Description
The existing evidence for treatment of atopic eczema (atopic dermatitis, AE) is
evaluated using the national standard Appraisal of Guidelines Research and
Evaluation (AGREE). The consensus process consisted of a nominal group process
and a DELPHI procedure. Management of AE must consider the individual
symptomatic variability of the disease. Basic therapy is focused on hydrating topical
treatment, and avoidance of specific and unspecific provocation factors. Antiinflammatory
treatment based on topical glucocorticosteroids and topical calcineurin
inhibitors is used for exacerbation management and more recently for proactive
therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, but
the topical calcineurin inhibitors tacrolimus and pimecrolimus are preferred in certain
locations. Systemic anti-inflammatory treatment is an option for severe refractory
cases. Microbial colonization and superinfection may induce disease exacerbation and
can justify additional antimicrobial treatment. Adjuvant therapy includes UV irradiation
preferably with UVA1 wavelength or UVB 311 nm. Dietary recommendations should
be specific and given only in diagnosed individual food allergy. Allergen-specific
immunotherapy to aeroallergens may be useful in selected cases. Stress-induced
exacerbations may make psychosomatic counselling recommendable. “Eczema
school” educational programs have been proven to be helpful. Pruritus is targeted with
the majority of the recommended therapies, but some patients need additional
antipruritic therapies