Topical Therapy for Atopic Dermatitis: AAD Guidelines- Translating Evidence into Practice

Conclusions

• Topical therapies remain central in managing atopic dermatitis (AD), incorporating moisturizers, topical corticosteroids, and newer non-steroidal agents.
• Strong recommendations exist for the use of topical steroids and moisturizers, whereas conditional recommendations are made for bathing practices and wet wrap therapy.
• Bathing is conditionally recommended for its benefits in hydrating the skin, despite minimal direct evidence supporting its efficacy for AD treatment.
• Moisturizers effectively reduce symptoms and inflammation, improve disease severity, and increase time between flares, but specific formulations require caution due to potential allergenic properties.
• Topical corticosteroids are effective as rapid anti-inflammatory treatments, with recommendations for their intermittent use to manage flares responsibly.
• Concerns about topical steroid withdrawal are prevalent but lack strong evidence, necessitating careful patient education and management.
• Topical calcineurin inhibitors (TCIs) are safe alternatives to corticosteroids, albeit with some risk of lymphoma, which is considered low and not clinically significant.
• Topical PDE-4 inhibitors like crisaborole receive strong recommendations based on solid evidence for treating mild-to-moderate AD.
• Ruxolitinib, a topical JAK inhibitor, is effective for AD but requires caution due to long-term safety data being limited at the time of evaluation.
• Emerging therapies, including additional topical agents, highlight the growing arsenal of treatment options for AD, emphasizing the need for personalized treatment regimens.