How can Atopic Dermatitis Flares be Managed in Routine Clinics?

Managing flares of atopic dermatitis (AD) can be challenging, particularly in treatment-resistant cases. Regular skin care using emollients and mild skin cleansers is essential to address the dysfunctional epidermal barrier. Additionally, educating patients and avoiding triggers are crucial components of management.

For visible skin lesions, topical anti-inflammatory treatments, including corticosteroids and calcineurin inhibitors, should be used. Topical corticosteroids are the first-line treatment for acute flares and should be applied at the first sign of a flare. If topical treatments fail or are inadequate, other therapeutic options should be considered. 

The choice of systemic immunosuppressive treatment must be based on the rapid onset of action, with JAK inhibitors generally being faster-acting than drugs targeting IL-4Rα or IL-13 inhibitors. 

If considering UV therapy, patients with acute flares should first follow the standard regimen for the short term before getting UV therapy, except for UVA1, which 340–400 nm wavelength. 

If there are clinical signs of bacterial infection, such as oozing and pustules, topical antiseptics, as well as topical and systemic antibiotics, can be given. Secondary infections caused by fungal or viral agents should also be investigated early and treated promptly if present.

Source: Girolomoni G, Busà VM. TherAdv Chronic Dis. 2022 Jan 13;13:20406223211066728. doi: 10.1177/20406223211066728.