Management of Atopic Dermatitis

Diagnosis

The diagnosis of atopic dermatitis is based on the presence of itch and at least three of the following criteria: history of skin fold involvement, personal or family history of atopy, generalized dry skin, visible flexural eczema, or onset in the first two years of life, as recommended by the British Medical Journal and the American Academy of Dermatology 1, 2
The extent, location, and severity of eczema should be evaluated, paying attention to signs of bacterial infection (crusts, discharge) or viral infection (grouped erosions, vesicles), according to the British Medical Journal and the American Academy of Dermatology 1, 3

Emollients are fundamental in management and should be applied generously, especially after bathing, as recommended by the British Medical Journal and the American Academy of Dermatology 1, 4
The use of soap substitutes (dispersible creams) for skin cleansing is recommended by the British Medical Journal 1, 5
Topical corticosteroids are the mainstay of treatment for acute flares of atopic dermatitis, and the least potent preparation that effectively controls the eczema should be used, according to the British Medical Journal and the American Academy of Dermatology 1, 5

Continuous use of topical corticosteroids (1-2 times a week) or topical calcineurin inhibitors (2-3 times a week) on previously affected skin after stabilization of the disease is recommended to reduce relapses, as suggested by the American Academy of Dermatology 4, 6
Daily use of emollients can prolong the time to the first flare compared to no treatment, according to the American Academy of Dermatology 4

If herpes simplex infection (eczema herpeticum) is suspected, systemic aciclovir treatment should be started immediately, especially if there is fever, as recommended by the American Academy of Dermatology 7
In case of secondary bacterial infection, anti-staphylococcal antibiotics are recommended by the American Academy of Dermatology 3

Educational programs are recommended as a complement to conventional therapy, according to the American Academy of Dermatology 6
It is essential to explain the application of topical preparations and the amount to use, as recommended by the British Medical Journal and the American Academy of Dermatology 1, 5

The response to treatment should be evaluated periodically, adjusting therapy as necessary, according to the British Medical Journal and the American Academy of Dermatology 1, 5