Consensus‐based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I

Andreas Wollenberg1,2, S. Barbarot3, Thomas Bieber4, Stéphanie Christen‐Zaech5, Mette Deleuran6, A. Fink‐Wagner7, Uwe Gieler8,9, Giampiero Girolomoni10, S. Lau11, Antonella Muraro12, Magdalena Czarnecka‐Operacz13, T. Schäfer14, Peter Schmid‐Grendelmeier15,16, Dagmar Simon17, Zsuzsanna Szalai18, Jacek C. Szepietowski19, Alain Taı̈eb20, Antonio Torrelo21, Thomas Werfel22, Johannes Ring16,23
1Department Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
2Klinik Thalkirchner Straße Munich Germany
3Department of Dermatology, Centre Hospitalier Universitaire CHU Nantes, Nantes, France
4Department of Dermatology and Allergy Christine Kühne‐Center for Allergy Research and Education University Bonn Bonn Germany
5Pediatric Dermatology Unit, Departments of Dermatology and Pediatrics, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
6Department Dermatology, Aarhus University Hospital, Aarhus, Denmark
7European Federation of Allergy and Airways Diseases Patients’ Associations (EFA) Global Allergy and Asthma Patient Platform (GAAPP) Konstanz Germany
8Department of Dermatology University of Gießen and Marburg GmbH Gießen Germany
9Department of Psychosomatics and Psychotherapy, University of Gießen and Marburg GmbH, Gießen, Germany
10Department of Medicine, Section of Dermatology, University of Verona, Verona, Italy
11Pediatric Pneumology and Immunology Universitätsmedizin Berlin Berlin Germany
12Centro di Specializzazione Regionale per lo Studio e la Cura delle Allergie e delle Intolleranze Alimentari presso l'Azienda Ospedaliera Università di Padova Padova Italy
13Department of Dermatology, Medical University, Poznan, Poland
14Dermatological Practice, Immenstadt, Germany
15Allergy Unit, Department of Dermatology, University of Zurich, Zurich, Switzerland
16Christine Kühne Center for Allergy Research and Education (CK Care), Davos, Switzerland
17Department Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
18Department of Dermatology, Heim Pál Children's Hospital, Budapest, Hungary
19Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
20Department of Dermatology and Pediatric Dermatology Hôpital St André Bordeaux France
21Department of Dermatology Hospital Niño Jesus Madrid Spain
22Department Dermatology and Allergy, Hannover Medical School, Hannover, Germany
23Department Dermatology and Allergy Biederstein Technische Universität München Munich Germany

Tóm tắt

AbstractThis guideline was developed as a joint interdisciplinary European project, including physicians from all relevant disciplines as well as patients. It is a consensus‐based guideline, taking available evidence from other guidelines, systematic reviews and published studies into account. This first part of the guideline covers methods, patient perspective, general measures and avoidance strategies, basic emollient treatment and bathing, dietary intervention, topical anti‐inflammatory therapy, phototherapy and antipruritic therapy, whereas the second part covers antimicrobial therapy, systemic treatment, allergen‐specific immunotherapy, complementary medicine, psychosomatic counselling and educational interventions. Management of AE must consider the individual clinical variability of the disease; highly standardized treatment rules are not recommended. Basic therapy is focused on treatment of disturbed barrier function by hydrating and lubricating topical treatment, besides further avoidance of specific and unspecific provocation factors. Topical anti‐inflammatory treatment based on glucocorticosteroids and calcineurin inhibitors is used for flare management and for proactive therapy for long‐term control. Topical corticosteroids remain the mainstay of therapy, whereas tacrolimus and pimecrolimus are preferred in sensitive skin areas and for long‐term use. Topical phosphodiesterase inhibitors may be a treatment alternative when available. Adjuvant therapy includes UV irradiation, preferably with UVB 311 nm or UVA1. Pruritus is targeted with the majority of the recommended therapies, but some patients may need additional antipruritic therapy. Antimicrobial therapy, systemic anti‐inflammatory treatment, immunotherapy, complementary medicine and educational intervention will be addressed in part II of the guideline.

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