Atopic Dermatitis Guidelines

Guidelines for the Management of Atopic Dermatitis

The American Academy of Dermatology (AAD) periodically issues clinical guidelines for the management of atopic dermatitis (AD) that include specific evidence-based recommendations formulated by a specially designated task force. The previous set of guidelines were released in 2014, and were comprised of the following four sections1:

• Section 1: Diagnosis and assessment of atopic dermatitis
• Section 2: Management and treatment of atopic dermatitis with topical therapies
• Section 3: Management and treatment with phototherapy and systemic agents
• Section 4: Prevention of disease flares and use of adjunctive therapies

Since then, many new developments, including new drug approvals, have occurred in the field of AD management and the AAD has begun the process of updating the guidelines. The new guidelines are being released sequentially, starting with a new guideline on the awareness of comorbidities associated with AD in adults (2022) and followed so far by an updated guideline on the management of AD in adults with topical therapies (2023), both of which are discussed in more details below.

The task force in charge of updating the guidelines used the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) methodology to formulate the recommendations and statements contained therein. This assigns each recommendation a strength of recommendation grade and each recommendation or statement a certainty of evidence ranking (Table 20-1).

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AAD Guidelines: Awareness of Comorbidities Associated with Atopic Dermatitis in Adults

The 2022 AAD guidelines for comorbidities associated with adult AD are the first comprehensive guidelines on this topic, offering an evidence-based overview of the existing literature. The aim of these guidelines is to educate healthcare professionals, patients and stakeholders, highlight the significance of comorbidities in confirming diagnoses of AD, and point out the importance of considering comorbid inflammatory conditions when planning treatments, since medications with multiple indications could be of great help in managing AD and related diseases simultaneously.

Note that the comorbidity guidelines do not provide specific recommendations for the management of AD. Instead, they contain statements regarding the association between AD and selected comorbidities. The GRADE certainty of evidence methodology was employed in the formulation of statements (Table 20-1). The 2022 comorbidity guidelines also include implications of the wording of each statement, as a reflection of the strength of the association between AD and each comorbidity; these are summarized in Table 20-2.

The guidelines contain 32 specific statements, organized into 8 categories by type of comorbidity – atopic and allergic conditions, immune-mediated conditions, mental health and substance abuse, ADHD and autism spectrum disorders, cardiovascular diseases, metabolic disorders, bone health and skin infection. The statements are shown in Table 20-3.

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Guidelines of Care for the Management of Atopic Dermatitis in Adults with Topical Therapies

The 2023 AAD guidelines for the management of AD in adults with topical therapy are an update to the 2014 AAD guidelines on the same topic. They provide evidence-based recommendations for managing adult AD, covering the use of nonprescription topical agents (moisturizers, bathing practice and wet wraps) and prescription topical agents (topical corticosteroids [TCS], topical calcineurin inhibitors [TCIs], Janus kinase [JAK] inhibitors, phosphodiesterase-4 [PDE-4] inhibitors, antimicrobial and antihistamines) with the goal of standardizing care and improving patient outcomes.

The guidelines contain 12 recommendations (Table 20-4), organized into 6 categories: non-prescription therapies, TCIs, TCS, topical antimicrobials/antiseptics and antihistamines, topical PDE-4 inhibitors, and topical JAK inhibitors.

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