The American Academy of Dermatology have recently updated their atopic dermatitis (adult & paediatric) guidelines across four articles, published in the Journal of the American Academy of Dermatology.  This is a great resource which is reviewed in this newsletter article.  We have also noted some points that the guidelines highlight below:

• Control & management
  • A “proactive” strategy is recommended for the management of long-term disease.  This involves scheduling intermittent treatment of areas where disease frequently recurs.  This contrasts with “reactive” management which is the use of treatment when symptoms arise.   The proactive approach is believed to reduce the frequency of flares and minimise complications.
  • The importance of sufficient education for patients and their caregivers is also recognised.
• Co-existent allergy
  • An increased rate of “environmental and food” allergy is noted in patients with atopic dermatitis, but it is recognised that establishing a link between these and diagnosis or flare ups is very challenging and typically one allergy is not solely responsible.
  • Allergy should be considered in those who, despite effective treatment, have persistent moderate to severe atopic dermatitis.
  • Food challenges are highlighted as the standard for confirming food allergy suggested by other tests.
  • Allergic contact dermatitis (ACD) has a higher prevalence in patients with atopic dermatitis.
  • This can be confirmed through patch testing, which should be considered when atopic dermatitis persists despite adequate standard treatments.  It can also be considered when the pattern of dermatitis is unusual or when clinical findings suggest ACD.  This can be difficult however, as it is acknowledged how difficult it can be to distinguish ACD from atopic dermatitis.
• Alternative treatments
  • The guidelines note the absence of evidence to support the use of specific washing techniques, covers to reduce dust mites, dietary supplements, massage therapy, homeopathy, naturopathy and aromatherapy.
  • There is also a cautionary note regarding Chinese herbal treatments with respect to liver toxicity concerns.

We will cover eczema in greater detail in our online dermatology webinar teaching series on Tuesday 4th November between 20:00 – 21:30.