Atopic dermatitis (AD) is a chronic relapsing
eczematous skin disease characterized by
pruritus and
inflammation and accompanied by cutaneous physiological dysfunction (dry and barrier-disrupted skin). Most of the patients have atopic
diathesis. A standard guideline for the management (diagnosis, severity classification and
therapy) of AD has been established. In our guideline, the necessity of dermatological training is emphasized in order to assure diagnostic skill and to enable evaluation of the severity of AD. The definitive diagnosis of AD requires the presence of all three features: (i)
pruritus; (ii) typical morphology and distribution; and (iii) chronic and chronically relapsing course. For the severity classification of AD, three elements of eruption (
erythema/acute papules, exudation/crusts and chronic papules/nodules/lichenification) are evaluated in the most severely affected part of each of the five body regions (head/neck, anterior trunk, posterior trunk, upper limbs and lower limbs). The areas of eruption on the five body regions are also evaluated, and both scores are totaled (maximum 60 points). The present standard
therapies for AD consist of the use of topical
corticosteroids and
tacrolimus ointment as the main treatment for the
inflammation, topical application of
emollients to treat the cutaneous physiological dysfunction, systemic
antihistamines and
anti-allergic drugs as adjunctive treatments for
pruritus, avoidance of apparent exacerbating factors, psychological counseling and advice about daily life.
Tacrolimus ointment (0.1%) and its low-density
ointment (0.03%) are available for adult patients and 2-15-year-old patients, respectively. The importance of the correct selection of topical
corticosteroids according to the severity of the eruption is also emphasized. Furthermore, deliberate use of oral
cyclosporine for severe recalcitrant adult AD is referred.