Most Read Articles
Tristan Manalac, 4 days ago
The causes, presentations and management of anaphylaxis vary considerably with age, according to a recent Singapore study, which reported that children are more likely to present with food anaphylaxis, while drug anaphylaxis is more common in adults.
Pearl Toh, 3 days ago
Low-density lipoprotein cholesterol (LDL-C) levels remained high in many patients with stable or acute coronary heart disease (CHD) in Asia, despite having a very high risk of recurrent cardiovascular (CV) events, indicating that the use of lipid-lowering therapies and lipid monitoring were inadequate.
13 Sep 2018
Substituting diets high in carbohydrates with those high in monounsaturated fatty acids in the context of low saturated fatty acids do not appear to yield favourable effects on blood pressure, according to a meta-analysis.
2 days ago
There is a strong association between smoking duration and colorectal polyps, independent of smoking intensity, cessation and other potential confounders, reports a recent study. Such association is more robust with distal rather than proximal polyps, and with serrated polyps rather than adenomas.

Guidelines for atopic dermatitis management: What is recommended and what is not

Stephen Padilla
15 Aug 2018

Most clinical guidelines recommend daily bathing in lukewarm water, followed by the application of moisturizers, in the treatment of atopic dermatitis (AD), according to an expert who presented at the 23rd Asian-Australasian Regional Conference of Dermatology (RCD 2018) held in Surabaya, Indonesia.

Dr. Agnes Heng, president of the Dermatological Society of Malaysia and a council member of the Asian Academy of Dermatology and Venereology, compared the different clinical guidelines used for the treatment of AD, which included those from Malaysia, Singapore, Taiwan, India, Korea, Japan, Hong Kong, Asia Pacific, Europe and the US.

“All guidelines encourage the avoidance of damaging, drying and irritating soaps with alkaline pH,” Heng said, adding that most guidelines also recommend applying moisturizers at least twice a day and preferably after bath while the skin is still moist.

Asia-Pacific, European and Korean guidelines recommend the application of 200–300 g/week of moisturizers to the whole body for an adult, she said.

“An ideal moisturizer should be safe, effective, inexpensive, and free of additives, fragrances, perfumes and other potentially sensitizing agents,” Heng added.

Topical pharmacotherapies, such as corticosteroids (TCS) and calcineurin inhibitors (TCI), are also endorsed as effective therapies for AD. In general, low-potency TCS are suggested for maintenance therapy, whereas intermediate and high-potency TCS are recommended for the acute control of AD.

“All guidelines recommend tailoring the strength of TCS based on location, severity, chronicity of eczema and age of the patients,” Heng said, adding that proactive, intermittent use of TCS as maintenance therapy (1–2 times/week) is suggested on areas that commonly flare (hotspots).

However, due to steroid-phobia, most guidelines urge clinicians to recognize and address patient fears of side effects associated with the use of TCS to improve adherence and to avoid undertreatment.

On the other hand, most guidelines recommend TCIs, including tacrolimus and pimecrolimus, for acute and chronic AD, along with maintenance, in both adults and children. In addition, all guidelines discuss the local side effects of TCI, such as burning, stinging and pruritus, and advise that patients be provided with this information when it is first prescribed.

For other topical therapies, phosphodiesterase 4 inhibitor and topical Janus kinase inhibitor are given passing mention in the American Academy of Dermatology (AAD), European, Malaysian and Korean guidelines, while antihistamines, capsaicin, cannabinoid receptor agonists, opioid receptor agonists and anaesthetics are discussed but not recommended in the AAD, European and Korean guidelines.

Systemic therapies (antihistamines, corticosteroids, cyclosporine, azathioprine, methotrexate, mycophenolate mofetil) are also discussed in some guidelines, but most agree that this kind of treatment may only be considered in moderate-to-severe cases of AD or as an alternative for patients who are unresponsive to topical therapy and should not be used for the long term.

Biologic agents, particularly dupilumab, are only mentioned in 2018 guidelines (Europe and Malaysia).

“Dupilumab is recommended as a disease-modifying drug for patients with moderate-to-severe AD, in whom topical treatment is not sufficient and other treatment is not advisable,” Heng said. “Dupilumab should be combined with daily emollients and may be combined with topical anti-inflammatory drugs as needed.”

Furthermore, adjunctive treatment, such as probiotics/prebiotics, essential free fatty acids, vitamin D, Chinese herbal medicine, acupuncture, homoeotherapy, allergen specific immunotherapy, autologous blood therapy, bioresonance, balneotherapy, topical oils and massage therapy, is not recommended.

Finally, Heng said that treatment adherence and poor quality of life (QoL) are key issues in patients with AD. Patient education interventions are needed to help patients and their families to better understand their disease and cope with treatment, potentially resulting in improved QoL and treatment adherence.

“Most guidelines discussed this in detail and recommend that educational intervention should be considered as part of management of AD. They advocate for multidisciplinary training programmes in addition to video interventions as a useful adjunct,” she said.

Clinical guidelines are “statements that include recommendations, intended to optimize patient care, that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options,” Heng explained.

Guidelines are a tool for making care more consistent, as well as close the gap between what clinicians do and what scientific evidence supports.

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Doctor - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Tristan Manalac, 4 days ago
The causes, presentations and management of anaphylaxis vary considerably with age, according to a recent Singapore study, which reported that children are more likely to present with food anaphylaxis, while drug anaphylaxis is more common in adults.
Pearl Toh, 3 days ago
Low-density lipoprotein cholesterol (LDL-C) levels remained high in many patients with stable or acute coronary heart disease (CHD) in Asia, despite having a very high risk of recurrent cardiovascular (CV) events, indicating that the use of lipid-lowering therapies and lipid monitoring were inadequate.
13 Sep 2018
Substituting diets high in carbohydrates with those high in monounsaturated fatty acids in the context of low saturated fatty acids do not appear to yield favourable effects on blood pressure, according to a meta-analysis.
2 days ago
There is a strong association between smoking duration and colorectal polyps, independent of smoking intensity, cessation and other potential confounders, reports a recent study. Such association is more robust with distal rather than proximal polyps, and with serrated polyps rather than adenomas.