Atopic Dermatitis Part 2: Management

Abstract

The goal of management of atopic dermatitis (AD) or eczema, is to achieve disease control in the absence of a cure. This review aims to outline the current management and treatment of AD and explore gaps in knowledge about the effectiveness of treatment control. Although there is no concrete definition of or specific features that constitute "control" in this context, control includes reducing disease activity, decreasing symptoms, and ultimately improving quality of life. Therapeutic patient education (TPE) improves outcomes and includes information about the disease; recognition of active disease; trigger reduction where possible; moisturization; and instructions on medication use. Applying moisturizers consistently is part of standard care and plays a role in flare prevention. Topical corticosteroids (TCS), for which there is good evidence to support efficacy and safety, are frequently used topical treatments. Despite the infrequent incidence of side effects, the use of TCS is often hindered by fear of these side effects. To ensure adherence to treatment, it is essential to assess and address patients' and caregivers' concerns about steroid use. Effective alternative topical treatments include calcineurin inhibitors, phosphodiesterase-4 inhibitors, and Janus kinase inhibitors (JAKI). Ancillary therapies may play a role in some selected patients, for example, wet-wrap therapy and bleach baths, but add complexity to management plans with inconsistent supporting evidence. Antihistamines are no longer routinely recommended. When topical therapy fails, systemic treatment options may be considered, including phototherapy, traditional immune-suppressant therapy, and newer agents such as biologic therapy or JAKI.