The existing evidence for treatment of atopic eczema (atopic dermatitis, AE) is evaluated using the national standard Appraisal of Guidelines Research and Evaluation. The consensus process consisted of a nominal group process and a DELPHI procedure. Management of AE must consider the individual symptomatic variability of the disease. Basic therapy is focused on hydrating topical treatment, and avoidance of specific and unspecific provocation factors. Anti-inflammatory treatment based on topical glucocorticosteroids and topical calcineurin inhibitors (TCI) is used for exacerbation management and more recently for proactive therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, but the TCI tacrolimus and pimecrolimus are preferred in certain locations. Systemic immune-suppressive treatment is an option for severe refractory cases. Microbial colonization and superinfection may induce disease exacerbation and can justify additional antimicrobial treatment. Adjuvant therapy includes UV irradiation preferably with UVA1 wavelength or UVB 311 nm. Dietary recommendations should be specific and given only in diagnosed individual food allergy. Allergen-specific immunotherapy to aeroallergens may be useful in selected cases. Stress-induced exacerbations may make psychosomatic counselling recommendable. 'Eczema school' educational programs have been proven to be helpful. Pruritus is targeted with the majority of the recommended therapies, but some patients need additional antipruritic therapies.

Guidelines for treatment of atopic eczema (atopic dermatitis) Part II / J. Ring, A. Alomar, T. Bieber, M. Deleuran, A. Fink-Wagner, C. Gelmetti, U. Gieler, J. Lipozencic, T. Luger, A. P. Oranje, T. Schäfer, T. Schwennesen, S. Seidenari, D. Simon, S. Ständer, G. Stingl, S. Szalai, J. C. Szepietowski, A. Taïeb, T. Werfel, A. Wollenberg, U. Darsow, European Dermatology Forum, European Academy of Dermatology and Venereology, European Task Force on Atopic Dermatitis, European Federation of Allergy, European Society of Pediatric Dermatology, Global Allergy and Asthma European Network. - In: JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY AND VENEREOLOGY. - ISSN 0926-9959. - 26:6(2012 Sep), pp. 1176-1193.

Guidelines for treatment of atopic eczema (atopic dermatitis) Part II

C. Gelmetti;
2012

Abstract

The existing evidence for treatment of atopic eczema (atopic dermatitis, AE) is evaluated using the national standard Appraisal of Guidelines Research and Evaluation. The consensus process consisted of a nominal group process and a DELPHI procedure. Management of AE must consider the individual symptomatic variability of the disease. Basic therapy is focused on hydrating topical treatment, and avoidance of specific and unspecific provocation factors. Anti-inflammatory treatment based on topical glucocorticosteroids and topical calcineurin inhibitors (TCI) is used for exacerbation management and more recently for proactive therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, but the TCI tacrolimus and pimecrolimus are preferred in certain locations. Systemic immune-suppressive treatment is an option for severe refractory cases. Microbial colonization and superinfection may induce disease exacerbation and can justify additional antimicrobial treatment. Adjuvant therapy includes UV irradiation preferably with UVA1 wavelength or UVB 311 nm. Dietary recommendations should be specific and given only in diagnosed individual food allergy. Allergen-specific immunotherapy to aeroallergens may be useful in selected cases. Stress-induced exacerbations may make psychosomatic counselling recommendable. 'Eczema school' educational programs have been proven to be helpful. Pruritus is targeted with the majority of the recommended therapies, but some patients need additional antipruritic therapies.
randomized controlled-trial; placebo-controlled trial; chinese herbal therapy; evening Primrose oil; narrow-band UVB; classical homeopathic treatment; anti-CD20 rituximab treatment; parent-child relationships; blind controlled trial; necrosis-factor-alpha
Settore MED/35 - Malattie Cutanee e Veneree
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/256347
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