New guidelines address atopic dermatitis diagnosis, assessment

                Steven Feldman
By Steven Feldman, MD, PhD

For the last two years, I’ve participated on the AAD Clinical Guidelines Workgroup that is charged with updating our previous clinical guidelines of care for atopic dermatitis (AD). These guidelines were last published in 2004, and since that time a great deal of research has been published on AD.

Together with a stellar group of colleagues, we have thoroughly analyzed new data to develop updated and expanded recommendations for the diagnosis, assessment, and treatment of AD. When complete, the Academy will have a four-part guideline series for this chronic and often debilitating condition.

This is the first guideline that the Academy has issued that covers the diagnosis of a condition.

This month, after reviewing member comments submitted during a 10-day feedback period in June, the first of four sections was published online in the Journal of the American Academy of Dermatology (JAAD). This first section provides recommendations for diagnostic criteria, the use of biomarkers, disease and outcomes scales in the clinical setting, and awareness of common clinical associations that affect patients with AD.

This is the first guideline that the Academy has issued that covers the diagnosis of a condition. These guidelines provide criteria for accurately diagnosing atopic dermatitis that differentiate it from other conditions with similar characteristics. 

Key recommendations

Based on a comprehensive review of available data for diagnosing and managing atopic dermatitis, the first section of the Academy’s guidelines includes three key recommendations:

  • Monitoring of patients’ immunoglobulin E levels is not recommended because they do not correlate with disease severity.
  • Physicians should ask their patients general questions about itch, sleep, effect on daily activity, and persistence of the disease.
  • Dermatologists should coordinate with other specialties when providing care for atopic dermatitis patients who have associated conditions that affect more than the skin, such as sleep issues, asthma, food allergies, ADHD, and other psychological conditions. (View the video above to learn more about comorbidities associated with AD.) 

The remaining three sections, which will be published in 2014, will focus on the management and treatment of atopic dermatitis with topical therapies, systemic agents and phototherapy, adjunctive therapies, and the prevention of flares. 

Steven Feldman, MD, PhD, is director at the Galderma Center for Dermatology Research and professor of dermatology, pathology, and public health sciences at Wake Forest University School of Medicine.

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