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)
- Management of Atopic Dermatitis in Adults with Topical Therapies (January 2023)
- Management Of Atopic Dermatitis in Adults with Phototherapy and Systemic Therapies (November 2023)
American Academy of Allergy, Asthma and Immunology (AAAAI) and American College of Allergy, Asthma and Immunology (ACAAI) Joint Task Force (JTF)
- Atopic Dermatitis (Eczema) (December 2023)
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:
| Therapy | AAD Guidelines | AAAAI/ACAAI Guidelines |
| Moisturizers | ||
| OTC Moisturizers | Strongly Recommended | Not Addressed |
| Rx Moisturizers | Not Addressed | Conditionally Recommended |
| Topic Corticosteroids | ||
| Topic Corticosteroids | Strongly Recommended | Strongly Recommended |
| Topical Calcineurin Inhibitors | ||
| Tacrolimus 0.03% or 0.1% | Strongly Recommended | Conditionally Recommended |
| Pimecrolimus 1% cream | Strongly Recommended for Mild-to-Moderate AD | Conditionally Recommended |
| Topical PDE4 Inhibitors | ||
| Crisaborole 2% | Strongly Recommended for Mild-to-Moderate AD | Conditionally Recommended for Mild-to-Moderate AD |
| Topical JAK Inhibitors | ||
| Ruxolitinib | Strongly Recommended for Mild-to-Moderate AD | Not Recommended |
| Biologics for Moderate-to-Severe AD | ||
| Dupilumab | Strongly Recommended | Strongly Recommended |
| Tralokinumab | Strongly Recommended | Strongly Recommended |
| Oral JAK inhibitors for Moderate-to-Severe AS | ||
| Abrocitinib | Strongly Recommended | Strongly Recommended |
| Baricitinib | Strongly Recommended | Strongly Recommended |
| Upadacitinib | Strongly Recommended | Strongly Recommended |
| Other Therapies | ||
| Azathioprine | Conditionally Recommended for Moderate-to-Severe AD | Not Recommended |
| Cyclosporine | Conditionally Recommended for Moderate-to-Severe AD | Conditionally Recommended for Moderate-to-Severe AD |
| Methotrexate | Conditionally Recommended for Moderate-to-Severe AD | Not Recommended |
| Mycophenolate | Conditionally Recommended for Moderate-to-Severe AD | Not Recommended |
| Narrow-Band UV-B | Conditionally Recommended | Conditionally Recommended for Moderate-to-Severe |
| Systemic Corticosteroids | Not Recommended | Not Recommended |
| Topical Antimicrobials | Not Recommended | Not Recommended |
| Topical Antihistamines | Not Recommended | Not Addressed |
| Topical Antiseptics | Not Recommended | Not Addressed |
| Elimination Diets | Not Addressed | Not Recommended |
| Allergen Immunotherapy | Not Addressed | Conditionally Recommended for Moderate-to-Severe; Not Recommended for Mild-to-Moderate |
| Wet Dressings | Conditionally Recommended for Moderate-to-Severe AD | Conditionally 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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