Update on therapy of atopic dermatitis

Atopic dermatitis (AD) is complicated and often difficult to manage. Effective therapy is commonly impeded by 3 ambivalencies: (1) prioritization of skin care versus allergy treatment; (2) uncertainty about optimal bathing and moisturizing, and (3) hesitation about the use of adequate topical corticosteroid therapies. With a confident, well-planned approach, effective therapy management may be achieved. On initial assessment, an evaluation form is a tool to keep the focus on important history and physical features critical for the diagnosis and to review trigger factors and past therapies. Patients and parents must be educated to become more aware of the trigger factors that may lead to an exacerbation of their disease. Errors in bathing and moisturizing are the major cause of persistent AD, and the confusing paradox that water is both good and bad for the skin must be resolved to achieve therapeutic success. Avoidance/approach conflicts regarding recommendations of topical steroid use has a detrimental effect on patient outcomes. With the proper use of mid-strength topical agents and with the recent development of topical macrolides for use in AD, effective management for this disease can be realized. (J Allergy Clin Immunol 1999;104:S123-5.)