Guidelines of care for the management of atopic dermatitis in adults with topical therapies

Robert Sidbury, Division of Dermatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington.
Ali Alikhan, Department of Dermatology, Sutter Medical Foundation, Sacramento, California.
Lionel Bercovitch, Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
David E. Cohen, The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York.
Jennifer M. Darr, Department of Pediatrics, National Jewish Health, Denver, Colorado.
Aaron M. Drucker, Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
Lawrence F. Eichenfield, University of California San Diego and Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California.
Lindsy Frazer-Green, American Academy of Dermatology, Rosemont, Illinois. Electronic address: lfrazer-green@aad.org.
Amy S. Paller, Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Kathryn Schwarzenberger, Department of Dermatology, Oregon Health and Science University, Portland, Oregon.
Jonathan I. Silverberg, Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC.
Anne Marie Singh, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Peggy A. Wu, Department of Dermatology, University of California, Davis, Sacramento, California.
Dawn M. Davis, Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota.

Document Type

Journal Article

Publication Date

1-11-2023

Journal

Journal of the American Academy of Dermatology

DOI

10.1016/j.jaad.2022.12.029

Keywords

JAK inhibitor; antihistamines; antimicrobials; atopic dermatitis; bathing; calcineurin inhibitors; corticosteroids; emollients; topicals; wet wraps

Abstract

BACKGROUND: New evidence has emerged since the 2014 guidelines that further informs the management of AD with topical therapies. These guidelines update the 2014 recommendations for management of atopic dermatitis (AD) with topical therapies. OBJECTIVE: To provide evidence-based recommendations related to management of AD in adults using topical treatments. METHODS: A multidisciplinary workgroup conducted a systematic review and applied the GRADE approach for assessing the certainty of evidence and formulating and grading recommendations. RESULTS: The workgroup developed 11 recommendations on the management of AD in adults with topical therapies, including non-prescription agents and prescription topical corticosteroids (TCSs), calcineurin inhibitors (TCIs), Janus kinase (JAK) inhibitors, phosphodiesterase-4 inhibitors (PDE-4), antimicrobials, and antihistamines. LIMITATIONS: The pragmatic decision to limit the literature review to English-language randomized trials may have excluded data published in other languages and relevant long-term follow-up data. CONCLUSIONS: Strong recommendations are made for the use of moisturizers, TCIs, TCSs, and topical PDE-4 and JAK inhibitors. Conditional recommendations are made for the use of bathing and wet wrap therapy and against the use of topical antimicrobials, antiseptics, and antihistamines.

Department

Dermatology

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