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American Academy Of Dermatology Eczema

Section On Dermatology Executive Committee 20132014

Treatments for atopic dermatitis

Bernard A. Cohen, MD, FAAP, Chairperson

Richard Antaya, MD, FAAP

  • TCI

    topical calcineurin inhibitor

This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.

The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

Clinical reports from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal and external reviewers. However, clinical reports from the American Academy of Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent.

All clinical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

Topical Antimicrobials And Antiseptics

Because they have a compromised physical barrier, decreased immune recognition, and reduced production of antimicrobial peptides, persons with atopic dermatitis are more susceptible to skin infections. Staphylococcus aureus is a common cause. However, no topical anti-staphylococcal treatments have been determined to be beneficial in persons with atopic dermatitis, and they are not typically recommended . Bleach baths with intranasal mupirocin may be recommended to reduce disease severity in persons with moderate to severe atopic dermatitis and signs of secondary bacterial infection .

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Eczema ecz-pert Mamta Jhaveri, M.D. is Assistant Professor of Dermatology at the Johns Hopkins University School of Medicine. She specializes in eczema care and contact dermatitis. She conducts research focused on integrative medicine in dermatology, including the role of meditation and herbal therapies

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Patterns Of Atopic Eczema

A study in JAMA Dermatology dove into the subject of atopic eczema, investigating the patterns of activity that may continue into adulthood.

Atopic eczema is characterized by a heterogenous waxing and waning course, with various ages of onset and persistence of symptoms. To help identify subtypes of atopic eczema by patterns of disease activity through mid-adulthood, a trial was created in the Journal of the American Medical Association Dermatology. Other goals included examining early risk factors and patients characteristics associated with subtype and how these subtypes may be related with other atopic skin issues and general health.1

The study investigated patients from 2 population birth cohorts, the 1958 National Childhood Development Study and the 1970 British Cohort Study . Data from both were collected between 1958 and 2016, with analysis taking place between 2018 to 2020.

The subtypes of the atopic eczema were based on self-reported atopic eczema flare-ups at multiple time points. The subtypes were the outcome in models of early life characteristics and an exposure variable in models of midlife health, the article explained.

In total, there were 4 subtypes identified among the 15,939 patients from the NCDS and 14,966 individuals from the BCS70 :

  • Rare/no
  • increasing and
  • persistently high probability of reporting prevalent atopic eczema with age.


Effects On Quality Of Life

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The effects of AD on the quality of life of patients and their families cannot be underestimated. Nearly 50% of children with AD report a severely negative effect of the disease on QoL. Factors that contribute to poor QoL in AD are fatigue and sleep deprivation , activity restriction, and depression. Children with severe AD also tend to have fewer friends and participate in fewer group activities than their peers. These children may be at higher risk of depression, anxiety, and other mental health disorders.

AD also has a negative effect on QoL of caregivers and parents of affected children. Parents of children with moderate and severe AD spend up to 3 hours per day caring for their childrens skin. The most commonly reported negative effects on parents are lack of sleep , fatigue, absence of privacy , treatment-related financial expenditures, and feelings of hopelessness, guilt, and depression. In fact, the depression rate in mothers of children with AD is twice as high as in mothers of children with asthma. Appropriate social and community support resources, such as referral to a counselor, psychologist, or patient support groups, such as the National Eczema Association , can be helpful when QoL issues are encountered in patients and families with AD.

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You Asked: Is Food Causing My Eczema To Flare

Eczema ecz-pert Vivian Shi, M.D. is a board-certified dermatologist and an Assistant Professor of Medicine in Dermatology at the University of Arizona where she directs the Eczema and Skin Barrier Specialty Clinic. She has extensive clinical and research experience in eczema and repair of the skins natural protective barrier. Her principal focus is atopic dermatitis and she lives with AD herself.

Atopic Dermatitis: Diagnosis And Treatment

WINFRED FRAZIER, MD, MPH, and NAMITA BHARDWAJ, MD, MS, University of Texas Medical Branch, Galveston, Texas

Am Fam Physician. 2020 May 15 101:590-598.

Patient information: A handout on this topic is available at .

Atopic dermatitis, or atopic eczema, is a chronic relapsing and remitting inflammatory skin disease with a 10% lifetime prevalence.1 The disease is characterized primarily by scaly, pruritic, erythematous lesions located on flexural surfaces. Atopic dermatitis affects up to 12% of children and 7.2% of adults, leading to high health care use.2 Atopic dermatitis typically starts in childhood, with 60% of patients developing atopic dermatitis before one year of age and 90% by five years of age.3 Compared with children who do not have atopic dermatitis, those who have the condition are more likely to develop food and environmental allergies , asthma , and allergic rhinitis .4 Patients with atopic dermatitis are also more likely to develop ear infections , streptococcal pharyngitis , and urinary tract infections .5

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One Young Patients Battle

Lal described the experience of one of his pediatric patients who was highly active in sports and had horrible eczema behind his knees that resulted in extreme pain. The 10-year-olds pants rubbed against the affected areas of his legs, staining his jeans with blood and making the pain even worse.

Lal treated the boy with ointments and a topical steroid medication, and he instructed the parents to make sure their sons legs were wrapped and lubricated at all times. Lal also prescribed Tylenol for pain relief.

It was really aggressive management he had to do these wraps on weekends when he could stay at home and rest and not move around a lot, said Lal. It took about nine days or so to clear him up, but it helped a lot.

Ten Things Physicians And Patients Should Question

How to treat eczema in babies

Released October 29, 2013 and August 19, 2015 Updated October 18, 2021

  • Dont prescribe oral antifungal therapy for suspected nail fungus without confirmation of fungal infection.

    Approximately half of nails with suspected fungus do not have a fungal infection. As other nail conditions, such as nail dystrophies, may look similar in appearance, it is important to ensure accurate diagnosis of nail disease before beginning treatment. By confirming a fungal infection, patients are not inappropriately at risk for the side effects of antifungal therapy, and nail disease is correctly treated.

  • Dont treat uncomplicated, keratinocyte carcinoma less than 1 centimeter in size on the trunk and extremities with Mohs Micrographic Surgery, in otherwise healthy individuals.

    In healthy individuals, the use of Mohs micrographic surgery for low-risk small , superficial or non-aggressive squamous cell carcinomas and basal cell carcinomas is inappropriate for skin cancers on the trunk and extremities. In these areas of the body, the clinical benefits of this specialized surgical procedure do not exceed the potential risks. It is important to note that Mohs micrographic surgery may be considered for skin cancers appearing on the hands, feet, ankles, shins, nipples or genitals, as they have been shown to have a higher risk for recurrence or require additional surgical considerations.

  • For more information, visit

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    Tips For Choosing A Moisturizer

    • When selecting a moisturizer, consider choosing a thick cream or ointment.

    • Some children do better with fragrance-free products, so consider petroleum jelly an inexpensive, fragrance-free product that works well for many children.

    • When selecting a product, trial and error sampling of different types may help to identify the best moisturizer for your child.

    Topical Tofacitinib Shows Promise For Eczema And Other Dermatological Diseases

    Tofacitinib, a Janus kinase inhibitor approved in oral form for rheumatoid arthritis may have promise as a potential treatment for alopecia, vitiligo and eczema.

    JAK inhibitors work by interrupting cytokines from signaling one another through the Janus kinase enzyme family. This signaling contributes to inflammation, resulting in symptoms common to eczema.

    A preliminary study of 69 patients with mild to moderate atopic dermatitis, showed that topical application of tofacitinib reduced symptoms of itch in as soon as 48 hours. Participants in the study reported significant reductions in itch and improved sleep.

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    Where And Why Eczema Hurts

    Jonathan Silverberg, MD, with the department of dermatology at George Washington University School of Medicine and Health Sciences, told the National Eczema Association that cracks and wounds on the palms, soles of feet, toes, chest, and around the mouth may trigger excruciating soreness. Atopic dermatitis on the buttocks, fingers, legs, neck, and forearms can also be particularly painful.

    In the Journal of Allergy and Clinical Immunology study cited above, Dr. Silverberg and colleagues found that patients with mild eczema were more likely to have pain related to scratching, while those with moderate or severe eczema felt more constant discomfort and aching due to inflammation.

    The scientists noted that for most eczema patients with pain, the issue was linked to open parts of the skin caused by scratching and with fissures in the skin . About a quarter said they were hurting from inflamed skin. Just 10 percent reported a burning sensation caused by topical medications like steroid creams.

    Karan Lal, DO, committee chair for the Society for Pediatric Dermatology, says that when inflamed skin opens up, exposed nerves increase the risk of pain as well as infection.

    I think a lot of people who get pain have more active eczema that is inadequately controlled and have chronic disease in the common eczema sites, says Dr. Lal.

    Eczema Types: Atopic Dermatitis Overview

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    All content solely developed by the American Academy of Dermatology

    The American Academy of Dermatology gratefully acknowledges the support from Incyte Dermatology, Leo Pharma, Inc., and Sanofi Genzyme and Regeneron.

    What is atopic dermatitis

    Learn about the most common form of eczema.

    What is atopic dermatitis? Often called eczema or atopic eczema, this is a condition that usually develops by 5 years of age and causes extremely itchy rashes that come and go.

    Is atopic dermatitis contagious? No.

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    Eczema ecz-pert Mamta Jhaveri, M.D. is Assistant Professor of Dermatology at the Johns Hopkins University School of Medicine. She specializes in eczema care and contact dermatitis. She conducts research focused on integrative medicine in dermatology, including the role of meditation and herbal therapies.

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    Eczema ecz-pert Andrew Alexis, M.D. is Chair of the Department of Dermatology at Mount Sinai St. Lukes and Mount Sinai West, and Professor of Dermatology at the Icahn School of Medicine at Mount Sinai. As Director of the Skin of Color Center, he is actively involved in advancing patient care, research, and education pertaining to dermatologic disorders that are prevalent in ethnic skin.

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    Guidelines On Comorbidities Associated With Atopic Dermatitis

    This guideline, completed in 2021 and published in early 2022, is the first in a new series on atopic dermatitis that are being developed by the American Academy of Dermatology and will supersede the 2014 guidelines when publication is complete. Highlights of the comorbidities guideline include:

  • In addition to AD itself, the patient- and population-level burden of disease is increased by associated comorbidities.

  • The objective of this guideline is to appraise the evidence for the association between AD and comorbid conditions, with the aim of improving awareness and understanding among dermatologists and other clinicians.

  • There is strong evidence that AD in adults is associated with select allergic, atopic, immune-mediated, mental health and bone health comorbidities and skin infections.

  • There is some evidence supporting an association between AD in adults and substance use, ADHD, and elements of metabolic syndrome.

  • Evidence suggests a small association with various cardiovascular conditions.

  • The association between AD in adults and autism spectrum disorders, myocardial infarction, stroke, and metabolic syndrome as a whole is uncertain.

  • Clinicians should be aware of comorbidities associated with AD. Further research is needed to determine whether screening or management of comorbidities is beneficial for adults with AD.

  • Read the full guideline

    How Many Of These Following Misconceptions Have You Heard

    How is atopic dermatitis diagnosed?

    Myth: You can get rid of AD by finding and eliminating the one thing causing it. When speaking with parents who have a child with eczema, dermatologists often find that parents want help finding that one food or another allergen causing their childs eczema. Before seeing a dermatologist, parents often say that they have already experimented with removing different foods from their childs diet, such as eggs, milk, and nuts.

    Fact: Years of research has proven that no one thing causes AD. Its a complex disease that has no cure.

    Removing foods from a childs diet cannot cure AD, but it can cause health problems. Children need the nutrients in foods, such as eggs and milk, to grow and develop properly.

    To provide relief from AD, dermatologists create a treatment plan that uses:

    • Skin care

    • Trigger management

    • Medication or light therapy as needed

    Myth: Children outgrow AD. Although its true that AD often goes away on its own before a childs 18th birthday, AD can be a lifelong condition.

    Fact: Theres no way to know if a childs eczema will go away or remain. To prevent AD from worsening and to relieve symptoms, dermatologists recommend treating it.

    Myth: To reduce flare-ups, cut back on bathing. Because AD causes extremely dry skin, some people believe they can relieve AD by taking fewer baths and showers. Research shows otherwise.

    Applying a fragrance-free moisturizer to the skin within a few minutes of bathing helps to lock moisture into the skin and reduce dryness.

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    Statement Of The Problem

    New data support the theory that AD results from primary abnormalities of the skin barrier, suggesting that skin-directed management of AD is of paramount importance. This clinical report reviews AD and provides an up-to-date approach to skin-directed management that is based on pathogenesis. Effectively using this information to create treatment plans and educate families should help pediatric primary care providers manage most children with AD, thereby improving patient satisfaction and clinical outcomes.

    American Academy Of Dermatology

    Allergic contact dermatitis and atopic dermatitis are common causes of rashes in the pediatric population. Patch testing can help demystify the cause of such skin conditions and determine treatment.

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    What are the best post- and pre-lightening products and strategies for optimal results on all skin types? Renata Block, president of the Society of Dermatology Physician Assistants, walked through her pearls in this interview at the American Academy of Dermatology 2022 Annual Meeting.

    Renata Block, MMS, PA-C, president of the Society of Dermatology Physician Assistants talked with Dermatology Times® at the American Academy of Dermatology 2022 Annual Meeting about the broadening opportunities for these advanced health care providers to help fill the demand gap for treatment of skin and hair disorders as well as aesthetic services.

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    Millions Live With Atopic Dermatitis

    Atopic dermatitis is common worldwide. People of all ages from newborns to adults 65 years of age and older live with this condition. Symptoms range from excessively dry, itchy skin to painful, itchy rashes that cause sleepless nights and interfere with everyday life.

    Atopic dermatitis is common

    1 in 10 Americans has atopic dermatitis.

    In the United States, research indicates that African American and Asian American children develop AD more often than white children.

    When a child has deeply pigmented skin, AD tends to be diagnosed later in life. Sometimes, the condition is missed altogether because its less noticeable. In brown or black skin, you tend to see gray to violet-brown skin discoloration rather than red rashes.

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    Eczema ecz-pert Vivian Shi, M.D. is a board-certified dermatologist and an Assistant Professor of Medicine in Dermatology at the University of Arizona where she directs the Eczema and Skin Barrier Specialty Clinic. She has extensive clinical and research experience in eczema and repair of the skins natural protective barrier. Her principal focus is atopic dermatitis and she lives with AD herself.

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