Clinical Practice Guidelines for the Management of Atopic Dermatitis 2016

Abstract

Atopic dermatitis (AD) is a disease characterized by relapsing eczema with pruritus as a primary lesion. Most patients have an atopic predisposition. The definitive diagnosis of AD requires the presence of all three features: (i) pruritus; (ii) typical morphology and distribution of the eczema; and (iii) chronic and chronically relapsing course. The current strategies to treat AD in Japan from the perspective of evidence-based medicine consist of three primary measures: (i) the use of topical corticosteroids and tacrolimus ointment as the main treatment for the inflammation; (ii) topical application of emollients to treat the cutaneous barrier dysfunction; and (iii) avoidance of apparent exacerbating factors, psychological counseling and advice about daily life. The guidelines present recommendations to review clinical research articles, evaluate the balance between the advantages and disadvantages of medical activities, and optimize medical activity-related patient outcomes with respect to several important points requiring decision-making in clinical practice.

The IL‐13–OVOL1–FLG axis in atopic dermatitis

“…Standard therapeutics for AD include topical emollients for barrier dysfunction and topical steroids and calcineurin inhibitors for skin inflammation . These conventional treatments are more or less effective in reducing atopic inflammation and itch; however, patient satisfaction and adherence to conventional treatments are generally low, as reported in daily clinics …”

“…The definition of ‘atopy’ is a diathesis for the overproduction of immunoglobulin E (IgE) antibodies or a personal and/or family history of asthma, allergic rhinitis, allergic conjunctivitis and AD . With the help of interleukin‐4 (IL‐4) and/or IL‐13 produced from type 2 helper T (Th2) cells, activated B cells produce IgE .…”

Management of Atopic Dermatitis in Japan

“…The use of moisturizers for the dry skin reverses the reduction in the water content of the stratum corneum, promoting recovery of the skin barrier function, preventing the recurrence of dermatitis, and inhibiting pruritus 2 .…”

T helper type 2 signatures in atopic dermatitis

“…[1][2][3][4] Clinical symptoms and signs of AD are characterized by skin inflammation, xerosis, and itching. 1,5,6 Severe pruritus induces sleep disturbance in AD patients and their caregivers. [7][8][9] The itch-sleepless circuit may increase attentiondeficit/hyperactivity disorder in children as well as in adults with AD.…”