Topical corticosteroids are commonly used as the first-line treatment for patients with atopic dermatitis in all skin regions. They help to relieve itching, decrease inflammation, and can decrease infections.
• Phosphodiesterase-4 inhibitor (crisaborole ointment) can reduce patients’ inflammation, help relieve itching, and decrease infections.
• Janus kinase inhibitor (ruxolitinib cream) can be used short term to ease the inflammation and itching of patients with mild to moderate atopic dermatitis.

The guidelines provide conditional recommendations for the use of bathing and wet wrap therapy. Conditional recommendations apply to most patients, but the most appropriate action may differ depending on individual patient factors.

• Bathing, followed by moisturization, helps patients hydrate the skin. Bleach baths can help patients prevent infection and get rid of bacteria on their skin.
• Wet wrap therapy utilizes wet bandages to help hydrate and soothe patients’ skin. This treatment provides a barrier against scratching, helps to decrease redness and inflammation, and can reduce the bacteria on patients’ skin.

The guidelines made conditional recommendations against the use of topical antimicrobials, antiseptics, and antihistamines due to the low certainty of evidence, which means the true effect may be substantially different from the estimated effect, according to AAD.

"The new AAD Guidelines for the Management of Atopic Dermatitis are an incredibly welcome addition to a rapidly changing area in dermatology," said Peter Lio, MD, a Clinical Assistant Professor of Dermatology and Pediatrics at Northwestern University Feinberg School of Medicine.

Calling the guidelines "well-written and extremely practical, yet based on a meticulous review of the evidence," Dr. Lio said that  so much has changed since the guidelines were last updated in 2014 that it has genuinely been difficult to keep up. "This paper serves as a clarifying review of the landscape for atopic dermatitis and should help both specialists and non-specialists better understand the state of the art with topical therapy in AD. The most challenging issue is that we are in the midst of continuing innovations, with new topicals and new systemic agents filling a rather full pipeline; I expect we will need more continuous guidance going forward, at least for the foreseeable future," he said. "For now, however, we have an excellent guide to help us navigate these exciting times."