Article Figures & Data
Figures
- Figure 1.
Treatment of AD. Abbreviations: TCS, Topical corticosteroids; AD, atopic dermatitis; PDE-4, Phosphodiesterase-4 inhibitor.
Tables
Major Criteria (3+) Minor Criteria (3+) Pruritis Facial features Facial pallor, erythema, hypopigmented patches, infraorbital darkening, cheilitis, infraorbital folds (Dennie-Morgan lines), recurrent conjunctivitis, anterior neck folds Dermatitis affecting flexural surfaces in adults or face and extensor surfaces in infants Triggers Emotional factors, environmental factors, food, skin irritants Chronic or relapsing dermatitis Complications Susceptibility to skin infections, impaired cell-mediated immunity, predisposition to keratoconus and anterior subcapsular cataracts, immediate skin reactivity Personal or family history of cutaneous or respiratory allergy Other Early age of onset, xerosis, ichthyosis vulgaris, hyperlinear palms, keratosis pilaris, hand or foot dermatitis, nipple dermatitis, white dermatographism, perifollicular accentuation Condition Morphology Distribution Pertinent Signs/Symptoms Atopic dermatitis Acute to chronic dermatitic lesions Infant: face, head and neck, extensor surfaces
Child: flexural folds with the wrist, ankles, hands, feet, and antecubital/popliteal fossae
Adult: flexural surface; many area-specific subtypesPruritus; personal or family history of atopy Irritant contact dermatitis Acute to chronic eczematous lesion Confined to area of exposure Burning/itch Allergic contact dermatitis Acute to chronic eczematous lesion Initial confinement to area of exposure but likely to spread Seborrheic dermatitis Ill-defined areas of erythema with greasy scale Nose, nasolabial folds, eyebrows, glabella, scalp
Children: cradle-cap and diaper area often affectedChildren: self-resolving within 2 weeks Psoriasis Bright beefy-red, well-circumscribed plaques with silvery micaceous scale Broad distribution with extensor surface involvement
Children: diaper area often affectedNail changes (including pitting; family history of psoriasis) Scabies Contiguous burrows of serpiginous tracks with secondary eczematous changes Children: palms, soles, dorsal feet, genitalia, diaper area
Adults: interdigital space, wrist, axillae, waist, umbilicus, nipples, genitals, breastsSevere pruritus, worse at night; excoriated papules in multiple areas Treatment for Mild-Moderate Atopic Dermatitis (Topical) Therapy Indication Dosage and Scheduling Side Effect Pearls Topical corticosteroids (TCS)± Antistaphylococcal antibiotics* (fucidic acid, mupirocin, bacitracin/polymyxin B, ozenoxacin 1%) First-line prescription therapy if uncontrolled by moisturizers/irritant avoidance Mild lesions: moderate potency for 2 to 4 weeks
Acute flares: high potency for up to 2 weeks
Apply 1× to 2× dailySteroid atrophy, purpura, telangiectasia, striae, focal hypertrichosis, acneiform or rosacea-like eruptions, allergic contact dermatitis, impairment of wound healing High potency TCS for areas of high absorption acceptable for 5 to 7 days before tapering Topical calcineurin inhibitors (TCIs) Second-line treatment of mild-to-moderate atopic dermatitis in patients aged 2 years and above (aged 3 months and above for pimecrolimus) On-label dosing Potential black box warning, temporary application-site burning Avoid use on suspected eczema herpeticum; tacrolimus is also indicated for maintenance treatment to prevent flares Topical PDE-4 inhibitors First-line treatment of mild-to-moderate atopic dermatitis in patients aged 2 years and above On-label dosing Transient application-site burning Treatment for Severe Atopic Dermatitis Phototherapy Failure of topical treatments 2× to 5× weekly administration Erythema, sunburn, advanced skin-aging, itching, nausea Burdensome and expensive Systemic immunosuppressants (eg, methotrexate [MTX], microphenylate mofetil [MMF], and azathioprine [AZA]) Failure of topical treatments MTX: 15 mg/week (adults)
MMF: 0.5 to 3 g/day (adult) or 40 to 50 mg/kg/day (pediatric)
AZA: 1 to 3 mg/kg/day (adult)Gastrointestinal upset, nausea, vomiting, fatigue, hepatotoxicity, bone marrow suppression, idiopathic pulmonary fibrosis, teratogenicity, headache, leukopenia, hypersensitivity, bloating, anorexia Order tuberculosis test, chest radiograph, hepatitis serologies, and ensure immunizations are up to date Dupilumab Failure of topical treatments 600 mg subcutaneous loading dose followed by 300 mg subcutaneous dose every 2 weeks Hypersensitivity reactions, anaphylaxis, injection site reactions, conjunctivitis High cost, no baseline investigations or routine laboratory monitoring required ↵* Topical antistaphylococcal antibiotics should be used as an adjunct to TCS treatment in the presence of signs of mild infection concurrent with atopic dermatitis. Combination topical steroid and antibiotic creams exist.
Tcs, topical corticosteroids; Tci, topical calcineurin inhibitors; PDE-4, Phosphodiesterase-4 inhibitor; mtx, methotrexate; mmf, microphenylate mofetil; aza, azathioprine.
