Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations.
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AAAAI/ACAAI JTF Atopic Dermatitis Guideline Panel, Chu Derek K, Schneider Lynda, Asiniwasis Rachel Netahe, Boguniewicz Mark, De Benedetto Anna, Ellison Kathy, Frazier Winfred T, Greenhawt Matthew, Huynh Joey, Kim Elaine, LeBovidge Jennifer, Lind Mary Laura, Lio Peter, Martin Stephen A, O'Brien Monica, Ong Peck Y, Silverberg Jonathan I, Spergel Jonathan M, Wang Julie, Wheeler Kathryn E, Guyatt Gordon H, Patient Groups: Global Parents for Eczema Research, Capozza Korey, National Eczema Association, Begolka Wendy Smith, Evidence in Allergy Group, Chu Alexandro W L, Zhao Irene X, Chen Lina, Oykhman Paul, Bakaa Layla, AAAAI/ACAAI Joint Task Force on Practice Parameters, Golden David, Shaker Marcus, Bernstein Jonathan A, Greenhawt Matthew, Horner Caroline C, Lieberman Jay, Stukus David, Rank Matthew A, Wang Julie, Ellis Anne, Abrams Elissa, Ledford Dennis, Chu Derek K
Аннотация
OBJECTIVE: To produce evidence-based guidelines that support patients, clinicians, and other decision-makers in the optimal treatment of AD.
METHODS: A multidisciplinary guideline panel consisting of patients and caregivers, AD experts (dermatology and allergy/immunology), primary care practitioners (family medicine, pediatrics, internal medicine), and allied health professionals (psychology, pharmacy, nursing) convened, prioritized equity, diversity, and inclusiveness, and implemented management strategies to minimize influence of conflicts of interest. The Evidence in Allergy Group supported guideline development by performing systematic evidence reviews, facilitating guideline processes, and holding focus groups with patient and family partners. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach informed rating the certainty of evidence and strength of recommendations. Evidence-to-decision frameworks, subjected to public comment, translated evidence to recommendations using trustworthy guideline principles.
RESULTS: The panel agreed on 25 recommendations to gain and maintain control of AD for patients with mild, moderate, and severe AD. The eAppendix provides practical information and implementation considerations in 1-2 page patient-friendly handouts.
CONCLUSION: These evidence-based recommendations address optimal use of (1) topical treatments (barrier moisturization devices, corticosteroids, calcineurin inhibitors, PDE4 inhibitors [crisaborole], topical JAK inhibitors, occlusive [wet wrap] therapy, adjunctive antimicrobials, application frequency, maintenance therapy), (2) dilute bleach baths, (3) dietary avoidance/elimination, (4) allergen immunotherapy, and (5) systemic treatments (biologics/monoclonal antibodies, small molecule immunosuppressants [cyclosporine, methotrexate, azathioprine, mycophenolate, JAK inhibitors], and systemic corticosteroids) and UV phototherapy (light therapy).