New Evidence-Based Guidelines for Eczema Treatment
The 2023 international guidelines for atopic dermatitis (eczema) offer a comprehensive, evidence-based approach to diagnosing and managing the condition in patients of all ages. These guidelines, updated from 2012, reflect advancements in treatment and improved methodologies, benefiting patients, caregivers, and clinicians worldwide.
Key Updates in the Guidelines
Led by McMaster University researcher Dr. Derek Chu, these guidelines incorporate multidisciplinary input, rigorous evidence synthesis, and patient involvement. Some notable updates include:
1. Topical Treatment Advancements
• Recommendations for topical corticosteroids and calcineurin inhibitors in managing uncontrolled eczema.
• Crisaborole 2% ointment suggested for mild-to-moderate atopic dermatitis.
• Introduction of proactive therapy with corticosteroids or calcineurin inhibitors for relapsing conditions.
• Avoidance of topical JAK inhibitors (e.g., ruxolitinib) and antimicrobials in non-infectious eczema.
2. Adjunctive Therapies
• Use of dilute bleach baths for moderate-to-severe eczema, excluding mild cases.
• Avoidance of elimination diets, as they lack evidence for improving eczema outcomes.
3. Systemic Treatments for Severe Cases
• Dupilumab for patients aged 6 months and older and tralokinumab for patients aged 12 years and older with moderate-to-severe eczema.
• Careful consideration of oral JAK inhibitors for severe cases unresponsive to other treatments.
• Avoidance of systemic corticosteroids due to their unfavorable risk-benefit profile.
4. Shared Decision-Making
• Emphasis on patient education, action plans, and medication adherence for better treatment outcomes.
Supporting Evidence and Methodology
These guidelines align with the American Academy of Dermatology’s recent updates on phototherapy and systemic treatments for moderate-to-severe eczema. They include 25 recommendations, summarized in an easy-to-digest infographic for clinicians.
Empowering Patients and Clinicians
The updated guidelines prioritize shared decision-making, encouraging personalized care plans tailored to individual needs. Patients, families, and healthcare providers are urged to collaborate for effective disease management.
For detailed recommendations and practical tools, refer to the complete guidelines published in Annals of Allergy, Asthma, and Immunology (2023).