Clinical Edge

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Atopic Dermatitis in Children

Putting guidelines into primary practice

Treatment guidelines for atopic dermatitis (AD) in children designed specifically for use by pediatricians and other primary care physicians includes basic management measures such as skin care, antiseptic measures, and trigger avoidance to be used regardless of AD severity, according to a roundtable discussion to address challenges in AD management. Recommendations for the PCP include:

• The diagnosis of eczema is a clinical one based on a chronic or relapsing course of a pruritic dermatitis consisting of erythematous papules or patches of scaling and/or excoriated skin.

• Basic management is important with skin hydration with an appropriate moisturizer, use of dilute bleach baths, trigger avoidance and acute treatment for flares.

• Treatment of acute flares is managed with topical corticosteroids, using a more potent topical steroid initially and then deescalating therapy to a less potent agent after a few days to weeks.

For patients with moderate to severe eczema, maintenance therapy for flare-prone areas should be applied regularly or at first sign of a flare-up. Recommended agents include tacrolimus or pimecrolimus (topical calcineurin inhibitors) or medium or low-potency topical corticosteroids (avoiding medium potency topical steroids on the face) depending upon the severity of eczema.

Citation: Eichenfield LF, Boguniewicz M, Simpson EL, Russell JJ, et al. Translating atopic dermatitis management guidelines into practice for primary care providers. Pediatrics. [Published online ahead of print August 3, 2015]. doi: 10.1542/peds.2014-3678.

Commentary: Eczema affects approximately 12% of children (aged 0-17 years) in the United States, most of who have mild disease and are well taken care of by primary care physicians. This article provides clear guidance for treatment of a disease that we see quite frequently. The clear recommendation for diluted bleach baths or washes based on very good evidence, an approach that is not well appreciated will, I suspect, lead to a helpful addition to the standard approach for many physicians. —Neil Skolnik, MD