Open Access Highly Accessed Review

Difficult to control atopic dermatitis

Ulf Darsow12*, Andreas Wollenberg3, Dagmar Simon4, Alain Taïeb5, Thomas Werfel6, Arnold Oranje7, Carlo Gelmetti8, Ake Svensson9, Mette Deleuran10, Anne-Marie Calza11, Francesca Giusti12, Jann Lübbe11, Stefania Seidenari12, Johannes Ring12 and the European Task Force on Atopic Dermatitis / EADV Eczema Task Force

Author Affiliations

1 Department of Dermatology and Allergy Biederstein, Technische Universität München, Munich, Germany

2 ZAUM – Center for Allergy and Environment, Munich, Germany

3 Department of Dermatology and Allergy, Ludwig-Maximilians-University Munich, Munich, Germany

4 Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

5 Service de Dermatologie, Hopital St André, Bordeaux, France

6 Hautklinik Linden, Deptartment of Dermatology MHH, Hannover, Germany

7 Department of Pediatrics (Pediatric Dermatology Unit), ERASMUS MC, Rotterdam, The Netherlands

8 Department of Pathophysiology and Transplantation, University of Milan, Ospedale Maggiore Policlinico, Milan, Italy

9 Department of Dermatology, University Hospital UMAS, Malmö, Sweden

10 Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark

11 Clinique de Dermatologie, Hôpital Cantonal Universitaire, Genève, Suisse, Switzerland

12 Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy

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World Allergy Organization Journal 2013, 6:6  doi:10.1186/1939-4551-6-6

Published: 14 March 2013

Abstract

Difficult to control atopic dermatitis (AD) presents a therapeutic challenge and often requires combinations of topical and systemic treatment. Anti-inflammatory treatment of severe AD most commonly includes topical glucocorticosteroids and topical calcineurin antagonists used for exacerbation management and more recently for proactive therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, the topical calcineurin inhibitors tacrolimus and pimecrolimus are preferred in certain locations. Systemic anti-inflammatory treatment is an option for severe refractory cases. Microbial colonization and superinfection contribute to disease exacerbation and thus justify additional antimicrobial / antiseptic treatment. Systemic antihistamines (H1) may relieve pruritus but do not have sufficient effect on eczema. Adjuvant therapy includes UV irradiation preferably of UVA1 wavelength. “Eczema school” educational programs have been proven to be helpful.

Keywords:
Atopic dermatitis; Eczema; Therapy; Guideline