When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Atopic dermatitis

Last reviewed: 12 Nov 2024
Last updated: 28 Oct 2024
07 Aug 2024

​New guidelines for use of systemic therapies in atopic dermatitis

​The American Academy of Dermatology has updated their 2014 guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies.[81]

  • The monoclonal antibodies dupilumab and tralokinumab may be considered for patients with moderate to severe atopic dermatitis who require systemic therapies. Both drugs are approved by the Food and Drug Administration for this indication.

  • The Janus kinase (JAK) inhibitors upadacitinib, abrocitinib, and baricitinib may be considered as a second-line systemic therapy. Upadacitnib and abrocitinib are approved by the FDA for use in moderate to severe atopic dermatitis.

See Management: approach

Original source of update

Summary

Definition

History and exam

Key diagnostic factors

  • pruritus
  • xerosis (dry skin)
  • sites of skin involvement
Full details

Other diagnostic factors

  • erythema
  • scaling
  • vesicles
  • papules
  • keratosis pilaris
  • excoriations
  • lichenification
  • hypopigmentation
Full details

Risk factors

  • filaggrin gene mutation
  • age <5 years
  • family history of atopic dermatitis
  • allergic rhinitis
  • asthma
  • active and passive exposure to smoke
  • female sex
  • African-American ethnicity
Full details

Diagnostic tests

1st tests to order

  • clinical diagnosis
Full details

Tests to avoid

  • IgG testing
  • radioallergosorbent test
Full details

Tests to consider

  • IgE levels
  • skin-prick testing
  • oral food challenge
  • trial elimination diet
  • patch testing
  • skin biopsy
Full details

Treatment algorithm

ACUTE

acute flare

ONGOING

chronic or relapsing disease

Contributors

Authors

Adelaide A. Hebert, MD

Professor & Director of Pediatric Dermatology

Clinical Specialist

Department of Dermatology and Pediatrics

University of Texas Health Sciences Center at Houston

Houston

TX

Disclosures

AAH has received research grants paid to UTHealth McGovern Medical School Houston from Pfizer, GSK, Dermavant, Arcutis, and Novan; has received honoraria from Pfizer, Verrica, and Novan; and is on the data safety monitoring boards for GSK, Ortho Dermatologics, and Regeneron-Sanofi.

Alexander Jafari, MD

Dermatology Clinical Research Fellow

Department of Dermatology

University of Texas Health Science Center at Houston

Houston

TX

Disclosures

AJ declares that he has no competing interests.

Matthew Dallo, MD

Clinical Research Fellow

Department of Dermatology

University of Texas Health Science Center at Houston

Houston

TX

Disclosures

MD declares that he has no competing interests.

Acknowledgements

Dr Adelaide A. Hebert, Dr Alexander Jafari, and Dr Matthew Dallo would like to gratefully acknowledge Dr Eugenio G. Galindo, Dr Quoc-Bao D. Nguyen, Dr Mary D. DarConte, Dr Christina M. Gelbard, and Dr Daniel A. Grabella, previous contributors to this topic.

Disclosures

EGG, QBDN, MDD, CMG, and DAG declare that they have no competing interests.

Peer reviewers

Amor Khachemoune, MD

Assistant Professor

New York University School of Medicine

NY

Disclosures

AK declares that he has no competing interests.

John English, MBBS, FRCP

Consultant Dermatologist

Department of Dermatology

Queen's Medical Centre

Nottingham University Hospitals

Nottingham

UK

Disclosures

JE declares that he has no competing interests.

  • Atopic dermatitis images
  • Differentials

    • Seborrheic dermatitis
    • Irritant contact dermatitis
    • Allergic contact dermatitis
    More Differentials
  • Guidelines

    • Living EuroGuiDerm guideline for the systemic treatment of atopic eczema
    • Atopic eczema in under 12s: diagnosis and management
    More Guidelines
  • Patient information

    Eczema

    More Patient information
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer