Atopic Dermatitis Guidelines: Topical Therapy for Adults

A multidisciplinary workgroup has released updated guidelines for the management of atopic dermatitis (AD) in adults using topical therapies in a study published in the Journal of the American Academy of Dermatology. These guidelines build on the 2014 recommendations, incorporating new evidence that sheds light on the effectiveness of various topical treatments for AD.

Researchers aimed to provide evidence-based recommendations related to the management of AD in adult patients using topical treatments. To achieve this, the workgroup conducted a comprehensive systematic review and utilized the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach to assess the certainty of evidence and formulate and grade their recommendations.

The workgroup arrived at 12 key recommendations for managing AD in adults with topical therapies. These recommendations encompass a range of treatments, including nonprescription agents and prescription topical corticosteroids (TCS), calcineurin inhibitors (TCIs), Janus kinase (JAK) inhibitors, phosphodiesterase-4 inhibitors (PDE-4), antimicrobials, and antihistamines. Among the recommendations, strong support was provided for the use of moisturizers, TCIs, TCS, and topical PDE-4 and JAK inhibitors in the management of AD in adults. The findings underscore the efficacy of these topical therapies in alleviating symptoms and improving the overall condition of patients. Conditional recommendations were also made for the use of bathing and wet wrap therapy. Although the evidence for these interventions is not as robust as for the other treatments, they remain potential options for managing AD in specific cases.

The guidelines discourage the use of topical antimicrobials, antiseptics, and antihistamines for treating AD in adults. The workgroup determined that the available evidence does not support the effectiveness of these treatments in this context.

“Strong recommendations are made for the use of moisturizers, TCIs, TCS, and topical PDE-4 and JAK inhibitors,” concluded study authors. “Conditional recommendations are made for the use of bathing and wet wrap therapy and against the use of topical antimicrobials, antiseptics, and antihistamines.”

Reference
Sidbury R, Alikhan A, Bercovitch L, et al. Guidelines of care for the management of atopic dermatitis in adults with topical therapies. J Am Acad Dermatol. 2023;89(1):e1-e20. doi:10.1016/j.jaad.2022.12.029