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J Eur Acad Dermatol Venereol. 2018 Jun;32(6):850-878. doi: 10.1111/jdv.14888.

Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part II.

Author information

1
Department Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany.
2
Klinik Thalkirchner Straße, Munich, Germany.
3
Department of Dermatology, Centre Hospitalier Universitaire CHU Nantes, Nantes, France.
4
Department of Dermatology and Allergy, Christine Kühne-Center for Allergy Research and Education, University Bonn, Bonn, Germany.
5
Pediatric Dermatology Unit, Departments of Dermatology and Pediatrics, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
6
Department Dermatology, Aarhus University Hospital, Aarhus, Denmark.
7
European Federation of Allergy and Airways Diseases Patients' Associations (EFA), Global Allergy and Asthma Patient Platform (GAAPP), Konstanz, Germany.
8
Department of Dermatology, University of Gießen and Marburg GmbH, Gießen, Germany.
9
Department of Psychosomatics and Psychotherapy, University of Gießen and Marburg GmbH, Gießen, Germany.
10
Department of Medicine, Section of Dermatology, University of Verona, Verona, Italy.
11
Pediatric Pneumology and Immunology, Universitätsmedizin Berlin, Berlin, Germany.
12
Centro di Specializzazione Regionale per lo Studio e la Cura delle Allergie e delle Intolleranze Alimentari presso l'Azienda Ospedaliera, Università di Padova, Padova, Italy.
13
Department of Dermatology, Medical University, Poznan, Poland.
14
Dermatological Practice, Immenstadt, Germany.
15
Allergy Unit, Department of Dermatology, University of Zurich, Zurich, Switzerland.
16
Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland.
17
Department Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
18
Department of Dermatology, Heim Pál Children's Hospital, Budapest, Hungary.
19
Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland.
20
Department of Dermatology & Pediatric Dermatology, Hôpital St André, Bordeaux, France.
21
Department of Dermatology, Hospital Niño Jesus, Madrid, Spain.
22
Department Dermatology and Allergy, Hannover Medical School, Hannover, Germany.
23
Department Dermatology and Allergy Biederstein, Technische Universität München, Munich, Germany.

Abstract

This 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 second part of the guideline covers antimicrobial therapy, systemic treatment, allergen-specific immunotherapy, complementary medicine, psychosomatic counselling and educational interventions, whereas the first part covers methods, patient perspective, general measures and avoidance strategies, basic emollient treatment and bathing, dietary intervention, topical anti-inflammatory therapy, phototherapy and antipruritic therapy. Management of AE must consider the individual clinical variability of the disease. Systemic immunosuppressive treatment with cyclosporine, methotrexate, azathioprine and mycophenolic acid is established option for severe refractory cases, and widely available. Biologicals targeting the T helper 2 pathway such as dupilumab may be a safe and effective, disease-modifying alternative when available. Oral drugs such as JAK inhibitors and histamine 4 receptor antagonists are in development. Microbial colonization and superinfection may cause disease exacerbation and can require additional antimicrobial treatment. Allergen-specific immunotherapy with aeroallergens may be considered in selected cases. Psychosomatic counselling is recommended especially in stress-induced exacerbations. Therapeutic patient education ('Eczema school') is recommended for children and adult patients. General measures, basic emollient treatment, bathing, dietary intervention, topical anti-inflammatory therapy, phototherapy and antipruritic therapy have been addressed in the first part of the guideline.

PMID:
29878606
DOI:
10.1111/jdv.14888
[Indexed for MEDLINE]

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