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Position paper on diagnosis and treatment of atopic dermatitis

Authors

  • U Darsow,

    Corresponding author
    1. Department of Dermatology and Allergy Biederstein, and Division of Environmental Dermatology and Allergy GSF/TUM, Technical University Munich, Germany,
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  • J Lübbe,

    1. Clinique de Dermatologie, Hôpital Cantonal Universitaire, Genève, Switzerland,
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  • A Taïeb,

    1. Service de Dermatologie, Hôpital St André, Bordeaux, France,
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  • S Seidenari,

    1. Department of Dermatology, University of Modena and Reggio Emilia, Italy,
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  • A Wollenberg,

    1. Department of Dermatology and Allergy, Ludwig-Maximilians-University Munich, Germany.
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  • AM Calza,

    1. Clinique de Dermatologie, Hôpital Cantonal Universitaire, Genève, Switzerland,
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  • F Giusti,

    1. Department of Dermatology, University of Modena and Reggio Emilia, Italy,
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  • J Ring,

    1. Department of Dermatology and Allergy Biederstein, and Division of Environmental Dermatology and Allergy GSF/TUM, Technical University Munich, Germany,
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  • for the European Task Force on Atopic Dermatitis

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    • a

      D Abeck, Munich, Germany; O Baadsgaard, Hellerup, Denmark; T Bieber, Bonn, Germany; E Bonifazi, Bari, Italy; CAFM Bruijnzeel-Koomen, Utrecht, the Netherlands; AM Calza, Geneva, Switzerland; U Darsow, Munich, Germany; J De la Cuadra, Valencia, Spain; L De Raeve, Brussels, Belgium; TL Diepgen, Heidelberg, Germany; P Dupuy, Castanet Tolosan, France; G Fabrizi, Rome, Italy; C Gelmetti, Milan, Italy; A Giannetti, Modena, Italy; U Gieler, Gießen, Germany; F Giusti, Modena, Italy; J Harper, London, UK; M Kägi, Zürich, Switzerland; B Kunz, Hamburg, Germany; R Lever, Glasgow, Scotland, UK; J Lübbe, Geneva, Switzerland; AB Olesen, Aarhus, Denmark; AP Oranje, Rotterdam, the Netherlands; Y de Prost, Paris, France; G Rajka, Oslo, Norway; T Reunala, Tampere, Finland; J Revuz, Créteil, France; J Ring, Munich, Germany; AM Schmitt, Toulouse, France; S Seidenari, Modena, Italy; D Simon, Bern, Switzerland; M Song, Brussels, Belgium; JF Stalder, Nantes, France; A Svensson, Malmö, Sweden; A Taïeb, Bordeaux, France; D Tennstedt, Brussels, Belgium; K Turjanmaa, Tampere, Finland; A Wollenberg, Munich, Germany.


* Corresponding author, Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, Biedersteiner Str. 29, 80802 Munich, Germany, fax +49 89 4140 3171; E-mail: ulf.darsow@lrz.tum.de

ABSTRACT

The diagnosis of atopic dermatitis (AD) is made using evaluated clinical criteria. Management of AD must consider the symptomatic variability of the disease. It is based on hydrating topical treatment, and avoidance of specific and unspecific provocation factors. Anti-inflammatory treatment is used for exacerbation management. Topical corticosteroids remain the first choice. Systemic anti-inflammatory treatment should be kept to a minimum, but may be necessary in rare refractory cases. The new topical calcineurin inhibitors (tacrolimus and pimecrolimus) expand the available choices of topical anti-inflammatory treatment. Microbial colonization and superinfection (e.g. with Staphylococcus aureus, Malassezia furfur) can have a role in disease exacerbation and can justify the use of antimicrobials in addition to the anti-inflammatory treatment. Evidence for the efficacy of systemic antihistamines in relieving pruritus is still insufficient, but some patients seem to benefit. Adjuvant therapy includes ultraviolet (UV) irradiation preferably of UVA wavelength; UVB 311 nm has also been used successfully. Dietary recommendations should be specific and only given in diagnosed individual food allergy. Stress-induced exacerbations may make psychosomatic counselling recommendable. ‘Eczema school’ educational programmes have proved to be helpful.

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