January 15, 2019

A team of investigators from the University of Colorado College of Nursing and National Jewish Health has identified comprehensive guidelines for managing severe atopic dermatitis (AD), the most common form of eczema.

The clinical management review was recently published in The Journal of Allergy and Clinical Immunology: In Practice.

“The FDA approval of biologic medication for treating moderate-to-severe AD has transformed the therapeutic landscape highlighting the need for comprehensive and clear guidelines,” said Noreen Nicol, PhD, RN, associate professor in the College of Nursing at the CU Anschutz Medical Campus. “Without comprehensive guidelines that analyze national and international findings, we risk clinicians skipping crucial conventional steps, such as wet-wrap therapy, that need to be utilized prior to initiating biologics.”

Life with severe AD is incredibly difficult

Atopic dermatitis affects up to 18 percent of children as well as seven percent of adults. As a chronic, relapsing disease, severe AD has a profound impact on the quality of life of patients and families. Recent studies reveal patients with severe cases report high itch frequency of up to 18 hours a day, sleep disturbance and borderline or abnormal quality of life scores.

Current guidelines for decision making about advancement to systemic therapy in severe AD are misunderstood or not used. Treatment has often been reactive with inappropriate use of systemic corticosteroids and unapproved systemic immunosuppressants – drugs that suppress, or reduce, the strength of the body’s immune response. Additionally, international guidelines for treatment differ widely among countries.

A new approach to treating patients

Algorithm for managing eczema
Annotated guidelines for the patient with severe atopic dermatitis.

In their clinical review, the researchers incorporate national and international guidelines to deliver a comprehensive algorithm to guide clinicians in treating AD patients, as seen in the chart.

The steps include:

  • Making a proper diagnosis and defining the severity of AD

Addressing the basics of AD care:

  • Appropriate skin hydration and use of moisturizers and topical medications
  • Identifying irritants and allergens
  • Treating bacterial, viral or fungal infections
  • Treating psychosocial aspects
  • Developing an action plan
  • Consultations with an AD specialist
  • Considering acute management with wet-wrap therapy
  • Considering hospitalization, treatment with the systemic biologic dupilumab and phototherapy

“Life with severe atopic dermatitis can be incredibly difficult for our patients and their families, and it can be quite challenging to care for. It’s important to let our patients, caregivers, and healthcare providers know that we have entered a new and exciting era in the treatment of AD with a number of targeted therapies approved or being studied which are referenced in this clinical review,” said Mark Boguniewicz, MD, professor, Division of Allergy-Immunology and Department of Pediatrics at National Jewish Health and University of Colorado School of Medicine.

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