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Treatment Approach

Step-Care Management: Maintenance Treatment for AD

Mild

Basic Management

1.Skin Care

  • Moisturizer (eg, emollient)
  • Warm baths or showers using non-soap cleansers, usually 1x/day followed by moisturizer (even on clear areas)

2.Trigger Avoidance

  • Proven allergens and common irritants (eg, soaps, wool, temperature extremes)
  • Consider comorbidities

Stepping Up to Moderate

Patient symptomatic despite appropriate use of low-to-medium potency TCS and following basic management recommendations for skin care and avoidance of allergens and irritantsa,b

Treatment Options:

  • Increase TCS dose or potency
  • Add TCI
  • Add crisaborole 2% ointmentc

Moderate

Basic Management + Topical Anti-inflammatory Medication

Reduce treatment potency OR use proactive therapy involving gradual dose reduction from 2x/day to 1x/day then 2x-3x/week on areas that are clear or almost clear. Proactive therapy controls disease, avoids flares, and reduces overall use of TCS.

Maintenance TCS

  • Low potency 1x-2x/day (including face)
  • Medium potency 1x-2x/day (except face)

OR Maintenance TCId

  • 1x-2x/day or 2x-3x/week as proactive therapy to maintain clearance at selected sites

OR Crisaborole 2%d,e

  • 2x/day

Severe

Basic Management + Referral to Specialist

Phototherapy

Dupilumab

Systemic immunosuppressants

  • Cyclosporine A
  • Methotrexate
  • Mycophenolate mofetil
  • Azathioprine

Consider acute treatment for some patients

  • Wet-wrap therapy
  • Short-term hospitalization

Antiseptic measures (dilute bleach baths, localized bleach soaks, or equivalent) may be used for moderate-to-severe disease. Use 2x/week to daily for maintenance. Can be used daily for severe, recurrent disease with crusting.

aPoorly or inadequately controlled signs and symptoms of AD; bBefore stepping up therapy, the patient should be assessed for nonadherence, comorbidities, and other factors that could mitigate treatment response; cIndicated for patients at least 2 years old with mild-to-moderate AD; dNonsteroidal treatments can be used in sensitive-skin areas (eg, face) on long-term basis; eIndicated for patients at least 2 years old.