Canadian Consensus Guidelines for the Management of Atopic Dermatitis with Topical Therapies

Melinda J Gooderham^{1

2

3}, H Chih-Ho Hong^{4

5}, Charles Lynde^{6

7}, Kim A Papp^{8

9

10}, Jensen Yeung^{9

11

12}, Harvey Lui^{4

13}, Yvette Miller-Monthrope^{9

11}, Julien Ringuet^{14

15}, Irina Turchin^{8

16

17}, Vimal H Prajapati^{18

19

20

21

22

23}

Affiliations

¹ SKiN Centre for Dermatology, 775 Monaghan Rd, Peterborough, ON, K9J 5K2, Canada. mgooderham@centrefordermatology.com.
² Probity Medical Research, Peterborough, ON, Canada. mgooderham@centrefordermatology.com.
³ Queen's University, Peterborough, ON, Canada. mgooderham@centrefordermatology.com.
⁴ Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.
⁵ Probity Medical Research, Surrey, BC, Canada.
⁶ Lynde Institute for Dermatology, Markham, ON, Canada.
⁷ Probity Medical Research, Markham, ON, Canada.
⁸ Probity Medical Research, Waterloo, ON, Canada.
⁹ Division of Dermatology, Temerty School of Medicine, University of Toronto, Toronto, ON, Canada.
¹⁰ Alliance Clinical Research, Waterloo, ON, Canada.
¹¹ Women's College Hospital, Toronto, ON, Canada.
¹² Probity Medical Research, Toronto, ON, Canada.
¹³ Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
¹⁴ Centre de Recherche Dermatologique du Québec Métropolitain, Quebec City, QC, Canada.
¹⁵ McGill University, Montreal, QC, Canada.
¹⁶ Brunswick Dermatology Center, Fredericton, NB, Canada.
¹⁷ Department of Medicine, Dalhousie University, Halifax, NS, Canada.
¹⁸ Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
¹⁹ Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, AB, Canada.
²⁰ Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada.
²¹ Dermatology Research Institute, Calgary, AB, Canada.
²² Skin Health and Wellness Centre, Calgary, AB, Canada.
²³ Probity Medical Research, Calgary, AB, Canada.

PMID: 40279086
PMCID: PMC12092898
DOI: 10.1007/s13555-025-01386-2

Canadian Consensus Guidelines for the Management of Atopic Dermatitis with Topical Therapies

Melinda J Gooderham et al. Dermatol Ther (Heidelb). 2025 Jun.

. 2025 Jun;15(6):1467-1485.

doi: 10.1007/s13555-025-01386-2. Epub 2025 Apr 25.

Authors

Affiliations

¹ SKiN Centre for Dermatology, 775 Monaghan Rd, Peterborough, ON, K9J 5K2, Canada. mgooderham@centrefordermatology.com.
² Probity Medical Research, Peterborough, ON, Canada. mgooderham@centrefordermatology.com.
³ Queen's University, Peterborough, ON, Canada. mgooderham@centrefordermatology.com.
⁴ Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.
⁵ Probity Medical Research, Surrey, BC, Canada.
⁶ Lynde Institute for Dermatology, Markham, ON, Canada.
⁷ Probity Medical Research, Markham, ON, Canada.
⁸ Probity Medical Research, Waterloo, ON, Canada.
⁹ Division of Dermatology, Temerty School of Medicine, University of Toronto, Toronto, ON, Canada.
¹⁰ Alliance Clinical Research, Waterloo, ON, Canada.
¹¹ Women's College Hospital, Toronto, ON, Canada.
¹² Probity Medical Research, Toronto, ON, Canada.
¹³ Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
¹⁴ Centre de Recherche Dermatologique du Québec Métropolitain, Quebec City, QC, Canada.
¹⁵ McGill University, Montreal, QC, Canada.
¹⁶ Brunswick Dermatology Center, Fredericton, NB, Canada.
¹⁷ Department of Medicine, Dalhousie University, Halifax, NS, Canada.
¹⁸ Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
¹⁹ Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, AB, Canada.
²⁰ Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada.
²¹ Dermatology Research Institute, Calgary, AB, Canada.
²² Skin Health and Wellness Centre, Calgary, AB, Canada.
²³ Probity Medical Research, Calgary, AB, Canada.

PMID: 40279086
PMCID: PMC12092898
DOI: 10.1007/s13555-025-01386-2

Abstract

Introduction: Atopic dermatitis (AD) is a highly prevalent disease in Canada with significant patient burden. Treatment guidance for topical therapy (the mainstay of AD management), with particular consideration of emerging treatments, may further improve patient care. Here, we aim to provide healthcare professionals with AD treatment recommendations from the perspective of 10 Canadian dermatologists with expertise in managing AD.

Methods: The panel of dermatologists conducted a systematic literature review and leveraged their clinical experience to develop generally accepted principles, consensus statements, and a treatment algorithm using an iterative consensus process.

Results: The panel collectively developed six generally accepted principles, 10 consensus statements, and a treatment algorithm. The guidance notes that assessment of disease severity should encompass both physician-rated measures and patient-reported outcomes. Disease education, lifestyle-based strategies (e.g., trigger avoidance), and supportive measures (e.g., moisturizers) can help reduce signs and symptoms of AD. Choice of therapy should consider disease-, patient-, and treatment-related factors. Although topical corticosteroids (TCS) are often used as first-line treatment in AD, they should be limited to intermittent short-term use. Noncorticosteroid topical therapies (e.g., topical calcineurin inhibitors; topical phosphodiesterase-4 inhibitors; and topical Janus kinase inhibitors) can be used for widespread involvement of AD according to approved use. Once treatment goals are achieved, noncorticosteroid topical maintenance therapy should continue to prevent flares and reduce the need for TCS.

Conclusion: Guidance reflecting the benefits and limitations of topical AD treatments in conjunction with patient understanding of treatment goals supports robust shared decision-making in the management of AD.

Keywords: Atopic dermatitis; Janus kinase inhibitor; Phosphodiesterase-4 inhibitor; Topical calcineurin inhibitor; Topical corticosteroid.

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Conflict of interest statement

Declarations. Conflict of Interest: Melinda J. Gooderham has served as a principal investigator for AbbVie, Alumis, Amgen, AnaptysBio, Apogee, Arcutis, Aristea, Aslan, Bausch Health, Boehringer Ingelheim International GmbH, Bristol Myers Squibb, Cara Therapeutics, Coherus Biosciences, Dermira, Eli Lilly, Galderma SA, GlaxoSmithKline, Incyte Corporation, InMagene, JAMP, Janssen, LEO Pharma, MedImmune, Meiji, MoonLake, Nektar Therapeutics, Nimbus, Novartis, Pfizer, Regeneron, Sanofi Genzyme, Sun Pharma, Takeda Pharmaceutical Company, Tarsus, UCB, Ventyx, and Vyne; a consultant for AbbVie, Amgen, Apogee, Aslan, Bausch Health, Boehringer Ingelheim International GmbH, Eli Lilly, Janssen, Novartis Pharmaceuticals, Sanofi Genzyme, Sun Pharma, and UCB; an advisory board member for AbbVie, Amgen, Apogee, Arena Pharmaceuticals, Asana BioSciences, Aslan, Bausch Health, Boehringer Ingelheim International GmbH, Eli Lilly, Galderma SA, Incyte Corporation, Janssen, LEO Pharma, Novartis, Pfizer, Regeneron, Sanofi Genzyme, Sun Pharma, UCB, and Union; and a paid speaker for AbbVie, Amgen, Bausch Health, Bristol Myers Squibb, Boehringer Ingelheim International GmbH, Eli Lilly, Galderma SA, Janssen, JAMP, LEO Pharma, L’Oréal, Novartis, Pfizer, Regeneron, Sanofi Genzyme, Sun Pharma, and UCB. H. Chih-ho Hong has served as a speaker, advisor, consultant, and/or investigator for AbbVie, Amgen, Arcutis, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Cutanea, Dermira, Dermavant, DS Biopharma, Eli Lilly, Galderma, GlaxoSmithKline, Incyte Corporation, Janssen, LEO Pharma, Medimmune, Merck, Mirimar, Novartis, Pfizer, Regeneron, Sanofi-Genzyme, Roche, and UCB. Charles Lynde has served as a speaker and/or consultant for AbbVie, Amgen, Aralez, Arcutis, Bausch Health, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Cipher, Dermavant, Eli Lilly, Fresnius Kabi, Galderma, GlaxoSmithKline, Incyte Corporation, Innovaderm, Intega Skin, Janssen, Kyowa Kirin, La Roche Posay, LEO Pharma, L’Oréal, Medexus, MedX, Merck, Novartis, P&G, Pediapharm, Pfizer, Regeneron, Roche, Sanofi Genzyme, Sandoz, Sentrex, Sun Pharma, TEVA, Tribute, UCB, Valeant, Viatris, and Volo Health and has served as a principal investigator for AbbVie, Acelyrin, Akros, Altius, Amgen, Aralez, Arcutis, Avillion, Bausch Health, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Celltrion, Cipher, Concert, Dermavant, Devonian, Eli Lilly, Evelo, Galderma, GlaxoSmithKline, Incyte Corporation, Innovaderm, Intega Skin, Janssen, Kyowa Kirin, La Roche Posay, LEO Pharma, L’Oréal, Medexus, MedX, Merck, MoonLake, Novartis, P&G, Pediapharm, Pfizer, Regeneron, Roche, Sanofi Genzyme, Sandoz, Sentrex, Sun Pharma, TEVA, Tribute, UCB, Valeant, Viatris, and Volo Health. Kim A. Papp has received honoraria and/or grants as a consultant, speaker, investigator, or scientific officer from AbbVie, Acelyrin, Akros, Alumis, Amgen, Arcutis, Bausch Health/Valeant, Boehringer Ingelheim, Bristol Myers Squibb, Can-Fite Biopharma, Celltrion, Concert Pharmaceuticals, Dermavant, Dermira, DICE Pharmaceuticals, DICE Therapeutics, Eli Lilly and Company, Evelo Biosciences, Forbion, Galderma, Horizon Therapeutics, Incyte Corporation, Janssen, Kymab, Kyowa Hakko Kirin, LEO Pharma, Meiji Seika Pharma, Mitsubishi Pharma, Nimbus Therapeutics, Novartis, Pfizer, Reistone, Sanofi-Aventis/Genzyme, Sandoz, Sun Pharma, Takeda, Tarsus Pharmaceuticals, UCB Pharma, and Zai Lab. Jensen Yeung has served as a consultant, investigator, or speaker or received honoraria from AbbVie, Amgen, Arcutis, Apogee, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celltrion, Fresenius Kabi, Galderma, Incyte Corporation, JAMP Pharma, Janssen, LEO Pharma, Lilly, Novartis, Pfizer, Regeneron, Sanofi Genzyme, Sun Pharma, Takeda, and UCB. Harvey Lui has served as an advisor, consultant, investigator, and/or speaker for AbbVie, Incyte Corporation, L’Oréal, Novartis, and Vita Imaging. Yvette Miller-Monthrope has served as an advisor, consultant, and/or speaker for AbbVie, Bristol Myers Squibb, Boehringer Ingelheim, Fresenius Kabi, Galderma, Incyte Corporation, Janssen, Sanofi, Sun Pharma, Novartis, and UCB. Julien Ringuet has served as an advisor, consultant, and/or speaker for AbbVie, Amgen, Apogee, Arcutis, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galderma, Incyte Corporation, Janssen, LEO Pharma, L’Oréal, NKS Health, Novartis, Organon, Pfizer, Sandoz, Sanofi Genzyme, Sun Pharma, and UCB and served as an investigator for AbbVie, Alumis, Amgen, Aristea, Aslan, Bristol Myers Squibb, Celgene, Concert Pharmaceuticals, CorEvitas, DICE Therapeutics, Incyte Corporation, Innovaderm, Janssen, LEO Pharma, Merck, Pfizer, Sanofi-Genzyme, Sun Pharma, and UCB. Irina Turchin has served as a speaker, advisor, consultant, or investigator for AbbVie, Amgen, Arcutis, Aristea, Bausch Health, Bristol Myers Squibb, Boehringer Ingelheim, Eli Lilly, Galderma, Horizon Therapeutics, Incyte Corporation, Janssen, Kiniksa, LEO Pharma, Mallinckrodt, MoonLake, Novartis, Pfizer, Sanofi, Sun Pharma, UCB, and Ventyx Biosciences. Vimal H. Prajapati has served as an advisor, consultant, and/or speaker for AbbVie, Actelion, Amgen, Apogee Therapeutics, Aralez, Arcutis, Aspen, Bausch Health, BioScript Solutions, Boehringer Ingelheim, Bristol Myers Squibb, Canadian Psoriasis Network, Celgene, Celltrion, Cipher, Concert, CorEvitas, Eczema Society of Canada, Eli Lilly, Galderma, GlaxoSmithKline, Homeocan, Incyte Corporation, JAMP Pharma, Janssen, Johnson & Johnson, LEO Pharma, Medexus, Novartis, Organon, Pediapharm, Pfizer, Sanofi Genzyme, Sun Pharma, Tribute, UCB, and Valeant; served as an investigator for AbbVie, AnaptysBio, Arcutis, Arena, Asana, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Concert, CorEvitas, Dermavant, Dermira, Eli Lilly, Galderma, Incyte Corporation, Janssen, LEO Pharma, Meiji Pharma, Nektar Therapeutics, Nimbus Lakshmi, Novartis, Pfizer, RAPT Therapeutics, Regeneron, Reistone, Sanofi Genzyme, Sun Pharma, Takeda, and UCB; and received grants from AbbVie, Bausch Health, Janssen, LEO Pharma, Novartis, and Sanofi Genzyme. Ethical Approval: This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

Figures

**Fig. 1**
Algorithm for the topical therapy of AD in children, adolescents, and adults. ^aSensitive areas include the face (eyelids and perioral region), neck, axillary/inguinal region, and genital region. ^bCochrane review has shown that QD application of TCS is as effective as BID application of TCS. ^cRuxolitinib (1.5% cream) can be resumed at the first sign of recurrence and stopped 3 days after signs/symptoms have resolved. AD atopic dermatitis, *BID* twice daily, *BSA* body surface area, QD once daily, *TCI* topical calcineurin inhibitor, *TCS* topical corticosteroid, *TJAKi* topical Janus kinase inhibitor, *TPDE-4i* topical phosphodiesterase-4 inhibitor

See this image and copyright information in PMC

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Canadian Consensus Guidelines for the Management of Atopic Dermatitis with Topical Therapies

Affiliations

Canadian Consensus Guidelines for the Management of Atopic Dermatitis with Topical Therapies

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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