Atopic Dermatitis in Children and Adults—Diagnosis and Treatment

Abstract

Background: Atopic dermatitis is a common, chronically recurring inflammatory skin disease. It gives rise to a high disease burden and is of major importance in social medicine.

Methods: This review is based on pertinent publications retrieved by a selective search in PubMed, including the current German and European guidelines.

Results: Basic therapy with drug-free topical agents markedly improves the barrier function of the skin. Adults should apply at least 250 g per week. Patient-specific trigger factors such as allergens, stress, microbial pathogens, or skin irritants should be eliminated or avoided. In mild and moderately severe forms, external treatment with topical glucocorticosteroids and topical calcineurin inhibitors usually suffices; proactive therapy is given to patients with frequent recurrences or a long course of disease. Systemic anti-inflammatory treatment with biological agents such as dupilumab and tralokinumab, Janus kinase inhibitors such as baricitinib, upadacitinib, and abrocitinib, or conventional immunosuppressant drugs is indicated particularly in severe cases. The patient should be actively involved in the choice and planning of treatment; the patient's age and the cutaneous findings should be taken into account. Interdisciplinary patient education yields a sustained benefit.

Conclusion: A combination of baseline therapy, reactive and proactive anti-inflammatory therapy, and systemic therapy as needed is the foundation of successful interdisciplinary treatment for atopic dermatitis.

Figure

Stepwise plan for the treatment of atopic dermatitis in adults – also antiseptic, antibiotic, antiviral, or antifungal therapy for infections – Ccheck compliance and diagnosis if treatment is not sufficiently effective *¹see (4, 5) for important limitations and definitions, as well as stepwise treatment schedule for adolescents and children, *² approved indication,*³ off-label treatment ↑↑ dark green) strong recommendation for use / ↑ (light green) weak recommendation for use Abro, abrocitinib; AZA,azathioprine; Bari, baricitinib; CyA,cyclosporin; Dupi, dupilumab; MTX, methotrexate; TCI, topical calcineurin inhibitors; TCS, topical corticosteroids; Tralo, tralokinumab; Upa, upadacitinib; UVA1, ultraviolet A1; NB-UVB, narrow-spectrum ultraviolet B