For this installment of our Guidelines Side-By-Side Series, we’re going to take a look at the current guidelines for atopic dermatitis (AD), commonly referred to as eczema. It is a chronic inflammatory skin condition, identified by dry, itchy skin that may release clear fluid when scratched. The National Institutes of Health (NIH) estimates that this condition impacts approximately 30% of the population in the United States, with children and adolescents being the most affected demographic.

In 2023, several guidelines were released for the management and treatment of this common dermatological condition. Today, we will be examining three of these guidelines published that year. The guidelines we will be looking at today include:

Academy of American Dermatology (AAD)

American Academy of Allergy, Asthma and Immunology (AAAAI) and American College of Allergy, Asthma and Immunology (ACAAI) Joint Task Force (JTF)

It is important to note that the guidelines from AAAAI/ACAAI offers recommendations for individuals of all ages, from children to adults. The AAD Guidelines, on the other hand, focuses on therapies for managing atopic dermatitis in adult patients, with plans to address pediatric patients in a future guideline.

The following chart provides a comparison of the topical therapies from each guideline: 


TherapyAAD GuidelinesAAAAI/ACAAI Guidelines
OTC MoisturizersStrongly RecommendedNot Addressed
Rx MoisturizersNot AddressedConditionally Recommended
Topic Corticosteroids
Topic CorticosteroidsStrongly RecommendedStrongly Recommended
Topical Calcineurin Inhibitors
Tacrolimus 0.03% or 0.1%Strongly RecommendedConditionally Recommended
Pimecrolimus 1% creamStrongly Recommended for Mild-to-Moderate ADConditionally Recommended
Topical PDE4 Inhibitors
Crisaborole 2%Strongly Recommended for Mild-to-Moderate ADConditionally Recommended for Mild-to-Moderate AD
Topical JAK Inhibitors
RuxolitinibStrongly Recommended for Mild-to-Moderate ADNot Recommended
Biologics for Moderate-to-Severe AD
DupilumabStrongly RecommendedStrongly Recommended
TralokinumabStrongly RecommendedStrongly Recommended
Oral JAK inhibitors for Moderate-to-Severe AS
AbrocitinibStrongly RecommendedStrongly Recommended
BaricitinibStrongly RecommendedStrongly Recommended
UpadacitinibStrongly RecommendedStrongly Recommended
Other Therapies
AzathioprineConditionally Recommended for Moderate-to-Severe ADNot Recommended
CyclosporineConditionally Recommended for Moderate-to-Severe ADConditionally Recommended for Moderate-to-Severe AD
MethotrexateConditionally Recommended for Moderate-to-Severe ADNot Recommended
MycophenolateConditionally Recommended for Moderate-to-Severe ADNot Recommended
Narrow-Band UV-BConditionally RecommendedConditionally Recommended for Moderate-to-Severe
Systemic CorticosteroidsNot RecommendedNot Recommended
Topical AntimicrobialsNot RecommendedNot Recommended
Topical AntihistaminesNot RecommendedNot Addressed
Topical AntisepticsNot RecommendedNot Addressed
Elimination DietsNot AddressedNot Recommended
Allergen ImmunotherapyNot AddressedConditionally Recommended for Moderate-to-Severe; Not Recommended for Mild-to-Moderate
Wet DressingsConditionally Recommended for Moderate-to-Severe ADConditionally Recommended for Moderate-to-Severe AD

Fortunately, they provide fairly consistent recommendations regarding topical therapies and hygiene practices. However, a significant difference between the two lies in the utilization of topical JAK inhibitors. The AAD strongly advocates for the use of topical JAK inhibitors in cases of mild-to-moderate atopic dermatitis. Conversely, the AAAAI/ACAAI guideline takes a more cautious approach. They highlight the lack of sufficient evidence and recommend exploring safer treatment alternatives with more established benefits and higher safety profiles.

Furthermore, there are discrepancies in the utilization of azathioprine, methotrexate, and mycophenolate between the AAD and AAAAI/ACAAI guidelines. These variations in recommendations highlight the importance of considering multiple perspectives when determining the most appropriate treatment plan for patients with atopic dermatitis.

We trust that this comparison has provided valuable insights for you. However, it is essential to recognize that this is merely a brief overview of the guidelines. We highly recommend conducting a thorough review of the complete guidelines for a more comprehensive understanding.

This concludes our Guidelines Side-By-Side for Atopic Dermatitis. Sign up for alerts and stay informed on the latest published guidelines and articles.

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