Quick Summary
Familial, chronic, relapsing inflammatory skin disease with intense itch and dry skin, often starting in infancy.
Clinical diagnosis using Hanifin and Rajka criteria with severity scoring, stepwise therapy from topical agents to systemic immunosuppressants and biologics, and proactive maintenance to reduce relapses.
Warning signs
- Severe eczema or secondary skin infection may require hospitalization.
- Eczema herpeticum or Kaposi’s varicelliform eruption requires hospital antivirals.
Initial assessment
- Pruritus is predominant.
- Pain is common from scratching or fissures.
- Infants under two: facial red papules with oozing or crusting.
- Diaper area is usually spared in infants.
- Children two to twelve: flexural eczema with lichenification.
- Adolescents and adults: face, neck, chest, and back involvement.
Diagnosis
- Diagnosis is clinical using history and skin findings.
- Screen for allergens, infections, irritants, stress, and temperature.
- Apply Hanifin and Rajka diagnostic criteria.
- Require three or more major features.
- Major feature: pruritus.
- Major feature: typical morphology and distribution.
Diagnostics (Lab Test and Imaging)
- Consider serum total IgE testing.
- IgE ≥500 IU/mL may indicate atopic dermatitis.
- Use specific IgE tests or skin prick tests.
- Monitor eosinophils, LDH, and TARC for progression.
- Raised LDH may reflect tissue damage.
- Routine FLG genetic testing is not recommended.
Pharmacological management
- Topical corticosteroids
- First line for flares and relapse prevention.
- Choose potency by site, severity, and age.
- Avoid high potency on face, groin, axillae.
- Intermittent one to two times weekly for maintenance.
- Taper high potency to prevent rebound.
- Topical calcineurin inhibitors
- Steroid sparing for face, folds, anogenital areas.
- Use in steroid atrophy or intolerance.
- Effective in patients older than two years.
- Improvement within three to seven days.
- No proven causal link to cancer.
- PDE‑4 inhibitors
- Crisaborole for mild to moderate from three months.
- Roflumilast for patients six years and older.
- Early itch improvement may occur.
- Consider apremilast in refractory disease.
- Systemic immunosuppressants and corticosteroids
- Ciclosporin short term for severe refractory disease.
- Methotrexate, azathioprine, or mycophenolate are options.
- Monitor TPMT with azathioprine.
- Short‑term oral steroids for severe flares or bridge therapy.
- Biologics and JAK inhibitors
- Dupilumab from six months of age.
- Tralokinumab from twelve years of age.
- Lebrikizumab from twelve years and forty kilograms.
- Nemolizumab from twelve years and thirty kilograms.
- Oral JAKs include abrocitinib, baricitinib, upadacitinib.
- Reassess baricitinib at eight weeks for response.
- Topical ruxolitinib for patients twelve years and older.
- Tapinarof approved from two years of age.
- Adjuncts and infection management
- Sedating oral antihistamines can aid sleep.
- Non sedating antihistamines have variable itch benefit.
- Topical antihistamines may cause contact dermatitis.
- Treat localized bacterial lesions with topical antibiotics.
- Use oral antibiotics for widespread infection.
- Consider antifungals for head and neck involvement.
- Hospital antivirals for eczema herpeticum.
Indications for surgery / procedural interventions
- Use potent steroids under occlusion for resistant plaques.
- Clear clinical infections before anti‑inflammatory therapy.
- Treat reservoirs such as nose and groin.
- For molluscum, consider KOH, cantharidin, or tretinoin.
- Consider cryotherapy or curettage for molluscum.
- Avoid combining ciclosporin with UV light therapies.
Follow up / Monitoring
- Use proactive maintenance on commonly flaring sites.
- Class II or III steroids one to two times weekly.
- Tacrolimus two to three times weekly for maintenance.
- Track severity with EASI, SCORAD, and POEM.
- Use QoL tools such as DLQI and CDLQI.
- Reassess baricitinib at eight weeks for response.
Special situations
- Infants under two: cheeks and chin with oozing and crusting.
- Children two to twelve: flexural distribution and lichenification.
- Adolescents and adults: face, neck, chest, and back involvement.
- Adult new‑onset without childhood history is unusual.
- Hand dermatitis in adults from irritant exposures.
Overview
Atopic dermatitis is a kind of dermatitis that has specific
characteristics that you can know more in the Introduction
section.
Atopic dermatitis is one of the most common dermatological diseases affecting millions worldwide. It can affect both children and adults. More information about the prevalence of this disease in the Epidemiology section.
Atopic dermatitis is one of the most common dermatological diseases affecting millions worldwide. It can affect both children and adults. More information about the prevalence of this disease in the Epidemiology section.
This is h3 text test - PD 4/6/26
There are many causes of atopic dermatitis. The Etiology section enumerated these causes. The Pathophysiology section discussed the development of this skin disease.
History and Physical Examination
Among 34 countries, it has been found that pain is the
second most common symptom after pruritus. To know more, see the Clinical Presentation section.
Atopic Dermatitis_summary
Atopic Dermatitis_summaryDiagnosis
In order to diagnose atopic dermatitis, the Hanifin and Rajka criteria in
the Diagnostic Criteria
section is used. In this section you will also learn how to assess the disease
severity.
The Laboratory Tests and Ancillaries section discuss what tests can be done to help with the diagnosis of atopic dermatitis.
There are several diseases that can mimic atopic dermatitis and the Differential Diagnosis section has enumerated them.
The Laboratory Tests and Ancillaries section discuss what tests can be done to help with the diagnosis of atopic dermatitis.
There are several diseases that can mimic atopic dermatitis and the Differential Diagnosis section has enumerated them.
Management
One of the goals of therapy is to reduce the symptoms to
know more about the goals of therapy. See the Principles
of Therapy section for further details.
Various topical and systemic therapies are recommended for the treatment of atopic dermatitis, such as corticosteroids, calcineurin inhibitors, phosphodiesterase type-4 (PDE-4) inhibitors, immunosuppressants, etc. The Pharmacological Therapy section contains a more extensive discussion on these treatment options.
There are Lifestyle Modifications (eg avoidance of trigger factors, skin care) and preventive measures that can be done in order to manage atopic dermatitis. These are discussed in the Prevention and Lifestyle Modifications sections.
Educating the patient or caregiver about the disease is also an important aspect in the management of atopic dermatitis. Refer to the Patient Education section for further details.
The sections of Other Therapy and Proactive Therapy discusses about the available options for the management of atopic dermatitis such as wet wrap therapy, phototherapy and immunoadsorption.
Various topical and systemic therapies are recommended for the treatment of atopic dermatitis, such as corticosteroids, calcineurin inhibitors, phosphodiesterase type-4 (PDE-4) inhibitors, immunosuppressants, etc. The Pharmacological Therapy section contains a more extensive discussion on these treatment options.
There are Lifestyle Modifications (eg avoidance of trigger factors, skin care) and preventive measures that can be done in order to manage atopic dermatitis. These are discussed in the Prevention and Lifestyle Modifications sections.
Educating the patient or caregiver about the disease is also an important aspect in the management of atopic dermatitis. Refer to the Patient Education section for further details.
The sections of Other Therapy and Proactive Therapy discusses about the available options for the management of atopic dermatitis such as wet wrap therapy, phototherapy and immunoadsorption.
FAQ
Q: What are the diagnostic criteria for Atopic Dermatitis in clinical practice?
A: Diagnosis of Atopic Dermatitis is based on patient history, cutaneous findings (atopic stigmata), and physical examination. The Hanifin & Rajka criteria require at least 3 major features (pruritus, typical morphology/distribution, chronic or relapsing dermatitis, personal/family history of atopy) and at least 3 minor features (e.g., cheilitis, hand/foot dermatitis, ichthyosis, xerosis, increased serum IgE, early onset, etc.).
Q: How should initial assessment and identification of exacerbating factors in Atopic Dermatitis be approached? A: Initial assessment involves a thorough history and physical exam, focusing on exacerbating factors such as aeroallergens, foods, infections, irritating chemicals, emotional stress, and extreme temperatures. Identifying these can help tailor management and patient education.
Q: What are the key non-pharmacological management strategies for Atopic Dermatitis?
A: Non-pharmacological therapy includes patient/caregiver education on the chronic nature of the disease, proper skin care (bathing, hydration, liberal use of emollients), stress-reduction techniques, and behavioral therapy to reduce scratching. Emphasis is placed on adherence to therapy and realistic expectations (control, not cure). Lifestyle modifications should be included and skin care
Q: What is the recommended approach to topical therapy in Atopic Dermatitis?
A: Topical corticosteroids should be applied 10–15 minutes after emollients, targeting only affected areas. Emollients should be used liberally and frequently, even in the absence of symptoms. Proper instruction reduces disease severity and corticosteroid use.
Q: How can pharmacists and doctors address corticosteroid phobia and improve adherence in Atopic Dermatitis management?
A: Address concerns about corticosteroid side effects by educating patients/caregivers on correct application, the importance of compliance, and the low risk of adverse effects with proper use. This improves adherence and clinical outcomes.
A: Diagnosis of Atopic Dermatitis is based on patient history, cutaneous findings (atopic stigmata), and physical examination. The Hanifin & Rajka criteria require at least 3 major features (pruritus, typical morphology/distribution, chronic or relapsing dermatitis, personal/family history of atopy) and at least 3 minor features (e.g., cheilitis, hand/foot dermatitis, ichthyosis, xerosis, increased serum IgE, early onset, etc.).
Q: How should initial assessment and identification of exacerbating factors in Atopic Dermatitis be approached? A: Initial assessment involves a thorough history and physical exam, focusing on exacerbating factors such as aeroallergens, foods, infections, irritating chemicals, emotional stress, and extreme temperatures. Identifying these can help tailor management and patient education.
Q: What are the key non-pharmacological management strategies for Atopic Dermatitis?
A: Non-pharmacological therapy includes patient/caregiver education on the chronic nature of the disease, proper skin care (bathing, hydration, liberal use of emollients), stress-reduction techniques, and behavioral therapy to reduce scratching. Emphasis is placed on adherence to therapy and realistic expectations (control, not cure). Lifestyle modifications should be included and skin care
Q: What is the recommended approach to topical therapy in Atopic Dermatitis?
A: Topical corticosteroids should be applied 10–15 minutes after emollients, targeting only affected areas. Emollients should be used liberally and frequently, even in the absence of symptoms. Proper instruction reduces disease severity and corticosteroid use.
Q: How can pharmacists and doctors address corticosteroid phobia and improve adherence in Atopic Dermatitis management?
A: Address concerns about corticosteroid side effects by educating patients/caregivers on correct application, the importance of compliance, and the low risk of adverse effects with proper use. This improves adherence and clinical outcomes.
