Diagnosis

Topical Treatments

Bleach Baths

Elimination Diets (With or Without Skin Testing)

Allergen Immunotherapy (Subcutaneous and Sublingual)

Systemic Treatments

Document Overview

Design and created by Guideline Central in participation with the American Academy of Allergy, Asthma & Immunology and American College of Allergy, Asthma, and Immunology.

Atopic Dermatitis (Eczema)

American College of Allergy, Asthma, and Immunology

American Academy of Allergy, Asthma & Immunology

Publication Date: Dec 17, 2023

Page Last Updated: May 5, 2026

Grading of Recommendations, Assessment, Development and Evaluation (GRADE)

GRADE Classification of Guideline Recommendations

Certainty of Evidence	Interpretation
H = High	Further research is very unlikely to change our confidence in the estimate of effect. The recommendation is based on high quality evidence — e.g., multiple highly rated randomized controlled trials, systematic reviews and metanalyses.
M= Moderate	Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. The recommendation would likely be based upon somewhat limited evidence — e.g., reduced number or quality of randomized controlled trials, controlled trials without randomization.
L = Low	Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. The recommendation would likely be based upon very weak evidence, — e.g., non-experimental studies, registries, comparative studies.
VL = Very low	Any estimate of effect is very uncertain. The recommendation is based largely on very low quality studies and/or on expert opinion.
GPS	Good Practice Statements

GRADE Strength of Recommendation Classifications and Interpretation

Strength of Recommendation	Description	Implications
S = Strong	The workgroup and Joint Task Force on Practice Parameters (JTFPP) are confident that the desirable effects of adherence to a recommendation outweigh the undesirable effects. This recommendation may be appropriate to be used as a practice standard indicator. When making a strong recommendation, the wording is “We recommend” implying that the clinician would choose to follow the recommendation in most circumstances.	For patients: Most people in your situation would want the recommended course of action and only a small proportion would not; request discussion if the intervention is not offered For clinicians: Most patients should receive the recommended course of action For policy makers: The recommendation can be adopted as a policy in most situations.
C = Conditional	The workgroup and JTFPP concluded that the desirable effects of adherence to a recommendation probably outweigh the undesirable effect but are not confident. When making a conditional recommendation, the wording is “We suggest” implying that the clinician may choose to follow the recommendation but that decisions may vary based on contextual factors.	For patients: Most people in your situation would want the recommended course of action, but many would not. For clinicians: You should recognize that different choices will be appropriate for different patients and that you must help each patient to arrive at a management decision consistent with her or his values and preferences. It is likely that shared decision making (SDM) will plan a major role in arriving at the management decision. For policy makers: Policy making will require substantial debate and involvement of many stakeholders.
Consensus-based Statement	When there are either no published studies, or very limited and/or weak evidence, a consensus statement without any category of certainty of evidence was developed. The degree of agreement by all JTFPP and workgroup members is indicated, with voting details provided if there were dissenting votes.

Document Overview

Document Title: Atopic Dermatitis (Eczema)

Authoring Societies

American College of Allergy, Asthma, and Immunology

American Academy of Allergy, Asthma & Immunology

Document Publication Date: Dec 17, 2023

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: www.annallergy.org/article/S1081-1206(23)01455-2/fulltext

Source Citation: AAAAI/ACAAI JTF Atopic Dermatitis Guideline Panel; Chu DK, Schneider L, Asiniwasis RN, Boguniewicz M, De Benedetto A, Ellison K, Frazier WT, Greenhawt M, Huynh J, Kim E, LeBovidge J, Lind ML, Lio P, Martin SA, O'Brien M, Ong PY, Silverberg JI, Spergel JM, Wang J, Wheeler KE, Guyatt GH; Patient Groups, Global Parents for Eczema Research; Capozza K; National Eczema Association; Begolka WS; Evidence in Allergy Group; Chu AWL, Zhao IX, Chen L, Oykhman P, Bakaa L; AAAAI/ACAAI Joint Task Force on Practice Parameters; Golden D, Shaker M, Bernstein JA, Greenhawt M, Horner CC, Lieberman J, Stukus D, Rank MA, Wang J, Ellis A, Abrams E, Ledford D, Chu DK. Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations. Ann Allergy Asthma Immunol. 2023 Dec 15:S1081-1206(23)01455-2. doi: 10.1016/j.anai.2023.11.009. Epub ahead of print. PMID: 38108679.

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: To produce evidence-based guidelines that support patients, clinicians, and other decision-makers in the optimal treatment of Atopic Dermatitis

Scope: Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D003876 - Dermatitis, Atopic

D003872 - Dermatitis

D003876 - Dermatitis, Atopic

D003872 - Dermatitis

Keywords: atopic dermatitis, dermatitis, exzema

Inclusion Criteria: Male, Female, Adolescent, Adult, Child, Older Adult

Health Care Settings: Ambulatory

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Supplemental Methodology Resource: Data Supplement

Number of Source Documents: 298

Literature Search Start Date: Wednesday, June 1, 2022

Literature Search End Date: Monday, July 31, 2023

Includes peer/external review process?: Yes

Includes public comment process?: No

Methodologist involvement?: Yes

Patient involvement?: Yes

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: No

Atopic Dermatitis (Eczema)

Diagnosis

Recommendation 1

Topical Treatments

Recommendation 2

Recommendation 3

Recommendation 4

Recommendation 5

Recommendation 6

Recommendation 7

Recommendation 8

Recommendation 9

Recommendation 10

Bleach Baths

Recommendation 11

Recommendation 12

Elimination Diets (With or Without Skin Testing)

Recommendation 13

Allergen Immunotherapy (Subcutaneous and Sublingual)

Recommendation 14

Recommendation 15

Systemic Treatments

Recommendation 16

Recommendation 17

Recommendation 18

Recommendation 19

Recommendation 20

Recommendation 21

Recommendation 22

Recommendation 23

Recommendation 24

Recommendation 25

Grading of Recommendations, Assessment, Development and Evaluation (GRADE)

GRADE Classification of Guideline Recommendations

GRADE Strength of Recommendation Classifications and Interpretation

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology