Consensus Guidelines for the Treatment of Atopic Dermatitis in Korea (Part I): General Management and Topical Treatment

Abstract

BackgroundSince the treatment guidelines for atopic dermatitis (AD) were released by the Korean Atopic Dermatitis Association (KADA) work group in 2006, there have been several advances in AD management.ObjectiveWe aimed to establish updated evidence- and experience-based treatment guidelines for Korean AD.MethodsWe collected a database of references from relevant systematic AD reviews and guidelines regarding general AD management such as bathing and skin care, avoidance of exacerbating factors, education and psychosocial support, and the use of moisturizers and topical anti-inflammatory and antipruritic drugs. Evidence for each statement was graded and the strength of the recommendation for each statement classified. Thirty-nine KADA council members participated in three rounds of voting to establish an expert consensus of recommendations.ResultsBasic AD treatment includes proper bathing and skin care, avoidance of exacerbating factors, proper education and psychosocial support, and use of moisturizers. The regular use of moisturizer has a steroid-sparing effect and reduces relapse episodes. The short- and long-term use of topical corticosteroids and calcineurin inhibitors improves AD symptoms and should be encouraged to use in an active and proactive treatment. Wet-wrap therapy can be used for rapid recovery of acute exacerbation. Topical antipruritic drugs cannot be recommended for the treatment of AD.ConclusionThis report provides up-to-date evidence- and experience-based treatment guidelines for AD regarding general management and topical treatment. In addition, the average agreement scores obtained by a panel of experts based on the Korean healthcare system and patient adherence are presented.

A comparison of international management guidelines for atopic dermatitis

“…Because conventional soaps strip the skin's natural oil and alkalize stratum corneum (SC) pH, the use of nonsoap, nonirritant, hypoallergenic, and neutral pH cleansers is generally recommended. The U.S., Korean, and Italian guidelines specifically recommend the use of synthetic syndets as nonsoap alternatives . Differences also exist regarding bath additive recommendations.…”

“…In contrast to the TCS guidelines, none of the TCI guidelines recommend blood monitoring. All guidelines state that there is currently no direct evidence to support the claim that TCI use increases risk for malignancy . Table includes a summary of the international guidelines for TCI use in AD.…”

“…There are also slight differences among recommendations regarding antiseptic cleansers. When bacterial infection is clinically evident, the Singaporean, Korean, U.S., Italian, and Taiwanese guidelines recommend bleach baths in conjunction with intranasal mupirocin . Alternatively, the Canadian, Taiwanese, and Italian guidelines recommend prophylactic bleach baths in patients with recurrent bacterial infections .…”

“…The U.S., Korean, and Italian guidelines specifically recommend the use of synthetic syndets as nonsoap alternatives. [6][7][8] Differences also exist regarding bath additive recommendations. Bleach baths are reviewed in the antimicrobials section.…”

“…7,10,11,17,18 no direct evidence to support the claim that TCI use increases risk for malignancy. [3][4][5]7,8,10,11,13,[16][17][18][19][20] Table 6 includes a summary of the international guidelines for TCI use in AD.…”