Diagnostic prophylactic and therapeutic guidelines in patients with atopic dermatitis. Position paper by the task force of the national specialists on dermatology and venereology and allergology

Treatment modalities of patients with atopic dermatitis (AD) are dependent on patient age, on the intensity of both skin symptoms and subjective signs of the disease i. e. itch and sleep disturbances, on the body surface involved with lesions, as well as on the type of sensitizing allergens. Characteristics of allergens are crucial to start prophylaxis and to make decision about specific immunotherapy.
In case of remission of the disease the most important factor is to prevent dryness of the skin using emollients, which reconstruct integrity and continuity of stratum corneum. This procedure prevents penetration of airborne allergens across damaged skin barrier into the dermis.
In mild AD cases, pimecrolimus (mainly in children) and corticosteroids of the lowest potency alternatively with their basis should be recommended.
In case of moderate intensity of AD either topical treatment with calcineurin inhibitors i.e. tacrolimus and pimecrolimus or topical glicocorticoids – group 4, 5 of American classification should be applied. In addition PUVA/ UVB phototherapy may be beneficial, as well as immunotherapy with specific airborne allergens. Coexisting bacterial skin infections should be treated with systemic antibiotics, macrolids, chinolons, and cephalosporins; in case of viral herpes infection acyclovir should be administered systemically for 5-7 days; and appropriate antimicotic treatment should be applied in case of fungal infections.
Severe AD is an indication for systemic treatment with cyclosporin A (rather than corticosteroids), and antibiotics as mentioned above. Specific immunotherapy should be proposed for selected cases of severe AD.
Sensitive skin areas such as face, orbicular skin and flexures should be treated rather with pimecrolimus and tacrolimus than with corticosteroids, however, topical corticosteroids are recommended within trunk and the extremities excluding flexures.
While clinical status of AD patients improves treatment modalities suitable for benign and mild AD should be applied. In all cases of exacerbiation of skin lesions 2nd generation of antihistaminic drugs should be administered or for a short time period 1st generation of antihistaminic in order to obtain additional sedation. Further treatment should be based on 2nd generation of antihistamines. Tranquilizers are also helpful in AD treatment while anti – leukotriene agents are not recommended.