Atopic dermatitis clinical guideline

These guidelines, published in 2023, arose due to the emergence of new evidence since the AAD’s 2014 atopic dermatitis guidelines that further informs the management of AD with systemic agents, and address the management of AD in adults with well-established systemic treatments (e.g. phototherapy modalities and systemic immunosuppressants) as well as new systemic treatments (e.g. biologics and JAK inhibitors).

Analysis of the evidence from a systematic view resulted in 11 evidence-based recommendations.

The guidelines strongly recommend the use of:

• Dupilumab;

• Tralokinumab;

• Abrocitinib;

• Baricitinib; and

• Upadacitinib.

The guidelines conditionally recommend the use of:

• Phototherapy;

• Azathioprine;

• Cyclosporine;

• Methotrexate; and

• Mycophenolate.

The guidelines recommend against the use of:

• Systemic corticosteroids.

Access the JAAD article to read the full guideline on phototherapy and systemic therapies for AD.

This guideline, completed in 2021 and published in early 2022, is the first in a new series on atopic dermatitis (AD) that are being developed by the American Academy of Dermatology and will supersede the 2014 guidelines (below) when publication is complete. Highlights of the comorbidities guideline include:

1. In addition to AD itself, the patient- and population-level burden of disease is increased by associated comorbidities.

2. The objective of this guideline is to appraise the evidence for the association between AD and comorbid conditions, with the aim of improving awareness and understanding among dermatologists and other clinicians.

3. There is strong evidence that AD in adults is associated with select allergic, atopic, immune-mediated, mental health and bone health comorbidities and skin infections.

4. There is some evidence supporting an association between AD in adults and substance use, ADHD, and elements of metabolic syndrome.

5. Evidence suggests a small association with various cardiovascular conditions.

6. The association between AD in adults and autism spectrum disorders, myocardial infarction, stroke, and metabolic syndrome as a whole is uncertain.

7. Clinicians should be aware of comorbidities associated with AD. Further research is needed to determine whether screening or management of comorbidities is beneficial for adults with AD.

Access the JAAD article to read the full guideline on comorbidities of AD.

The Academy has published updated guidelines of care for the management of atopic dermatitis in adults with topical therapies.  

These guidelines update the Academy’s previous AD guidelines, published in 2014, based on new evidence that has emerged regarding the management of AD with topical therapies. The guidelines include strong evidence-based recommendations for several treatments, including:  

• Moisturizers; 

• Topical calcineurin inhibitors; 

• Topical corticosteroids; and 

• Topical PDE-4 and JAK inhibitors. 

Additionally, the guidelines include conditional recommendations for the use of bathing and wet wrap therapy, and recommend against the use of topical antimicrobials, antiseptics, and antihistamines. 

Full details of these guidelines and the specific recommendations can be found in this JAAD article.