SummaryBackgroundGuidelines discourage the use of systemic corticosteroids for atopic dermatitis (AD), but their use remains widespread.ObjectivesTo reach consensus among an international group of AD experts on the use of systemic corticosteroids for AD.MethodsA survey consisting of statements accompanied by visual analogue scales ranging from ‘strongly disagree’ to ‘neutral’ to ‘strongly agree’ was distributed to the International Eczema Council (IEC). Consensus was reached in agreement on a statement if < 30% of respondents marked to the left of ‘neutral’ towards ‘strongly disagree’.ResultsSixty of 77 (78%) IEC members participated. Consensus was reached on 12 statements, including that systemic corticosteroids should generally be avoided but can be used rarely for severe AD under certain circumstances, including a lack of other treatment options, as a bridge to other systemic therapies or phototherapy, during acute flares in need of immediate relief, in anticipation of a major life event or in the most severe cases. If used, treatment should be limited to the short term. Most respondents agreed that systemic corticosteroids should never be used in children, but consensus was not reached on that statement. The conclusions of our expert group are limited by a dearth of high‐quality published evidence. If more stringent consensus criteria were applied (e.g. requiring < 20% of respondents marking towards ‘strongly disagree’), consensus would have been reached on fewer statements.ConclusionsBased on expert opinion from the IEC, routine use of systemic corticosteroids for AD is generally discouraged and should be reserved for special circumstances.

Atopic dermatitis (AD) is a relatively common disease in patients in the Asia-Pacific region. It presents a particular clinical challenge and requires careful clinical management. The chronic nature of AD characterized by flares, exacerbations and periods of quiescence requires a multipronged approach aimed at reducing itch, inflammation and the appearance of secondary lesions. In addition, varying levels of maintenance therapy may be required to avoid exacerbations. Survey data from the region indicate that there is significant variation across the Asia-Pacific with regard to current treatment practices. The management of AD may also be influenced by differing health-care systems, variable climate, access to medical care and cultural diversity. The current consensus guidelines have been developed to provide up-to-date and concise evidence-and experience-based recommendations directed towards general practitioners and general dermatologists in the Asia-Pacific region on the management of pediatric and adult AD.

Patients with atopic dermatitis (AD) have an increased risk of bacterial skin infections, which cause significant morbidity and, if untreated, may become systemic. Staphylococcus aureus colonizes the skin of most patients with AD and is the most common organism to cause infections. Overt bacterial infection is easily recognized by the appearance of weeping lesions, honey-coloured crusts and pustules. However, the wide variability in clinical presentation of bacterial infection in AD and the inherent features of ADcutaneous erythema and warmth, oozing associated with oedema, and regional lymphadenopathyoverlap with those of infection, making clinical diagnosis challenging. Furthermore, some features may be masked because of anatomical site-and skin-type-specific features, and the high frequency of S. aureus colonization in AD makes positive skin swab culture of suspected infection unreliable as a diagnostic tool. The host mechanisms and microbial virulence factors that underlie S. aureus colonization and infection in AD are incompletely understood. The aim of this article is to present the latest evidence from animal and human studies, including recent microbiome research, to define the clinical features of bacterial infections in AD, and to summarize our current understanding of the host and bacterial factors that influence microbial colonization and virulence. The role of bacterial skin infections in atopic dermatitis, H. Alexander et al. 1335 Fig 6. Hypothetical damage-response framework for Staphylococcus aureus in atopic dermatitis (AD). 82 Different host-S. aureus interactions result in different damage-response relationships. Curves A and B represent the damage-response relationships of S. aureus with two different hosts or those of a single host with two different S. aureus strains. The outcome for the host depends on the strength of the host response to S. aureus or the virulence of S. aureus. During intermediate host responses neither interaction (A or B) causes clinical evidence of infection, as the amount of damage incurred by the host is insufficient (1). However, in the setting of weak or strong responses both interactions cause an AD flare (2) and interaction B causes overtly infected AD (3). The position of the curve is determined by multiple host and S. aureus factors.

Background: Stable and refractory vitiligo may be unresponsive to medical therapy. Melanocyte transplantation by punch grafting (PG) can restore the normal pigmentation. Objective: To evaluate the efficacy of PG on repigmentation of vitiligo patches. Methods: Autologous miniature PG was undertaken in 1,000 patients with stable and recalcitrant vitiligo. Test grafting (TG) was done in all the patients. Those who showed negative TG results were excluded from the study. Results: Of the 1,000 patients, 880 (88%) showed positive TG results. In 656 (74.55%) patients, 90–100% repigmentation was achieved. In 93 (10.57%) patients, there was no spread of pigment, while in 21 (2.39%) patients depigmentation of the graft(s) was notices. Of various complications, polka dot appearance (43.98%) and colour mismatch (34.32%) were most frequent. Conclusion: Partial to near – total repigmentation of a vitiligo patch can be achieved by PG.

Various epidemiologic factors and clinical patterns of atopic dermatitis (AD) were evaluated in 672 children. Of these, 210 were infants (up to 1 year) and 462 were children. Mean age at onset and mean duration of the disease were 4.2 months and 3.3 months, respectively, in the "infantile AD" group. In the "childhood AD" group the corresponding figures were 4.1 years and 1.9 years. In both groups, patients from urban areas significantly outnumbered those from rural backgrounds. In the infantile AD group, the disease was aggravated in winter in 67.14%, in summer in 23.36% and in spring in 9.51% of patients. The corresponding figures in the childhood AD group were 58% in winter, 32.92% in summer, 7.43% in spring, and 1.74% in the rainy season. In the infantile AD group, personal and family history of atopy were seen in 0.91% and 36.19% of patients, respectively. No patient had a history of drug allergy. In the childhood AD group, 15.35% had a personal history of atopy, 36.44% had a family history of atopy, and 7.36% had both a personal and family history of atopy. A history of drug allergy was reported in 3.16% of children. In the infantile AD group, 79% had facial involvement, 42% had flexors affected, and 5.70% had both flexors and extensors affected. The types of eczema seen were acute in 52.72%, subacute in 23.35%, chronic in 23.35%, and follicular in 0.46%. In the childhood AD group, 74.50% had facial involvement, 35.53% had flexural involvement, 56.32% had extensor involvement, and 8.24% had both flexors and extensors involved. Acute eczema was seen in 28.79%, subacute in 23.38%, chronic in 47.40%, and follicular in 0.43% of the children.