Review ArticleClinical Review

Diagnosis and Management of Atopic Dermatitis for Primary Care Providers

Patrick Fleming, Yue Bo Yang, Charles Lynde, Braden O'Neill and Kyle O. Lee
The Journal of the American Board of Family Medicine July 2020, 33 (4) 626-635; DOI: https://doi.org/10.3122/jabfm.2020.04.190449

References

  1. 1.↵
    1. Drucker A,
    2. Eyerich K,
    3. de Bruin-Weller M,
    4. et al
    . Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement. Br J Dermatol 2018;178:768–75.
    OpenUrl
  2. 2.↵
    1. Barbarot S,
    2. Auziere S,
    3. Gadkari A,
    4. et al
    . Epidemiology of atopic dermatitis in adults: Results from an international survey. Allergy 2018;73:1284–1293.
    OpenUrl
  3. 3.↵
    1. Mallol J,
    2. Crane J,
    3. von Mutius E,
    4. et al
    . The International Study of Asthma and Allergies in Childhood (ISAAC) phase three: a global synthesis. Allergol Immunopathol (Madr) 2013;41:73–85.
    OpenUrlCrossRefPubMed
  4. 4.↵
    1. Williams H,
    2. Strachan D
    . The natural history of childhood eczema: observations from the British 1958 birth cohort study. Br J Dermatol 1998;139:834–9.
    OpenUrlPubMed
  5. 5.↵
    1. Silverberg JI,
    2. Hanifin JM
    . Adult eczema prevalence and associations with asthma and other health and demographic factors: a US population-based study. J Allergy Clin Immunol 2013;132:1132–8.
    OpenUrlCrossRef
  6. 6.↵
    1. Paternoster L,
    2. Standl M,
    3. Waage J,
    4. et al
    . Multi-ancestry genome-wide association study of 21,000 cases and 95,000 controls identifies new risk loci for atopic dermatitis. Nat Genet 2015;47:1449–56.
    OpenUrlCrossRefPubMed
  7. 7.↵
    1. Rodríguez E,
    2. Baurecht H,
    3. Herberich E,
    4. et al
    . Meta-analysis of filaggrin polymorphisms in eczema and asthma: robust risk factors in atopic disease. J Allergy Clin Immunol 2009;123:1361–70.e7.
    OpenUrlCrossRefPubMedWeb of Science
  8. 8.↵
    1. Weidinger S,
    2. Novak N
    . Atopic dermatitis. Lancet 2016;387:1109–22.
    OpenUrlCrossRefPubMed
  9. 9.↵
    1. Tsakok T,
    2. Woolf R,
    3. Smith C,
    4. Weidinger S,
    5. Flohr C
    . Atopic dermatitis: the skin barrier and beyond. Br J Dermatol 2019;180:464–74.
    OpenUrl
  10. 10.↵
    1. Kim J,
    2. Kim BE,
    3. Leung DY
    . Pathophysiology of atopic dermatitis: clinical implications. Allergy asthma Proc 2019;40:84–92.
    OpenUrl
  11. 11.↵
    1. Draaisma E,
    2. Garcia-Marcos L,
    3. Mallol J,
    4. et al
    . A multinational study to compare prevalence of atopic dermatitis in the first year of life. Pediatr Allergy Immunol 2015;26:359–66.
    OpenUrl
  12. 12.↵
    1. Kantor R,
    2. Kim A,
    3. Thyssen JP,
    4. Silverberg JI
    . Association of atopic dermatitis with smoking: a systematic review and meta-analysis. J Am Acad Dermatol 2016;75:1119–25.e1.
    OpenUrl
  13. 13.↵
    1. Schram M,
    2. Tedja A,
    3. Spijker R,
    4. Bos J,
    5. Williams H,
    6. Spuls PI
    . Is there a rural/urban gradient in the prevalence of eczema? A systematic review. Br J Dermatol 2010;162:964–73.
    OpenUrlCrossRefPubMed
  14. 14.↵
    1. Lee J,
    2. Seto D,
    3. Bielory L
    . Meta-analysis of clinical trials of probiotics for prevention and treatment of pediatric atopic dermatitis. J Allergy Clin Immunol 2008;121:116–21.e11.
    OpenUrlCrossRefPubMedWeb of Science
  15. 15.↵
    1. Pelucchi C,
    2. Chatenoud L,
    3. Turati F,
    4. et al
    . Probiotics supplementation during pregnancy or infancy for the prevention of atopic dermatitis: a meta-analysis. Epidemiology 2012;23:402–14.
    OpenUrlCrossRefPubMedWeb of Science
  16. 16.↵
    1. Fortson E,
    2. Feldman S,
    3. Strowd L
    . Management of atopic dermatitis: methods and challenges: New York (NY): Springer; 2017.
  17. 17.↵
    1. Silverberg JI,
    2. Margolis DJ,
    3. Boguniewicz M,
    4. et al
    . Distribution of atopic dermatitis lesions in United States adults. J Eur Acad Dermatol Venereol 2019;33:1341–8.
    OpenUrl
  18. 18.↵
    1. Hanifin J,
    2. Rajka G
    . Diagnostic features of atopic dermatitis. Dermatol Venereol 1980;92:44–7.
    OpenUrl
  19. 19.↵
    1. Rothe M,
    2. Grant-Kels J
    . Diagnostic criteria for atopic dermatitis. Lancet 1996;348:769–70.
    OpenUrlCrossRefPubMedWeb of Science
  20. 20.↵
    1. Weston W,
    2. Howe W
    . Overview of dermatitis (Eczema). UpToDate. Available from: https://www.uptodate.com/contents/overview-of-dermatitis-eczema. Published 2018.
  21. 21.↵
    Severity scoring of atopic dermatitis: the SCORAD Index (consensus report of the European Task Force on Atopic Dermatitis). Dermatology 1993;186:23–31.
    OpenUrlCrossRefPubMedWeb of Science
  22. 22.↵
    National Institute for Health and Clinical Excellence. Atopic eczema in under 12s: diagnosis and management. London: NICE; 2007. Available from: www.nice.org.uk/CG057.
  23. 23.↵
    1. Barrett M,
    2. Luu M
    . Differential diagnosis of atopic dermatitis. Immunol Allergy Clin North Am 2017;37:11–34.
    OpenUrl
  24. 24.↵
    1. Gupta A,
    2. Bluhm R
    . Seborrheic dermatitis. J Eur Acad Dermatol Venerol 2004;18:13–26.
    OpenUrlCrossRefPubMedWeb of Science
  25. 25.↵
    1. Johnston G,
    2. Sladden M
    . Scabies: diagnosis and treatment. BMJ 2005;331:619–22.
    OpenUrlFREE Full Text
  26. 26.↵
    1. Schlievert PM,
    2. Strandberg KL,
    3. Lin Y-C,
    4. Peterson ML,
    5. Leung DY
    . Secreted virulence factor comparison between methicillin-resistant and methicillin-sensitive Staphylococcus aureus, and its relevance to atopic dermatitis. J Allergy Clin Immunol 2010;125:39–49.
    OpenUrlCrossRefPubMedWeb of Science
  27. 27.↵
    1. Sun D,
    2. Ong PY
    . Infectious complications in atopic dermatitis. Immunol Allergy Clin North Am 2017;37:75–93.
    OpenUrlPubMed
  28. 28.↵
    1. Silverberg JI
    . Comorbidities and the impact of atopic dermatitis. Ann Allergy Asthma Immunol 2019;123:144–51.
    OpenUrl
  29. 29.↵
    1. Ascott A,
    2. Mulick A,
    3. Yu AM,
    4. et al
    . Atopic eczema and major cardiovascular outcomes: a systematic review and meta-analysis of population-based studies. J Allergy Clin Immunol 2019;143:1821–9.
    OpenUrl
  30. 30.↵
    1. Jeon C,
    2. Yan D,
    3. Nakamura M,
    4. et al
    . Frequency and management of sleep disturbance in adults with atopic dermatitis: a systematic review. Dermatol Ther (Heidelb) 2017;7:349–64.
    OpenUrl
  31. 31.↵
    1. Lee CH,
    2. Chuang HY,
    3. Hong CH,
    4. et al
    . Lifetime exposure to cigarette smoking and the development of adult-onset atopic dermatitis. Br J Dermatol 2011;164:483–489.
    OpenUrlPubMed
  32. 32.↵
    1. Silverberg JI,
    2. Song J,
    3. Pinto D,
    4. et al
    . Atopic dermatitis is associated with less physical activity in US adults. J Invest Dermatol 2016;136:1714–6.
    OpenUrl
  33. 33.↵
    1. Yaghmaie P,
    2. Koudelka CW,
    3. Simpson EL
    . Mental health comorbidity in patients with atopic dermatitis. J Allergy Clin Immunol 2013;131:428–33.
    OpenUrlCrossRefPubMedWeb of Science
  34. 34.↵
    1. Patel KR,
    2. Immaneni S,
    3. Singam V,
    4. Rastogi S,
    5. Silverberg JI
    . Association between atopic dermatitis, depression, and suicidal ideation: a systematic review and meta-analysis. J Am Acad Dermatol 2019;80:402–10.
    OpenUrl
  35. 35.↵
    1. Sandhu JK,
    2. Wu KK,
    3. Bui T-L,
    4. Armstrong AW
    . Association between atopic dermatitis and suicidality: a systematic review and meta-analysis. JAMA Dermatol 2019;155:178–87.
    OpenUrl
  36. 36.↵
    1. Schmitt J,
    2. Romanos M,
    3. Schmitt NM,
    4. Meurer M,
    5. Kirch W
    . Atopic eczema and attention-deficit/hyperactivity disorder in a population-based sample of children and adolescents. JAMA 2009;301:724–6.
    OpenUrlCrossRefPubMedWeb of Science
  37. 37.↵
    1. Chamlin SL,
    2. Mattson CL,
    3. Frieden IJ,
    4. et al
    . The price of pruritus: sleep disturbance and cosleeping in atopic dermatitis. Arch Pediatr Adolesc Med 2005;159:745–50.
    OpenUrlCrossRefPubMedWeb of Science
  38. 38.↵
    1. Weinstein M,
    2. Barber K,
    3. Bergman J,
    4. et al
    . Atopic dermatitis: a practical guide to management. Health Care Provid Resour 2016;12:1–12.
    OpenUrl
  39. 39.↵
    1. Dhadwal G,
    2. Albrecht L,
    3. Gniadecki R,
    4. et al
    . Approach to the assessment and management of adult patients with atopic dermatitis: a consensus document. section IV: treatment options for the management of atopic dermatitis. J Cutan Med and Surg 2018;22:21S–29S.
    OpenUrl
  40. 40.↵
    1. Draelos ZD
    . The science behind skin care: moisturizers. J Cosmet Dermatol 2018;17:138–44.
    OpenUrl
  41. 41.↵
    1. Feingold KR
    . Thematic review series: skin lipids. The role of epidermal lipids in cutaneous permeability barrier homeostasis. J Lipid Res 2007;48:2531–46.
    OpenUrlAbstract/FREE Full Text
  42. 42.↵
    1. Lowe A,
    2. Su J,
    3. Allen K,
    4. et al
    . A randomized trial of a barrier lipid replacement strategy for the prevention of atopic dermatitis and allergic sensitization: the PEBBLES pilot study. Br J Dermatol 2018;178:e19–e21.
    OpenUrl
  43. 43.↵
    1. Horimukai K,
    2. Morita K,
    3. Narita M,
    4. et al
    . Application of moisturizer to neonates prevents development of atopic dermatitis. J Allergy Clin Immunol 2014;134:824–30.e6.
    OpenUrlCrossRefPubMed
  44. 44.↵
    1. Simpson EL,
    2. Chalmers JR,
    3. Hanifin JM,
    4. et al
    . Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention. J Allergy Clin Immunol 2014;134:818–23.
    OpenUrlCrossRefPubMed
  45. 45.↵
    1. Evangelista MT,
    2. Abad-Casintahan F,
    3. Lopez-Villafuerte L
    . The effect of topical virgin coconut oil on SCORAD index, transepidermal water loss, and skin capacitance in mild to moderate pediatric atopic dermatitis: a randomized, double-blind, clinical trial. Int J Dermatol 2014;53:100–8.
    OpenUrl
  46. 46.↵
    1. Moro G,
    2. Arslanoglu S,
    3. Stahl B,
    4. et al
    . A mixture of prebiotic oligosaccharides reduces the incidence of atopic dermatitis during the first six months of age. Arch Dis Child 2006;91:814–9.
    OpenUrlAbstract/FREE Full Text
  47. 47.↵
    1. Grüber C,
    2. Van Stuijvenberg M,
    3. Mosca F,
    4. et al
    . Reduced occurrence of early atopic dermatitis because of immunoactive prebiotics among low-atopy-risk infants. J Allergy Clin Immunol 2010;126:791–7.
    OpenUrlCrossRefPubMedWeb of Science
  48. 48.↵
    1. Hon KL,
    2. Kung JSC,
    3. Ng WGG,
    4. et al
    . Emollient treatment of atopic dermatitis: latest evidence and clinical considerations. Drugs Context 2018;7:212530.
    OpenUrl
  49. 49.↵
    1. Hon KL,
    2. Leung AK,
    3. Barankin B
    . Barrier repair therapy in atopic dermatitis: an overview. Am J Clin Dermatol 2013;14:389–99.
    OpenUrlCrossRefPubMed
  50. 50.↵
    1. Wong S-M,
    2. Ng TG,
    3. Baba R
    . Efficacy and safety of sodium hypochlorite (bleach) baths in patients with moderate to severe atopic dermatitis in Malaysia. J Dermatol 2013;40:874–80.
    OpenUrlPubMed
  51. 51.↵
    1. Huang JT,
    2. Rademaker A,
    3. Paller AS
    . Dilute bleach baths for Staphylococcus aureus colonization in atopic dermatitis to decrease disease severity. Arch Dermatol 2011;147:246–7.
    OpenUrlCrossRefPubMed
  52. 52.↵
    1. Chopra R,
    2. Vakharia PP,
    3. Sacotte R,
    4. Silverberg JI
    . Efficacy of bleach baths in reducing severity of atopic dermatitis: a systematic review and meta-analysis. Ann Allergy Asthma Immunol 2017;119:435–40.
    OpenUrlPubMed
  53. 53.↵
    1. Engebretsen K,
    2. Johansen J,
    3. Kezic S,
    4. Linneberg A,
    5. Thyssen J
    . The effect of environmental humidity and temperature on skin barrier function and dermatitis. J Eur Acad Dermatol Venereol 2016;30:223–49.
    OpenUrl
  54. 54.↵
    1. Scheinman PL
    . Allergic contact dermatitis to fragrance: a review. Am J Contact Dermatitis 1996;7:65–76.
    OpenUrlPubMed
  55. 55.↵
    1. Larsen W,
    2. Nakayama H,
    3. Lindberg M
    . Fragrance contact dermatitis: a worldwide multicenter investigation (part I). Am J Contact Dermat 1996;7:77–83.
    OpenUrlCrossRefPubMed
  56. 56.↵
    1. Hoare C,
    2. Li Wan Po A,
    3. Williams H
    . Systematic review of treatments for atopic eczema. Health Technol Assess 2000;4:1.
    OpenUrlPubMed
  57. 57.↵
    1. Mayba JN,
    2. Gooderham MJ
    . Review of atopic dermatitis and topical therapies. J Cutan Med Surg 2017;21:227–36.
    OpenUrl
  58. 58.↵
    1. Green C,
    2. Colquitt J,
    3. Kirby J,
    4. Davidson P,
    5. Payne E
    . Clinical and cost-effectiveness of once-daily versus more frequent use of same potency topical corticosteroids for atopic eczema: a systematic review and economic evaluation. Health Technol Assess 2004;8:1–120.
    OpenUrlPubMed
  59. 59.↵
    1. Bewley A
    , Dermatology Working Group. Expert consensus: time for a change in the way we advise our patients to use topical corticosteroids. Br J Dermatol 2008;158:917–20.
    OpenUrlCrossRefPubMed
  60. 60.↵
    1. Rosen T,
    2. Albareda N,
    3. Rosenberg N,
    4. et al
    . Efficacy and safety of ozenoxacin cream for treatment of adult and pediatric patients with impetigo: a randomized clinical trial. JAMA Dermatol 2018;154:806–13.
    OpenUrl
  61. 61.↵
    1. Cowling T,
    2. Jones S
    . Topical antibiotics for infected wounds: a review of the clinical effectiveness and guidelines. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2017.
  62. 62.↵
    1. El-Batawy MMY,
    2. Bosseila M-W,
    3. Mashaly HM,
    4. Hafez V
    . Topical calcineurin inhibitors in atopic dermatitis: a systematic review and meta-analysis. J Dermatol Sci 2009;54:76–87.
    OpenUrlCrossRefPubMedWeb of Science
  63. 63.↵
    1. Legendre L,
    2. Barnetche T,
    3. Mazereeuw-Hautier J,
    4. Meyer N,
    5. Murrell D,
    6. Paul C
    . Risk of lymphoma in patients with atopic dermatitis and the role of topical treatment: A systematic review and meta-analysis. J Am Acad Dermatol 2015;72:992–1002.
    OpenUrlPubMed
  64. 64.↵
    Bausch Health Canada. Elidel (pimecrolimus) product monograph. Available from: https://pdf.hres.ca/dpd_pm/00053301.PDF. Published November 3, 2011. Accessed March 2, 2020.
  65. 65.↵
    1. Cury Martins J,
    2. Martins C,
    3. Aoki V,
    4. Gois A,
    5. Ishii H,
    6. da Silva E
    . Topical tacrolimus for atopic dermatitis. Cochrane Database Syst Rev 2015;2015:CD009864.
    OpenUrl
  66. 66.↵
    Canadian Dermatology Association. Topical calcineurin inhibitors position statement. Available from: https://www.dermatology.ca/tciposition-statement/. Published 2018.
  67. 67.↵
    1. Zebda R,
    2. Paller AS
    . Phosphodiesterase 4 inhibitors. J Am Acad Dermatol 2018;78:S43–S52.
    OpenUrl
  68. 68.↵
    1. Hoy SM
    . Crisaborole ointment 2%: a review in mild to moderate atopic dermatitis. Am J Clin Dermatol 2017;18:837–43.
    OpenUrl
  69. 69.↵
    1. Eichenfield LF,
    2. Call RS,
    3. Forsha DW,
    4. et al
    . Long-term safety of crisaborole ointment 2% in children and adults with mild to moderate atopic dermatitis. J Am Acad Dermatol 2017;77:641–9.e5.
    OpenUrlPubMed
  70. 70.↵
    1. Paller AS,
    2. Tom WL,
    3. Lebwohl MG,
    4. et al
    . Efficacy and safety of crisaborole ointment, a novel, nonsteroidal phosphodiesterase 4 (PDE4) inhibitor for the topical treatment of atopic dermatitis (AD) in children and adults. J Am Acad Dermatol 2016;75:494–503.e496.
    OpenUrlCrossRefPubMed
  71. 71.↵
    1. Sidbury R,
    2. Davis DM,
    3. Cohen DE,
    4. et al
    . Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol 2014;71:327–49.
    OpenUrlCrossRefPubMed
  72. 72.↵
    1. Jekler J,
    2. Larkö O
    . UVB phototherapy of atopic dermatitis. Br J Dermatol 1988;119:697–705.
    OpenUrlCrossRefPubMedWeb of Science
  73. 73.↵
    1. Jekler J,
    2. Larkö O
    . Combined UVA-UVB versus UVB phototherapy for atopic dermatitis: a paired-comparison study. J Am Acad Dermatol 1990;22:49–53.
    OpenUrlCrossRefPubMedWeb of Science
  74. 74.↵
    1. Meduri NB,
    2. Vandergriff T,
    3. Rasmussen H,
    4. Jacobe H
    . Phototherapy in the management of atopic dermatitis: a systematic review. Photoderm Photoimm Photomed 2007;23:106–12.
    OpenUrl
  75. 75.↵
    1. Tzaneva S,
    2. Seeber A,
    3. Schwaiger M,
    4. Hönigsmann H,
    5. Tanew A
    . High-dose versus medium-dose UVA1 phototherapy for patients with severe generalized atopic dermatitis. J Am Acad Dermatol 2001;45:503–7.
    OpenUrlPubMed
  76. 76.↵
    1. Abeck D,
    2. Schmidt T,
    3. Fesq H,
    4. et al
    . Long-term efficacy of medium-dose UVA1 phototherapy in atopic dermatitis. J Am Acad Dermatol 2000;42:254–7.
    OpenUrlCrossRefPubMedWeb of Science
  77. 77.↵
    1. Grundmann-Kollmann M,
    2. Behrens S,
    3. Podda M,
    4. Peter RU,
    5. Kaufmann R,
    6. Kerscher M
    . Phototherapy for atopic eczema with narrow-band UVB. J Am Acad Dermatol 1999;40:995–7.
    OpenUrlPubMed
  78. 78.↵
    1. Sidbury R,
    2. Tom WL,
    3. Bergman JN,
    4. et al
    . Guidelines of care for the management of atopic dermatitis: Section 4. Prevention of disease flares and use of adjunctive therapies and approaches. J Am Acad Dermatol 2014;71:1218–33.
    OpenUrlCrossRefPubMed
  79. 79.↵
    1. Gooderham MJ,
    2. Hong H-h,
    3. Eshtiaghi P,
    4. Papp KA
    . Dupilumab: a review of its use in the treatment of atopic dermatitis. J Am Acad Dermatol 2018;78:S28–S36.
    OpenUrl
  80. 80.↵
    1. Fleming P,
    2. Drucker AM
    . Risk of infection in patients with atopic dermatitis treated with dupilumab: a meta-analysis of randomized controlled trials. J Am Acad Dermatol 2018;78:62–9. e61.
    OpenUrlCrossRef
  81. 81.↵
    1. Agnihotri G,
    2. Shi K,
    3. Lio PA
    . A clinician's guide to the recognition and management of dupilumab-associated conjunctivitis. Drugs R D 2019;19:311–8.
    OpenUrl
  82. 82.↵
    1. Worm M,
    2. Simpson EL,
    3. Thaçi D,
    4. et al
    . Efficacy and safety of multiple dupilumab dose regimens after initial successful treatment in patients with atopic dermatitis: a randomized clinical trial. JAMA Dermatol 2020;156:131–143.
    OpenUrl
  83. 83.↵
    1. Damsky W,
    2. King BA
    . JAK inhibitors in dermatology: the promise of a new drug class. J Am Acad Dermatol 2017;76:736–44.
    OpenUrl
Back to top

In this issue

Print
Download PDF
Article Alerts
Email Article
Citation Tools

Jump to section

Keywords