Clinical practice guidelines for the diagnosis and management of atopic dermatitis
Kanokvalai Kulthanan,1 Papapit Tuchinda,1 Rattanavalai Nitiyarom,2 Amornsri Chunharas,3 Hiroshi Chantaphakul,4 Kobkul Aunhachoke,5 Leena Chularojanamontri,1 Natta Rajatanavin,6 Orathai Jirapongsananuruk,7 Pakit Vichyanond,7 Pantipa Chatchatee,8 Pasuree Sangsupawanich,9 Siriwan Wananukul,10 Srisupalak Singalavanija,11 Suphattra Trakanwittayarak,1 Ticha Rerkpattanapipat,12 Torpong Thongngarm,13 Wanee Wisuthsarewong,2 Wanida Limpongsanurak,11 Wasu Kamchaisatian,14 Nopadon Noppakun15
1 Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
2 Division of Pediatric Dermatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
3 Division of Pediatric Dermatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
4 Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
5 Division of Dermatology, Department of Medicine, Faculty of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
6 Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
7 Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
8 Pediatric Allergy & Clinical Immunology Research Unit, Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
9 Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
10 Division of Pediatric Dermatology, Department of Pediatrics, Faculty of Medicine Chulalongkorn University, Bangkok, Thailand
11 Dermatology unit, Queen Sirikit National Institute of Child Health, Department of Medical Services, Ministry of Public Health, Bangkok, Thailand
12 Division of Allergy and Immunology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
13 Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
14 Division of Allergy and Clinical Immunology, Pediatrics Department, Samitivej Children’s Hospital, Bangkok, Thailand
15 Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Abstract
Atopic dermatitis (AD), a chronic, relapsing dermatitis, is characterized by dry and pruritus skin in patients with a personal or family history of atopy. It affects up to 20% of children and 1-3% of adults in most countries worldwide, and leads to significant treatment costs and morbidity. These guidelines are developed in accordance with evidence-based publications and expert opinions. Following simple algorithms, the guidelines aim to assist adult and pediatric physicians in the better care of patients with AD. As with other diseases, there have been several diagnosis criteria proposed over time. Nonetheless, the classical Hanifin and Rajka criterion with no pathognomonic laboratory biomarkers is still the most widely used worldwide for the diagnosis of AD. The management of AD must be considered case by case to provide suitable care for each patient. Basic therapy is focused on avoiding specific/unspecific provoking factors and hydrating skin. Topical anti-inflammatory treatments such as glucocorticoids and calcineurin inhibitors are suggested for disease flare, and proactive therapy is best for long-term control. Other therapies, including antimicrobial agents, systemic antihistamines, systemic anti-inflammatory agents, immunotherapy, phototherapy, and psychotherapy, are reviewed in these guidelines. Crisaborole, a new topical phosphodiesterase 4 inhibitor, can be used twice daily in AD patients over three months old. Dupilumab, a biological drug for patients with moderate-to-severe AD, may be considered in patients with no improvement from other systemic treatments.
Key words: atopic dermatitis, Thai, guidelines, diagnosis, management