General

Guideline Title

Guidelines of care for the management of atopic dermatitis. Section 1. Diagnosis and assessment of atopic dermatitis.

Bibliographic Source(s)

  • Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, Berger TG, Bergman JN, Cohen DE, Cooper KD, Cordoro KM, Davis DM, Krol A, Margolis DJ, Paller AS, Schwarzenberger K, Silverman RA, Williams HC, Elmets CA, Block J, Harrod CG, Smith Begolka W, Sidbury R. Guidelines of care for the management of atopic dermatitis. Section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014 Feb;70(2):338-51. [176 references] PubMed

Guideline Status

This is the current release of the guideline.

This guideline updates a previous version: Hanifin JM, Cooper KD, Ho VC, Kang S, Krafchik BR, Margolis DJ, Schachner LA, Sidbury R, Whitmore SE, Sieck CK, Van Voorhees AS. Guidelines of care for atopic dermatitis. J Am Acad Dermatol. 2004 Mar;50(3):391-404. [212 references]

Recommendations

Major Recommendations

Level of evidence grades (I-III) and strength of recommendations (A-C) are defined at the end of the “Major Recommendations” field.

Note from the National Guideline Clearinghouse (NGC) : This document is the first section in a series of four and covers methods for diagnosis and assessment of atopic dermatitis (AD). The second guideline in the series will address the management and treatment of AD with pharmacologic and nonpharmacologic topical modalities; the third section will cover phototherapy and systemic treatment options; and the fourth section will address the minimization of disease flares, educational interventions, and use of adjunctive approaches.

Features to Be Considered in the Diagnosis of Patients with AD

Essential Features —Must be present:

  • Pruritus
  • Eczema (acute, subacute, chronic):
    • Typical morphology and age-specific patterns*
    • Chronic or relapsing history

* Patterns Include :

  1. Facial, neck, and extensor involvement in infants and children
  2. Current or previous flexural lesions in any age group
  3. Sparing of the groin and axillary regions

Important Features —Seen in most cases, adding support to the diagnosis:

  • Early age of onset
  • Atopy:
    • Personal and/or family history
    • Immunoglobulin E reactivity
  • Xerosis

Associated Features —These clinical associations help to suggest the diagnosis of AD but are too nonspecific to be used for defining or detecting AD for research and epidemiologic studies:

  • Atypical vascular responses (e.g., facial pallor, white dermographism, delayed blanch response)
  • Keratosis pilaris/pityriasis alba/hyperlinear palms/ichthyosis
  • Ocular/periorbital changes
  • Other regional findings (e.g., perioral changes/periauricular lesions)
  • Perifollicular accentuation/lichenification/prurigo lesions

Exclusionary Conditions —It should be noted that a diagnosis of AD depends on excluding conditions, such as:

  • Scabies
  • Seborrheic dermatitis
  • Contact dermatitis (irritant or allergic)
  • Ichthyoses
  • Cutaneous T-cell lymphoma
  • Psoriasis
  • Photosensitivity dermatoses
  • Immune deficiency diseases
  • Erythroderma of other causes

Adapted from Eichenfield LF, Hanifin JM, Luger TA, Stevens SR, Pride HB. Consensus conference on pediatric atopic dermatitis. J Am Acad Dermatol 2003;49:1088-95. Used with permission of the American Academy of Dermatology.

Recommendation for the Diagnosis of AD

Patients with presumed AD should have their diagnosis based on the criteria summarized in the box above. On occasion, skin biopsy specimens or other tests (such as serum immunoglobulin E, potassium hydroxide preparation, patch testing, and/or genetic testing) may be helpful to rule out other or associated skin conditions.

Strength of Recommendations for the Diagnosis and Assessment of AD

Recommendation Strength of Recommendation Level of Evidence References
Diagnosis made using criteria in the box above C III Mevorah et al., 1988; Gu et al., 2001; Lan et al., 2009; Diepgen, Sauerbrei, & Fartasch, 1996; De, Kanwar, & Handa, 2006; Loden, Andersson, & Lindberg, 1998; Samochocki & Dejewska, 2012; Samochocki, Paulochowska, & Zabielski, 2000; Chalmers et al., 2007; Firooz et al., 1999; Saeki et al., 2007; Firooz & Kashani, 2008; Hamada et al., 2005; Williams et al., 1994; Williams et al., 1996
No specific biomarkers for diagnosis or severity assessment B II Murat-Susic et al., 2006; Schulte-Herbruggen et al., 2007; Amon et al., 2000; Dhar et al., 2005; Gerdes, Kurrat, & Mrowietz, 2009; Aral et al, 2006; Di Lorenzo et al., 2003; El Mongy et al., 2008; Ezzat, Hasan, & Shaheen, 2011; Jahnz-Rozyk et al., 2005; Nakazato et al., 2008; Belloni Fortina et al., 2006; Gutgesell et al., 2002; Hirai et al., 1996; Hon et al., 2007; Horikawa et al., 2002; Kakinuma et al., 2003; La Grutta et al., 2005; Leung et al., 2003; Mostafa et al., 2008; Oflazoglu et al., "CD30 expression," 2008; Oflazoglu et al., "CD40 expression," 2008; Ott et al., 2010; Raap et al., 2006; Song et al., 2006; Wolkerstorfer et al., 1998
Immunoglobulin E levels not routinely recommended A I Schneider et al., 2013; Murat-Susic et al., 2006; Schulte-Herbruggen et al., 2007; Gerdes, Kurrat, & Mrowietz, 2009; Aral et al., 2006; Vakirlis et al., 2011; Wu et al., 2011
Available disease severity scales not for routine clinical use C II Schmitt, Langan, & Williams, 2007; Schram et al., 2012; Sprikkelman et al., 1997; Angelova-Fischer et al., 2005; Wolkerstorfer et al., 1999; Linnet & Jemec, 1999; Hon et al., 2006; Barbier et al., 2004; Charman, Venn, & Williams, 2002; Charman, Venn, & Williams, 2004; Charman et al., 1999; Cosickic et al., 2010; Emerson, Charman, & Williams, 2000; Hanifin et al., 2001; Holm et al., 2007; Oranje et al., 1997; Rullo et al., 2008
Available quality of life severity scales not for routine clinical use C II Chamlin et al., 2007; Augustin et al., 2004; Hon et al, 2006; Misery et al., 2007
Should query itch, sleep, impact on daily activity, and disease persistence C III Chamlin et al., 2005; Hon et al., 2008; Dawn et al., 2009; Lewis-Jones, 2006; Weisshaar et al., 2008; Ricci et al., 2007; Bender et al., 2008; Ben-Gashir, Seed, & Hay, 2002
Awareness and discussion of common associations C I and II Chamlin et al., 2005; Hon et al., 2008; Batlles-Garrido et al., 2010; Chawes et al., 2010; Sultesz et al., 2010; Kyllonen et al., 2006; Hwang et al., 2010; Hyvarinen et al., 2005; Eller et al., 2009; Horwitz, Hossain, & Yousef, 2009; Bashir, Dar, & Rao, 2010; Schmitt et al., "Psychiatric comorbidity," 2009; Schmitt et al., "Atopic eczema," 2009; Yaghmaie, Koudelka, & Simpson, 2013; Harding et al., 2008; Synnerstad et al., 2008; Vajdic et al., 2009; Kajbaf, Asar, & Alipoor, 2011; Vlaski et al., 2006
Integrated, multidisciplinary approach to care C III Boguniewicz et al., 2008; Ricci et al., 2009

Recommendations for the Use of Biomarkers in the Assessment of AD

  • For patients with presumed AD, there are no specific biomarkers that can be recommended for diagnosis and/or assessment of disease severity.
  • Monitoring of immunoglobulin E levels is not recommended for the routine assessment of disease severity.

Recommendations for Disease Severity and Clinical Outcomes Assessment

  • For the general management of patients with AD, available disease severity measurement scales are not recommended for routine clinical practice, because they were not usually designed for this purpose.
  • For the general management of patients with AD, available patient quality of life measurement scales are not recommended for routine clinical practice.
  • It is recommended that clinicians ask general questions about itch, sleep, impact on daily activity, and persistence of disease, and currently available scales be used mainly when practical.

Recommendations for the Assessment of Clinical Associations of AD

  • Physicians should be aware of and assess for conditions associated with AD, such as rhinitis/rhinoconjunctivitis, asthma, food allergy, sleep disturbance, depression, and other neuropsychiatric conditions, and it is recommended that physicians discuss them with the patient as part of the treatment/management plan, when appropriate.
  • An integrated, multidisciplinary approach to care may be valuable and is suggested for AD patients who present with common associations.

Definitions:

Levels of Evidence

  1. Good-quality patient-oriented evidence (i.e., evidence measuring outcomes that matter to patients: morbidity, mortality, symptom improvement, cost reduction, and quality of life)
  2. Limited-quality patient-oriented evidence
  3. Other evidence including consensus guidelines, opinion, case studies, or disease-oriented evidence (i.e., evidence measuring intermediate, physiologic, or surrogate end points that may or may not reflect improvements in patient outcomes)

Grades of Recommendation

  1. Recommendation based on consistent and good quality patient-oriented evidence
  2. Recommendation based on inconsistent or limited quality patient-oriented evidence
  3. Recommendation based on consensus, opinion, case studies, or disease-oriented evidence

Clinical Algorithm(s)

None provided

Scope

Disease/Condition(s)

Atopic dermatitis (AD; atopic eczema)

Notes :

  • For the guideline, AD is defined as a chronic, pruritic inflammatory skin disease that occurs most frequently in children, but also affects many adults. Atopic eczema is synonymous with AD.
  • Other forms of dermatitis, such as irritant dermatitis and allergic contact dermatitis in those without AD, are outside of the scope of this document.

Guideline Category

  • Diagnosis
  • Evaluation
  • Risk Assessment

Clinical Specialty

  • Allergy and Immunology
  • Dermatology
  • Family Practice
  • Internal Medicine
  • Pediatrics

Intended Users

  • Advanced Practice Nurses
  • Nurses
  • Physicians

Guideline Objective(s)

To address the diagnosis and assessment of pediatric and adult atopic dermatitis (AD; atopic eczema) of all severities

Target Population

Pediatric and adult patients with atopic dermatitis (AD; atopic eczema)

Interventions and Practices Considered

  1. Consideration of essential features, important features, associated features, and exclusionary conditions for diagnosis
  2. Disease severity and clinical outcomes assessment: * Awareness that there are no specific biomarkers for diagnosis or severity assessment * Asking general questions about itch, sleep, impact on daily activity and persistence of disease
  3. Assessment of clinical associations: * Awareness and assessment of conditions associated with atopic dermatitis (AD) as rhinitis/rhinoconjunctivitis, asthma, food allergy, sleep disturbance, depression, and other neuropsychiatric conditions * Integrated, multidisciplinary approach

Note : The following interventions were considered but not recommended for routine clinical practice:

  • Monitoring of immunoglobulin E levels for assessment of disease severity
  • Existing disease severity measurement scales
  • Existing quality of life measurement scales

Major Outcomes Considered

  • Occurrence of atopic dermatitis (AD)
  • Signs and symptoms of AD
  • Associated conditions and risk factors

Methodology

Methods Used to Collect/Select the Evidence

  • Searches of Electronic Databases

Description of Methods Used to Collect/Select the Evidence

An evidence-based model was used and evidence was obtained using a systematic search of PubMed, the Cochrane Library, and the Global Resource for Eczema Trials (GREAT) databases from November 2003 through November 2012 for clinical questions addressed in the previous version of this guideline published in 2004, and from 1964 to 2012 for all newly identified clinical questions as determined by the work group to be of importance to clinical care. Searches were prospectively limited to publications in the English language. Medical Subject Headings (MeSH) terms used in various combinations in the literature search included: atopic dermatitis, atopic eczema, diagnosis, diagnostic, severity course, assessment, biomarkers, outcomes measures, morbidity, quality of life, appearance, comorbidity, food allergy, allergic rhinitis, asthma, cancer, sleep, growth effects, developmental effects, behavioral, psychological, attention deficit hyperactivity disorder (ADHD), treatment, and outcome. A total of 1417 abstracts were initially assessed for possible inclusion. After removal of duplicate data, 292 were retained for final review based on relevancy and the highest level of available evidence for the outlined clinical questions.

The Academy’s previously published guidelines on atopic dermatitis (AD) were also evaluated, as were other current published guidelines on AD.

Number of Source Documents

292 publications were retained for final review

Methods Used to Assess the Quality and Strength of the Evidence

  • Weighting According to a Rating Scheme (Scheme Given)

Rating Scheme for the Strength of the Evidence

Evidence was graded using a 3-point scale based on the quality of study methodology as follows:

  1. Good-quality patient-oriented evidence (i.e., evidence measuring outcomes that matter to patients: morbidity, mortality, symptom improvement, cost reduction, and quality of life).
  2. Limited-quality patient-oriented evidence.
  3. Other evidence, including consensus guidelines, opinion, case studies, or disease-oriented evidence (i.e., evidence measuring intermediate, physiologic, or surrogate end points that may or may not reflect improvements in patient outcomes).

Methods Used to Analyze the Evidence

  • Review of Published Meta-Analyses
  • Systematic Review with Evidence Tables

Description of the Methods Used to Analyze the Evidence

Evidence tables were generated for included studies and used by the work group in developing recommendations.

The available evidence was evaluated using a unified system called the Strength of Recommendation Taxonomy (SORT) developed by editors of US family medicine and primary care journals (i.e., American Family Physician, Family Medicine, Journal of Family Practice, and BMJ USA ). Evidence was graded using a 3-point scale based on the quality of study methodology (e.g., randomized control trial, case control, prospective/retrospective cohort, case series, etc.) and the overall focus of the study (i.e., diagnosis, treatment/prevention/screening, or prognosis) (see the “Rating Scheme for the Strength of the Evidence” field).

Methods Used to Formulate the Recommendations

  • Expert Consensus

Description of Methods Used to Formulate the Recommendations

A work group of recognized atopic dermatitis (AD) experts was convened to determine the audience and scope of the guideline, and to identify important clinical questions in the diagnosis and assessment of AD.

Clinical questions used to structure the evidence review for the diagnosis and assessment of atopic dermatitis:

  • What are the most valid and reliable methods for diagnosing atopic dermatitis?
  • What are the most useful tools to assess the severity and course of atopic dermatitis?
  • What are the patient- and disease-specific outcome measures used to determine the relative effectiveness of a given treatment for atopic dermatitis?
  • What common clinical associations may affect patients with atopic dermatitis?
  • What are the epidemiologic risk factors associated with atopic dermatitis?

Clinical recommendations were developed based on the best available evidence. In situations where documented evidence-based data were not available, expert opinion was used to generate the clinical recommendations.

Rating Scheme for the Strength of the Recommendations

Clinical recommendations were developed based on the best available evidence. These are ranked as follows:

  1. Recommendation based on consistent and good-quality patient-oriented evidence.
  2. Recommendation based on inconsistent or limited-quality patient-oriented evidence.
  3. Recommendation based on consensus, opinion, case studies, or disease-oriented evidence.

Cost Analysis

A formal cost analysis was not performed and published cost analyses were not reviewed.

Method of Guideline Validation

  • Internal Peer Review

Description of Method of Guideline Validation

This guideline has been developed in accordance with the American Academy of Dermatology (AAD)/AAD Association “Administrative Regulations for Evidence-based Clinical Practice Guidelines” (version approved May 2010), which includes the opportunity for review and comment by the entire AAD membership and final review and approval by the AAD Board of Directors.

Evidence Supporting the Recommendations

References Supporting the Recommendations

  • Amon U, Memmel U, Stoll R, Amon S. Comparison of severity scoring of atopic dermatitis values and serum levels of eosinophil cationic protein and mast cell tryptase for routine evaluation of atopic dermatitis. Acta Derm Venereol. 2000 Jul-Aug;80(4):284-6. PubMed
  • Angelova-Fischer I, Bauer A, Hipler UC, Petrov I, Kazandjieva J, Bruckner T, Diepgen T, Tsankov N, Williams M, Fischer TW, Elsner P, Fluhr JW. The objective severity assessment of atopic dermatitis (OSAAD) score: validity, reliability and sensitivity in adult patients with atopic dermatitis. Br J Dermatol. 2005 Oct;153(4):767-73. PubMed
  • Aral M, Arican O, Gul M, Sasmaz S, Kocturk SA, Kastal U, Ekerbicer HC. The relationship between serum levels of total IgE, IL-18, IL-12, IFN-gamma and disease severity in children with atopic dermatitis. Mediators Inflamm. 2006;2006(4):73098. PubMed
  • Augustin M, Lange S, Wenninger K, Seidenglanz K, Amon U, Zschocke I. Validation of a comprehensive Freiburg Life Quality Assessment (FLQA) core questionnaire and development of a threshold system. Eur J Dermatol. 2004 Mar-Apr;14(2):107-13. PubMed
  • Barbier N, Paul C, Luger T, Allen R, De Prost Y, Papp K, Eichenfield LF, Cherill R, Hanifin J. Validation of the Eczema Area and Severity Index for atopic dermatitis in a cohort of 1550 patients from the pimecrolimus cream 1% randomized controlled clinical trials programme. Br J Dermatol. 2004 Jan;150(1):96-102. PubMed
  • Bashir K, Dar NR, Rao SU. Depression in adult dermatology outpatients. J Coll Physicians Surg Pak. 2010 Dec;20(12):811-3. PubMed
  • Batlles-Garrido J, Torres-Borrego J, Rubí-Ruiz T, Bonillo-Perales A, González-Jiménez Y, Momblán-De Cabo J, Aguirre-Rodríguez J, Losillas-Maldonado A, Torres-Daza M. Prevalence and factors linked to allergic rhinitis in 10 and 11-year-old children in Almería. Isaac Phase II, Spain. Allergol Immunopathol (Madr). 2010 May-Jun;38(3):135-41. PubMed
  • Belloni Fortina A, Tonin E, Pigozzi B, Romano I, Michelotto G, Alaibac M. IL-16 serum level in children with atopic dermatitis. Int J Immunopathol Pharmacol. 2006 Oct-Dec;19(4):841-5. PubMed
  • Bender BG, Ballard R, Canono B, Murphy JR, Leung DY. Disease severity, scratching, and sleep quality in patients with atopic dermatitis. J Am Acad Dermatol. 2008 Mar;58(3):415-20. PubMed
  • Ben-Gashir MA, Seed PT, Hay RJ. Are quality of family life and disease severity related in childhood atopic dermatitis?. J Eur Acad Dermatol Venereol. 2002 Sep;16(5):455-62. PubMed
  • Boguniewicz M, Nicol N, Kelsay K, Leung DY. A multidisciplinary approach to evaluation and treatment of atopic dermatitis. Semin Cutan Med Surg. 2008 Jun;27(2):115-27. PubMed
  • Chalmers DA, Todd G, Saxe N, Milne JT, Tolosana S, Ngcelwane PN, Hlaba BN, Mngomeni LN, Nonxuba TG, Williams HC. Validation of the U.K. Working Party diagnostic criteria for atopic eczema in a Xhosa-speaking African population. Br J Dermatol. 2007 Jan;156(1):111-6. PubMed
  • Chamlin SL, Lai JS, Cella D, Frieden IJ, Williams ML, Mancini AJ, Chren MM. Childhood Atopic Dermatitis Impact Scale: reliability, discriminative and concurrent validity, and responsiveness. Arch Dermatol. 2007 Jun;143(6):768-72. PubMed
  • Chamlin SL, Mattson CL, Frieden IJ, Williams ML, Mancini AJ, Cella D, Chren MM. The price of pruritus: sleep disturbance and cosleeping in atopic dermatitis. Arch Pediatr Adolesc Med. 2005 Aug;159(8):745-50. PubMed
  • Charman CR, Venn AJ, Williams HC. Reliability testing of the Six Area, Six Sign Atopic Dermatitis severity score. Br J Dermatol. 2002 Jun;146(6):1057-60. PubMed
  • Charman CR, Venn AJ, Williams HC. The patient-oriented eczema measure: development and initial validation of a new tool for measuring atopic eczema severity from the patients’ perspective. Arch Dermatol. 2004 Dec;140(12):1513-9. PubMed
  • Charman D, Varigos G, Horne DJ, Oberklaid F. The development of a practical and reliable assessment measure for atopic dermatitis (ADAM). J Outcome Meas. 1999;3(1):21-34. PubMed
  • Chawes BL, Bønnelykke K, KreinerMøller E, Bisgaard H. Children with allergic and nonallergic rhinitis have a similar risk of asthma. J Allergy Clin Immunol. 2010 Sep;126(3):567-73.e1-8. PubMed
  • Cosickic A, Skokic F, ColicHadzic B, Jahic M. Clinical characteristics and estimation severity of the atopic dermatitis in children. Med Arh. 2010;64(3):178-82. PubMed
  • Dawn A, Papoiu AD, Chan YH, Rapp SR, Rassette N, Yosipovitch G. Itch characteristics in atopic dermatitis: results of a web-based questionnaire. Br J Dermatol. 2009 Mar;160(3):642-4. PubMed
  • De D, Kanwar AJ, Handa S. Comparative efficacy of Hanifin and Rajka’s criteria and the UK working party’s diagnostic criteria in diagnosis of atopic dermatitis in a hospital setting in North India. J Eur Acad Dermatol Venereol. 2006 Aug;20(7):853-9. PubMed
  • Dhar S, Malakar R, Chattopadhyay S, Dhar S, Banerjee R, Ghosh A. Correlation of the severity of atopic dermatitis with absolute eosinophil counts in peripheral blood and serum IgE levels. Indian J Dermatol Venereol Leprol. 2005 Jul-Aug;71(4):246-9. PubMed
  • Di Lorenzo G, Gangemi S, Merendino RA, Minciullo PL, Cannavò SP, Martinelli N, Mansueto P, Rini GB, Corrocher R, Pacor ML. Serum levels of soluble CD30 in adult patients affected by atopic dermatitis and its relation to age, duration of disease and Scoring Atopic Dermatitis index. Mediators Inflamm. 2003 Apr;12(2):123-5. PubMed
  • Diepgen TL, Sauerbrei W, Fartasch M. Development and validation of diagnostic scores for atopic dermatitis incorporating criteria of data quality and practical usefulness. J Clin Epidemiol. 1996 Sep;49(9):1031-8. PubMed
  • El Mongy S, Metwaly SS, Arafat MS, Hady HA. Serum levels of soluble CD30 in patients with atopic dermatitis: correlations with age, disease duration and severity. Egypt J Immunol. 2008;15(1):123-9. PubMed
  • Eller E, Kjaer HF, Høst A, Andersen KE, BindslevJensen C. Food allergy and food sensitization in early childhood: results from the DARC cohort. Allergy. 2009 Jul;64(7):1023-9. PubMed
  • Emerson RM, Charman CR, Williams HC. The Nottingham Eczema Severity Score: preliminary refinement of the Rajka and Langeland grading. Br J Dermatol. 2000 Feb;142(2):288-97. PubMed
  • Ezzat MH, Hasan ZE, Shaheen KY. Serum measurement of interleukin-31 (IL-31) in paediatric atopic dermatitis: elevated levels correlate with severity scoring. J Eur Acad Dermatol Venereol. 2011 Mar;25(3):334-9. PubMed
  • Firooz A, Davoudi SM, Farahmand AN, Majdzadeh R, Kashani N, Dowlati Y. Validation of the diagnostic criteria for atopic dermatitis. Arch Dermatol. 1999 May;135(5):514-6. PubMed
  • Firooz A, Kashani MN. Diagnostic criteria for atopic dermatitis. J Eur Acad Dermatol Venereol. 2008 Jan;22(1):130. PubMed
  • Gerdes S, Kurrat W, Mrowietz U. Serum mast cell tryptase is not a useful marker for disease severity in psoriasis or atopic dermatitis. Br J Dermatol. 2009 Apr;160(4):736-40. PubMed
  • Gu H, Chen XS, Chen K, Yan Y, Jing H, Chen XQ, Shao CG, Ye GY. Evaluation of diagnostic criteria for atopic dermatitis: validity of the criteria of Williams et al. in a hospital-based setting. Br J Dermatol. 2001 Sep;145(3):428-33. PubMed
  • Gutgesell C, Heise S, Seubert A, Stichtenoth DO, Frölich JC, Neumann C. Comparison of different activity parameters in atopic dermatitis: correlation with clinical scores. Br J Dermatol. 2002 Nov;147(5):914-9. PubMed
  • Hamada M, Furusyo N, Urabe K, Morita K, Nakahara T, Kinukawa N, Nose Y, Hayashi J, Furue M. Prevalence of atopic dermatitis and serum IgE values in nursery school children in Ishigaki Island, Okinawa, Japan. J Dermatol. 2005 Apr;32(4):248-55. PubMed
  • Hanifin JM, Thurston M, Omoto M, Cherill R, Tofte SJ, Graeber M. The eczema area and severity index (EASI): assessment of reliability in atopic dermatitis. EASI Evaluator Group. Exp Dermatol. 2001 Feb;10(1):11-8. PubMed
  • Harding NJ, Birch JM, Hepworth SJ, McKinney PA. Atopic dysfunction and risk of central nervous system tumours in children. Eur J Cancer. 2008 Jan;44(1):92-9. PubMed
  • Hirai S, Kageshita T, Kimura T, Tsujisaki M, Okajima K, Imai K, Ono T. Soluble intercellular adhesion molecule-1 and soluble E-selectin levels in patients with atopic dermatitis. Br J Dermatol. 1996 Apr;134(4):657-61. PubMed
  • Holm EA, Wulf HC, Thomassen L, Jemec GB. Assessment of atopic eczema: clinical scoring and noninvasive measurements. Br J Dermatol. 2007 Oct;157(4):674-80. PubMed
  • Hon KL, Kam WY, Lam MC, Leung TF, Ng PC. CDLQI, SCORAD and NESS: are they correlated?. Qual Life Res. 2006 Dec;15(10):1551-8. PubMed
  • Hon KL, Lam MC, Wong KY, Leung TF, Ng PC. Pathophysiology of nocturnal scratching in childhood atopic dermatitis: the role of brain-derived neurotrophic factor and substance P. Br J Dermatol. 2007 Nov;157(5):922-5. PubMed
  • Hon KL, Leung TF, Wong KY, Chow CM, Chuh A, Ng PC. Does age or gender influence quality of life in children with atopic dermatitis?. Clin Exp Dermatol. 2008 Nov;33(6):705-9. PubMed
  • Horikawa T, Nakayama T, Hikita I, Yamada H, Fujisawa R, Bito T, Harada S, Fukunaga A, Chantry D, Gray PW, Morita A, Suzuki R, Tezuka T, Ichihashi M, Yoshie O. IFN-gamma-inducible expression of thymus and activation-regulated chemokine/CCL17 and macrophage-derived chemokine/CCL22 in epidermal keratinocytes and their roles in atopic dermatitis. Int Immunol. 2002 Jul;14(7):767-73. PubMed
  • Horwitz AA, Hossain J, Yousef E. Correlates of outcome for atopic dermatitis. Ann Allergy Asthma Immunol. 2009 Aug;103(2):146-51. PubMed
  • Hwang CY, Chen YJ, Lin MW, Chen TJ, Chu SY, Chen CC, Lee DD, Chang YT, Wang WJ, Liu HN. Prevalence of atopic dermatitis, allergic rhinitis and asthma in Taiwan: a national study 2000 to 2007. Acta Derm Venereol. 2010 Nov;90(6):589-94. PubMed
  • Hyvärinen MK, Kotaniemi-Syrjänen A, Reijonen TM, Korhonen K, Korppi MO. Teenage asthma after severe early childhood wheezing: an 11-year prospective follow-up. Pediatr Pulmonol. 2005 Oct;40(4):316-23. PubMed
  • Jahnz-Rozyk K, Targowski T, Paluchowska E, Owczarek W, Kucharczyk A. Serum thymus and activation-regulated chemokine, macrophage-derived chemokine and eotaxin as markers of severity of atopic dermatitis. Allergy. 2005 May;60(5):685-8. PubMed
  • Kajbaf TZ, Asar S, Alipoor MR. Relationship between obesity and asthma symptoms among children in Ahvaz, Iran: a cross sectional study. Ital J Pediatr. 2011;37:1. PubMed
  • Kakinuma T, Saeki H, Tsunemi Y, Fujita H, Asano N, Mitsui H, Tada Y, Wakugawa M, Watanabe T, Torii H, Komine M, Asahina A, Nakamura K, Tamaki K. Increased serum cutaneous T cell-attracting chemokine (CCL27) levels in patients with atopic dermatitis and psoriasis vulgaris. J Allergy Clin Immunol. 2003 Mar;111(3):592-7. PubMed
  • Kyllönen H, Malmberg P, Remitz A, Rytilä P, Metso T, Helenius I, Haahtela T, Reitamo S. Respiratory symptoms, bronchial hyper-responsiveness, and eosinophilic airway inflammation in patients with moderate-to-severe atopic dermatitis. Clin Exp Allergy. 2006 Feb;36(2):192-7. PubMed
  • La Grutta S, Richiusa P, Pizzolanti G, Mattina A, Pajno GB, Citarrella R, Passalacqua G, Giordano C. CD4(+)IL-13(+) cells in peripheral blood well correlates with the severity of atopic dermatitis in children. Allergy. 2005 Mar;60(3):391-5. PubMed
  • Lan CC, Lee CH, Lu YW, Lin CL, Chiu HH, Chou TC, Hu SC, Wu CY, Kim YY, Yang HJ, Chen YC, Wu CS, Hsu HY, Shieh SL, Yu HS, Ko YC, Chen GS. Prevalence of adult atopic dermatitis among nursing staff in a Taiwanese medical center: a pilot study on validation of diagnostic questionnaires. J Am Acad Dermatol. 2009 Nov;61(5):806-12. PubMed
  • Leung TF, Ma KC, Hon KL, Lam CW, Wan H, Li CY, Chan IH. Serum concentration of macrophage-derived chemokine may be a useful inflammatory marker for assessing severity of atopic dermatitis in infants and young children. Pediatr Allergy Immunol. 2003 Aug;14(4):296-301. PubMed
  • Lewis-Jones S. Quality of life and childhood atopic dermatitis: the misery of living with childhood eczema. Int J Clin Pract. 2006 Aug;60(8):984-92. PubMed
  • Linnet J, Jemec GB. An assessment of anxiety and dermatology life quality in patients with atopic dermatitis. Br J Dermatol. 1999 Feb;140(2):268-72. PubMed
  • Lodén M, Andersson AC, Lindberg M. The number of diagnostic features in patients with atopic dermatitis correlates with dryness severity. Acta Derm Venereol. 1998 Sep;78(5):387-8. PubMed
  • Mevorah B, Frenk E, Wietlisbach V, Carrel CF. Minor clinical features of atopic dermatitis. Evaluation of their diagnostic significance. Dermatologica. 1988;177(6):360-4. PubMed
  • Misery L, Finlay AY, Martin N, Boussetta S, Nguyen C, Myon E, Taieb C. Atopic dermatitis: impact on the quality of life of patients and their partners. Dermatology (Basel). 2007;215(2):123-9. PubMed
  • Mostafa GA, Tomoum HY, Salem SA, Abd El-Aziz MM, Abou El-Maged DI, El-Sayed El-Far I. Serum concentrations of CCR4 ligands in relation to clinical severity of atopic dermatitis in Egyptian children. Pediatr Allergy Immunol. 2008 Dec;19(8):756-62. PubMed
  • Murat-Susic S, Lipozencic J, Zizic V, Husar K, Marinovic B. Serum eosinophil cationic protein in children with atopic dermatitis. Int J Dermatol. 2006 Oct;45(10):1156-60. PubMed
  • Nakazato J, Kishida M, Kuroiwa R, Fujiwara J, Shimoda M, Shinomiya N. Serum levels of Th2 chemokines, CCL17, CCL22, and CCL27, were the important markers of severity in infantile atopic dermatitis. Pediatr Allergy Immunol. 2008 Nov;19(7):605-13. PubMed
  • Oflazoglu E, Simpson EL, Takiguchi R, Grewal IS, Hanifin JM, Gerber HP. CD30 expression on CD1a+ and CD8+ cells in atopic dermatitis and correlation with disease severity. Eur J Dermatol. 2008 Jan-Feb;18(1):41-9. PubMed
  • Oflazoglu E, Simpson EL, Takiguchi R, Hanifin JM, Grewal IS, Gerber HP. CD40 expression on antigen presenting cells and correlation with disease severity in atopic dermatitis. Eur J Dermatol. 2008 Sep-Oct;18(5):527-33. PubMed
  • Oranje AP, Stalder JF, Taïeb A, Tasset C, de Longueville M. Scoring of atopic dermatitis by SCORAD using a training atlas by investigators from different disciplines. ETAC Study Group. Early Treatment of the Atopic Child. Pediatr Allergy Immunol. 1997 Feb;8(1):28-34. PubMed
  • Ott H, Wilke J, Baron JM, Höger PH, FölsterHolst R. Soluble immune receptor serum levels are associated with age, but not with clinical phenotype or disease severity in childhood atopic dermatitis. J Eur Acad Dermatol Venereol. 2010 Apr;24(4):395-402. PubMed
  • Raap U, Werfel T, Goltz C, Deneka N, Langer K, Bruder M, Kapp A, SchmidOtt G, Wedi B. Circulating levels of brain-derived neurotrophic factor correlate with disease severity in the intrinsic type of atopic dermatitis. Allergy. 2006 Dec;61(12):1416-8. PubMed
  • Ricci G, Bendandi B, Aiazzi R, Patrizi A, Masi M. Three years of Italian experience of an educational program for parents of young children affected by atopic dermatitis: improving knowledge produces lower anxiety levels in parents of children with atopic dermatitis. Pediatr Dermatol. 2009 Jan-Feb;26(1):1-5. PubMed
  • Ricci G, Bendandi B, Bellini F, Patrizi A, Masi M. Atopic dermatitis: quality of life of young Italian children and their families and correlation with severity score. Pediatr Allergy Immunol. 2007 May;18(3):245-9. PubMed
  • Rullo VE, Segato A, Kirsh A, Sole D. Severity scoring of atopic dermatitis: a comparison of two scoring systems. Allergol Immunopathol (Madr). 2008 Jul-Aug;36(4):205-11. PubMed
  • Saeki H, Iizuka H, Mori Y, Akasaka T, Takagi H, Kitajima Y, Oiso N, Kawada A, Tezuka T, Tanaka T, Hide M, Yamamoto S, Hirose Y, Kodama H, Urabe K, Furue M, Kasagi F, Morita E, Tsunemi Y, Tamaki K. Community validation of the U.K. diagnostic criteria for atopic dermatitis in Japanese elementary schoolchildren. J Dermatol Sci. 2007 Sep;47(3):227-31. PubMed
  • Samochocki Z, Dejewska J. A comparison of criteria for diagnosis of atopic dermatitis in children. World J Pediatr. 2012 Nov;8(4):355-8. PubMed
  • Samochocki Z, Paulochowska E, Zabielski S. Prognostic value of Hanifin and Rajka’s feature sets in adult atopic dermatitis patients. J Med. 2000;31(3-4):177-82. PubMed
  • Schmitt J, Langan S, Williams HC, European Dermato-Epidemiology Network. What are the best outcome measurements for atopic eczema? A systematic review. J Allergy Clin Immunol. 2007 Dec;120(6):1389-98. PubMed
  • Schmitt J, Romanos M, Pfennig A, Leopold K, Meurer M. Psychiatric comorbidity in adult eczema. Br J Dermatol. 2009 Oct;161(4):878-83. PubMed
  • Schmitt J, Romanos M, Schmitt NM, Meurer M, Kirch W. Atopic eczema and attention-deficit/hyperactivity disorder in a population-based sample of children and adolescents. JAMA. 2009 Feb 18;301(7):724-6. PubMed
  • Schneider L, Tilles S, Lio P, Boguniewicz M, Beck L, LeBovidge J, Novak N, Bernstein D, Blessing-Moore J, Khan D, Lang D, Nicklas R, Oppenheimer J, Portnoy J, Randolph C, Schuller D, Spector S, Tilles S, Wallace D. Atopic dermatitis: a practice parameter update 2012. J Allergy Clin Immunol. 2013 Feb;131(2):295-9.e1-27. PubMed
  • Schram ME, Spuls PI, Leeflang MM, Lindeboom R, Bos JD, Schmitt J. EASI, (objective) SCORAD and POEM for atopic eczema: responsiveness and minimal clinically important difference. Allergy. 2012 Jan;67(1):99-106. PubMed
  • Schulte-Herbrüggen O, Fölster-Holst R, von Elstermann M, Augustin M, Hellweg R. Clinical relevance of nerve growth factor serum levels in patients with atopic dermatitis and psoriasis. Int Arch Allergy Immunol. 2007;144(3):211-6. PubMed
  • Song TW, Sohn MH, Kim ES, Kim KW, Kim KE. Increased serum thymus and activation-regulated chemokine and cutaneous T cell-attracting chemokine levels in children with atopic dermatitis. Clin Exp Allergy. 2006 Mar;36(3):346-51. PubMed
  • Sprikkelman AB, Tupker RA, Burgerhof H, Schouten JP, Brand PL, Heymans HS, van Aalderen WM. Severity scoring of atopic dermatitis: a comparison of three scoring systems. Allergy. 1997 Sep;52(9):944-9. PubMed
  • Sultész M, Katona G, Hirschberg A, Gálffy G. Prevalence and risk factors for allergic rhinitis in primary schoolchildren in Budapest. Int J Pediatr Otorhinolaryngol. 2010 May;74(5):503-9. PubMed
  • Synnerstad I, Fredrikson M, Ternesten-Bratel A, Rosdahl I. Low risk of melanoma in patients with atopic dermatitis. J Eur Acad Dermatol Venereol. 2008 Dec;22(12):1423-8. PubMed
  • Vajdic CM, Falster MO, de Sanjose S, Martínez-Maza O, Becker N, Bracci PM, Melbye M, Smedby KE, Engels EA, Turner J, Vineis P, Costantini AS, Holly EA, Kane E, Spinelli JJ, La Vecchia C, Zheng T, Chiu BC, Dal Maso L, Cocco P, Maynadié M, Foretova L, Staines A, Brennan P, Davis S, Severson R, Cerhan JR, Breen EC, Birmann B, Cozen W, Grulich AE. Atopic disease and risk of non-Hodgkin lymphoma: an InterLymph pooled analysis. Cancer Res. 2009 Aug 15;69(16):6482-9. PubMed
  • Vakirlis E, Lazaridou E, Tzellos TG, Gerou S, Chatzidimitriou D, Ioannides D. Investigation of cytokine levels and their association with SCORAD index in adults with acute atopic dermatitis. J Eur Acad Dermatol Venereol. 2011 Apr;25(4):409-16. PubMed
  • Vlaski E, Stavric K, Isjanovska R, Seckova L, Kimovska M. Overweight hypothesis in asthma and eczema in young adolescents. Allergol Immunopathol (Madr). 2006 Sep-Oct;34(5):199-205. PubMed
  • Weisshaar E, Diepgen TL, Bruckner T, Fartasch M, Kupfer J, Lob-Corzilius T, Ring J, Scheewe S, Scheidt R, Schmid-Ott G, Schnopp C, Staab D, Szcepanski R, Werfel T, Wittenmeier M, Wahn U, Gieler U. Itch intensity evaluated in the German Atopic Dermatitis Intervention Study (GADIS): correlations with quality of life, coping behaviour and SCORAD severity in 823 children. Acta Derm Venereol. 2008;88(3):234-9. PubMed
  • Williams HC, Burney PG, Pembroke AC, Hay RJ. The U.K. Working Party’s Diagnostic Criteria for Atopic Dermatitis. III. Independent hospital validation. Br J Dermatol. 1994 Sep;131(3):406-16. PubMed
  • Williams HC, Burney PG, Pembroke AC, Hay RJ. Validation of the U.K. diagnostic criteria for atopic dermatitis in a population setting. U.K. Diagnostic Criteria for Atopic Dermatitis Working Party. Br J Dermatol. 1996 Jul;135(1):12-7. PubMed
  • Wolkerstorfer A, de Waard van der Spek FB, Glazenburg EJ, Mulder PG, Oranje AP. Scoring the severity of atopic dermatitis: three item severity score as a rough system for daily practice and as a pre-screening tool for studies. Acta Derm Venereol. 1999 Sep;79(5):356-9. PubMed
  • Wolkerstorfer A, Laan MP, Savelkoul HF, Neijens HJ, Mulder PG, Oudesluys-Murphy AM, Sukhai RN, Oranje AP. Soluble E-selectin, other markers of inflammation and disease severity in children with atopic dermatitis. Br J Dermatol. 1998 Mar;138(3):431-5. PubMed
  • Wu KG, Li TH, Chen CJ, Cheng HI, Wang TY. Correlations of serum Interleukin-16, total IgE, eosinophil cationic protein and total eosinophil counts with disease activity in children with atopic dermatitis. Int J Immunopathol Pharmacol. 2011 Jan-Mar;24(1):15-23. PubMed
  • Yaghmaie P, Koudelka CW, Simpson EL. Mental health comorbidity in patients with atopic dermatitis. J Allergy Clin Immunol. 2013 Feb;131(2):428-33. PubMed

Type of Evidence Supporting the Recommendations

The type of supporting evidence is identified and graded for selected recommendations (see the “Major Recommendations” field).

Benefits/Harms of Implementing the Guideline Recommendations

Potential Benefits

Appropriate diagnosis and assessment of pediatric and adult atopic dermatitis (AD; atopic eczema)

Potential Harms

Not stated

Qualifying Statements

Qualifying Statements

  • Adherence to these guidelines will not ensure successful treatment in every situation. In addition, these guidelines should not be interpreted as setting a standard of care, or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific therapy must be made by the physician and the patient in light of all the circumstances presented by the individual patient and the known variability and biologic behavior of the disease. This guideline reflects the best available data at the time the guideline was prepared. The results of future studies may require revisions to the recommendations in this guideline to reflect new data.
  • In review of the currently available highest level of evidence, the expert work group acknowledges that while much is known about the diagnosis and evaluation of atopic dermatitis, much has yet to be learned.

Implementation of the Guideline

Description of Implementation Strategy

An implementation strategy was not provided.

Implementation Tools

  • Patient Resources

Institute of Medicine (IOM) National Healthcare Quality Report Categories

IOM Care Need

  • Living with Illness

IOM Domain

  • Effectiveness
  • Patient-centeredness

Identifying Information and Availability

Bibliographic Source(s)

  • Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, Berger TG, Bergman JN, Cohen DE, Cooper KD, Cordoro KM, Davis DM, Krol A, Margolis DJ, Paller AS, Schwarzenberger K, Silverman RA, Williams HC, Elmets CA, Block J, Harrod CG, Smith Begolka W, Sidbury R. Guidelines of care for the management of atopic dermatitis. Section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014 Feb;70(2):338-51. [176 references] PubMed

Adaptation

Not applicable: The guideline was not adapted from another source.

Date Released

2004 Mar (revised 2014 Feb)

Guideline Developer(s)

  • American Academy of Dermatology - Medical Specialty Society

Source(s) of Funding

American Academy of Dermatology operational funds and member volunteer time supported the development of this guideline.

Guideline Committee

Atopic Dermatitis Work Group

Composition of Group That Authored the Guideline

Work Group Members : Lawrence F. Eichenfield, MD ( Co-chair ); Robert Sidbury, MD ( Co-chair ); Wynnis L. Tom, MD; Sarah L. Chamlin, MD, MSCI; Steven R. Feldman, MD, PhD; Jon M. Hanifin, MD; Eric L. Simpson, MD; Timothy G. Berger, MD; James N. Bergman, MD; David E. Cohen, MD; Kevin D. Cooper, MD; Kelly M. Cordoro, MD; Dawn M. Davis, MD; Alfons Krol, MD; David J. Margolis, MD, PhD; Amy S. Paller, MS, MD; Kathryn Schwarzenberger, MD; Robert A. Silverman, MD; Hywel C. Williams, PhD; Craig A. Elmets, MD; Julie Block, BA; Christopher G. Harrod, MS; Wendy Smith Begolka, MBS

Financial Disclosures/Conflicts of Interest

The American Academy of Dermatology (AAD) strives to produce clinical guidelines that reflect the best available evidence supplemented with the judgment of expert clinicians. Significant efforts are taken to minimize the potential for conflicts of interest to influence guideline content. Funding of guideline production by medical or pharmaceutical entities is prohibited, full disclosure is obtained and evaluated for all guideline contributors, and recusal is used to manage identified relationships. The AAD conflict of interest policy summary may be viewed at www.aad.org.

Work group members completed a disclosure of interests that was updated and reviewed for potential relevant conflicts of interest throughout guideline development. If a potential conflict was noted, the work group member recused him or herself from discussion and drafting of recommendations pertinent to the topic area of the disclosed interest.

The information below represents the authors’ identified relationships with industry that are relevant to the guideline. Relevant relationships requiring recusal for drafting of guideline recommendations and content were not noted for this section.

Dr Tom is supported by a National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases research career development grant (K23AR060274).

Lawrence F. Eichenfield, MD: Dr Eichenfield served as a consultant for Anacor, Bayer, and Leo Pharma receiving honoraria and TopMD receiving stock options; was a consultant and speaker for Galderma, receiving honoraria; served as a consultant, speaker, and member of the advisory board for Medicis/Valeant, receiving honoraria; and was an investigator for Anacor, Astellas, Galderma, and Leo Pharma, receiving no compensation.

Sarah L. Chamlin, MD: Dr Chamlin served on the advisory boards for Galderma and Valeant, receiving honoraria.

Steven R. Feldman, MD, PhD: Dr Feldman served on the advisory boards for Amgen, Doak, Galderma, Pfizer, Pharmaderm, Skin Medica, and Stiefel, receiving honoraria; was a consultant for Abbott, Astellas, Caremark, Coria, Gerson Lehrman, Kikaku, Leo Pharma, Medicis, Merck, Merz, Novan, Peplin, and Pfizer receiving honoraria and Celgene, HanAll, and Novartis receiving other financial benefits; was a speaker for Abbott, Amgen, Astellas, Centocor, Dermatology Foundation, Galderma, Leo Pharma, Novartis, Pharmaderm, Sanofi-Aventis, Stiefel, and Taro, receiving honoraria; served as a stockholder and founder for Causa Technologies and Medical Quality Enhancement Corporation, receiving stock; served as an investigator for Abbott, Amgen, Anacor, Astellas, Basilea, Celgene, Centocor, Galderma, Medicis, Skin Medica, and Steifel, receiving grants, and Suncare Research, receiving honoraria; and had other relationships with Informa, UptoDate, and Xlibris receiving royalty and Medscape receiving honoraria.

Jon M. Hanifin, MD: Dr Hanifin served on the advisory board for Chugai Pharma USA receiving honoraria; was a consultant for GlaxoSmithKline, Merck Elocon Advisory Board, Pfizer, and Valeant Elidel Advisory Board receiving honoraria; and served as an investigator for Asubio and Merck Sharp & Dohme receiving grants.

Eric L. Simpson, MD: Dr Simpson served as a consultant for Asubio, Brickell Biotech, Galderma, Medicis, Panmira Pharmaceuticals, and Regeneron, and a speaker for Centocor and Galderma receiving honoraria; and was an investigator for Amgen, Celgene, Galderma, and Regeneron receiving other financial benefits.

James N. Bergman, MD: Dr Bergman served as a speaker and consultant for Pediapharm receiving honoraria.

David E. Cohen, MD: Dr Cohen served on the advisory boards and as a consultant for Onset, Ferndale Labs, and Galderma, receiving honoraria; served on the board of directors and as a consultant for Brickell Biotechnology and Topica receiving honoraria, stock, and stock options; and was a consultant for Dermira and Dr Tatoff receiving honoraria and stock options.

Alfons Krol, MD: Dr Krol served as an investigator for Pierre-Fabre receiving grants.

Amy S. Paller, MD: Dr Paller served as a consultant to AbbVie, Alwyn, Amgen, Galderma, GlaxoSmithKline, Leo Pharma, Lundbeck, Medicis, Pfizer, Promius, Sanofi/Regeneron, and TopMD receiving honoraria; and was an investigator for Amgen, Galderma, and Leo Pharma receiving no compensation.

Robert A. Silverman, MD: Dr Silverman served as a speaker for Galderma and Promius receiving honoraria.

Craig A. Elmets, MD: Dr Elmets served on a data safety monitoring board for Astellas receiving honoraria.

Robert Sidbury, MD, Wynnis L. Tom, MD, Timothy M. Berger, MD, Kevin D. Cooper, MD, Kelly M. Cordoro, MD, Dawn M. Davis, MD, David J. Margolis, MD, PhD, Kathryn Schwarzenberger, MD, Hywel C. Williams, PhD, Julie Block, Christopher G. Harrod, MS, and Wendy Smith Begolka, MBS, have no relevant relationships to disclose.

Guideline Status

This is the current release of the guideline.

This guideline updates a previous version: Hanifin JM, Cooper KD, Ho VC, Kang S, Krafchik BR, Margolis DJ, Schachner LA, Sidbury R, Whitmore SE, Sieck CK, Van Voorhees AS. Guidelines of care for atopic dermatitis. J Am Acad Dermatol. 2004 Mar;50(3):391-404. [212 references]

Guideline Availability

Electronic copies: Available from the American Academy of Dermatology Association Web site.

Print copies: Available from the AAD, PO Box 4014, Schaumburg, IL 60168-4014, Phone: (847) 330-0230 ext. 333; Fax: (847) 330-1120; Web site: www.aad.org.

Availability of Companion Documents

The following is available:

Patient Resources

The following is available:

Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information, it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline’s content.

NGC Status

This NGC summary was completed by ECRI on April 19, 2004. The information was verified by the guideline developer on May 19, 2004. This summary was updated by ECRI on March 15, 2005 following release of a public health advisory from the U.S. Food and Drug Administration regarding the use of Elidel. This summary was updated by ECRI on January 31, 2006, following release of a public health advisory from the U.S. Food and Drug Administration regarding the use of Elidel Cream (pimecrolimus) and Protopic Ointment (tacrolimus). This summary was updated by ECRI Institute on November 6, 2007, following the U.S. Food and Drug Administration advisory on CellCept (mycophenolate mofetil). This summary was updated by ECRI Institute on July 8, 2008, following the updated U.S. Food and Drug Administration (FDA) advisory on CellCept (mycophenolate mofetil) and Myfortic (mycophenolate acid). This summary was updated by ECRI Institute on February 19, 2009, following the U.S. Food and Drug Administration (FDA) advisory on CellCept (mycophenolate mofetil). This summary was updated by ECRI Institute on March 26, 2009, following the updated FDA advisory on CellCept and Myfortic. This summary was updated by ECRI Institute on August 18, 2009, following the revised FDA advisory on CellCept (mycophenolate mofetil). This summary was updated by ECRI Institute on August 24, 2009, following the revised FDA advisory on CellCept (mycophenolate mofetil). This summary was updated by ECRI Institute on September 11, 2009, following the revised FDA advisory on Myfortic (mycophenolic acid). This summary was updated by ECRI Institute on March 18, 2014. The updated information was verified by the guideline developer on May 7, 2014.

The “Guidelines of Care for Atopic Dermatitis” is subject to the American Academy of Dermatology’s copyright restrictions.

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