Atopic dermatitis Guidelines

Consensus-based European guidelines

In 2018, a joint interdisciplinary European project updated the 2012 guidelines and developed extensive consensus-based guidelines and recommendations for the management of atopic dermatitis. A collaboration between several dermatology, immunology and allergy societies (consisting of the European Dermatology Forum (EDF), the European Academy of Dermatology and Venereology (EADV), the European Academy of Allergy and Clinical Immunology (EAACI), the European Task Force on Atopic Dermatitis (ETFAD), European Federation of Allergy and Airways Diseases Patients’ Associations (EFA), the European Society for Dermatology and Psychiatry (ESDaP), the European Society of Pediatric Dermatology (ESPD), Global Allergy and Asthma European Network (GA2LEN) and the European Union of Medical Specialists (UEMS)), it was decided that the guidelines should focus on therapeutic regimens rather than clinical entity, diagnosis or pathophysiology. Consensus was formed over a series of meetings between 2015 and 2017 and all recommendations required at least a 75% approval among the panel members (Wollenberg et al., 2018).

The guidelines provide a thorough overview of the available data for non-pharmacological and pharmacological therapies that are currently available or have shown promise in ongoing clinical trials. In addition, the consensus guidelines offer treatment recommendations for adult and child patients with different atopic dermatitis severities (Wollenberg et al., 2018).

Treatment recommendations for adult patients with atopic dermatitis.
Treatment recommendations for child patients with atopic dermatitis.

Figure 25: Treatment recommendations for adult and child patients with atopic dermatitis (Wollenberg et al., 2018).

Stepwise approach to management

In 2013, Leung offered a stepwise approach to managing atopic dermatitis based on disease severity (Leung, 2013).

A stepwise approach to managing atopic dermatitis

Figure 26: A stepwise approach to managing atopic dermatitis (Leung et al., 2013).

National Institute for Health and Care Excellence

The National Institute for Health and Care Excellence (NICE) in the UK have developed interactive treatment and management guidelines based on their published recommendations. The guidelines also offer recommendations on issues such as transitioning from child to adult services and when patients should be referred. However, the lack of new therapeutic options in recent years is reflected in their guidelines with the version for children with atopic dermatitis developed in 2007. A 2016 data audit found no necessary updates and the next review is scheduled for 2019 (National Institute for Health and Care Excellence).

Interactive guideline flowchart: https://pathways.nice.org.uk/pathways/eczema#content=view-info-category%3Aview-about-menu.

American Academy of Dermatology (AAD)

The AAD 2014 atopic dermatitis clinical guideline is commonly used by physicians both inside and outside of the USA. It contains four specific sections covering diagnosis and assessment, topical therapy, phototherapy and systemic agents, and disease flares and adjunctive therapy. 

Publication: https://www.aad.org/practicecenter/quality/clinical-guidelines/atopic-dermatitis.

Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V., AWMF)

The AMWF is an association that brings together 178 scientific societies in Germany from all branches of medicine. In 2015, it published guidelines for eczema (neurodermatitis in Germany) at a classification of S2k (moderate, consensus-based). A review in March 2018 found the guidelines (in German and English) remained up-to-date and the validity was extended to the end of 2018 (www.awmf.org).

Publication: www.awmf.org/en/clinical-practice-guidelines/detail/ll/013-027.html.

Available in English: www.ncbi.nlm.nih.gov/pmc/articles/PMC4861742/.

Italian Society of Allergy and Pediatric Immunology (Società Italiana di Allergologia e Immunologia Pediatrica; SIAIP)

In 2015, SIAIP published Italian consensus guidelines on the clinical management of paediatric atopic dermatitis.

Publication: https://www.siaip.it/site/api/vue/download/file/1977_CC_DA_RIAP2015.pdf.

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