shutterstock_163496477New guidelines from the American Academy of Dermatology call for a more proactive approach to the management of adult and pediatric atopic dermatitis.

Published in the Journal of the American Academy of Dermatology, the evidence-based guideline is the final section of a four-part series on the care and management of atopic dermatitis.

Previous approaches to atopic dermatitis management were solely reactive, using anti-inflammatory therapies only when symptoms arise. By contrast, proactive management includes the intermittent, but scheduled use of topical corticosteroids or topical calcineurin inhibitors to areas of the body that frequently have recurrent disease.

The new guidelines also stress the importance of patient and caregiver education. This education can include individualized “eczema schools,” nurse-led programs, or video-assisted approaches. These personalized or group education settings have been shown to increase patients’ knowledge of the disease, improve their understanding of treatments, and increase treatment compliance, which can reduce disease severity.

Establishing a link between allergens and atopic dermatitis remains challenging
, the guidelines state. Food allergy evaluation is recommended for children under 5 who have persistent moderate to severe atopic dermatitis despite effective treatment or who have a history of reaction after eating certain foods. This evaluation should be for the major food allergens, such as milk, egg, wheat, peanut, and soy.

Atopic dermatitis patients can have a high prevalence of allergic contact dermatitis (ACD)
.
 Common contact allergens include nickel, neomycin, fragrance, formaldehyde and other preservatives, lanolin, and rubber chemicals. 
Patch testing should be done to positively diagnose ACD, as it can be difficult to visually distinguish from atopic dermatitis

Use of alternative and complementary approaches for atopic dermatitis is not proven, the guidelines state. For example, using specific laundering techniques or putting covers over pillows and mattresses to reduce dust mites, have not been shown to consistently improve atopic dermatitis. In addition, there has not been any evidence to show that following a specific diet or taking dietary supplements reduces or improves disease severity. Eastern medicine, such as Chinese herbal therapies, has been studied, but there are conflicting study results and concerns about liver toxicity with some of these herbal treatments. Other approaches that are lacking adequate evidence to make recommendations include massage therapy, aromatherapy, homeopathy, and naturopathy.

Part 1 of the guidelines was published in the February 2014 issue of the Journal of the American Academy of Dermatology and focused on the diagnosis and assessment of individuals affected by atopic dermatitis. Parts 2 and 3 in the series were published in the July 2014 and August 2014 issues, respectively, and discussed topical, phototherapy, and systemic treatments for mild and severe disease.