ETFAD/EADV eczema task force 2009 position paper on diagnosis and treatment of atopic dermatitis
Identifieur interne : 000245 ( France/Analysis ); précédent : 000244; suivant : 000246ETFAD/EADV eczema task force 2009 position paper on diagnosis and treatment of atopic dermatitis
Auteurs : U. Darsow [Allemagne] ; A. Wollenberg [Suisse] ; D. Simon [Suisse] ; A. Taïeb [France] ; T. Werfel [Allemagne] ; A. Oranje [Pays-Bas] ; C. Gelmetti [Italie] ; A. Svensson [Suède] ; M. Deleuran [Danemark] ; A-M Calza [Suisse] ; F. Giusti [Italie] ; J. Lübbe [Suisse] ; S. Seidenari [Italie] ; J. Ring [Allemagne]Source :
- Journal of the European Academy of Dermatology and Venereology [ 0926-9959 ] ; 2010-03.
English descriptors
- Teeft :
- Acad, Acad dermatol, Adult patients, Aeroallergens, Allergen, Allergy, Allergy clin immunol, Antihistamine, Arch dermatol, Ares, Asthma, Atopic, Atopic dermatitis, Atopic eczema, Atopic patients, Atopy, Atopy patch test, Aureus, Authors journal compilation, Bath oils, Calcineurin, Clin, Clinical trials, Colonization, Contact allergy, Contact derm, Contact sensitization, Corticosteroid, Cutaneous, Darsow, Dermatitis, Dermatol, Dermatology, Eczema, Eczema herpeticum, Eczema molluscatum, Educational programmes, Emollient, European academy, Food allergens, Food allergy, Germany department, House dust mites, Immunol, Inhibitor, Irritant, Jeadv, Lesion, Objective scorad, Ointment, Patch testing, Phototherapy, Pilot study, Pimecrolimus, Pimecrolimus cream, Proactive, Proactive therapy, Probiotic, Programme, Pruritus, Randomized, Regimen, Reitamo, Remission, Seidenari, Sensitization, Severe atopic dermatitis, Skin cancer, Skin folds, Staphylococcus, Staphylococcus aureus, Steroid, Systematic review, Systemic treatment, Tacrolimus, Tacrolimus ointment, Topical, Topical calcineurin inhibitors, Topical corticosteroids, Topical steroids, Topical therapy, Topical treatment, Uva1, Venereology, Venereology darsow, Venereology treatment, Werfel, Wollenberg.
Abstract
Background The diagnosis of atopic dermatitis (AD) is made using evaluated clinical criteria. Management of AD must consider the symptomatic variability of the disease. Methods EADV eczema task force developed its guideline for atopic dermatitis diagnosis and treatment based on literature review and repeated consenting group discussions. Results and Discussion Basic therapy relies on hydrating topical treatment and avoidance of specific and unspecific provocation factors. Anti‐inflammatory treatment based on topical glucocorticosteroids and topical calcineurin antagonists is used for exacerbation management and more recently for proactive therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, but the topical calcineurin inhibitors, tacrolimus and pimecrolimus are preferred in certain locations. Systemic anti‐inflammatory treatment is an option for severe refractory cases. Microbial colonization and superinfection may induce disease exacerbation and can justify additional antimicrobial/antiseptic treatment. Systemic antihistamines (H1) can relieve pruritus, but do not have sufficient effect on eczema. Adjuvant therapy includes UV irradiation preferably of UVA1 wavelength or UVB 311 nm. Dietary recommendations should be specific and given only in diagnosed individual food allergy. Allergen‐specific immunotherapy to aeroallergens may be useful in selected cases. Stress‐induced exacerbations may make psychosomatic counselling recommendable. ‘Eczema school’ educational programmes have been proven to be helpful.
Url:
DOI: 10.1111/j.1468-3083.2009.03415.x
Affiliations:
- Allemagne, Danemark, France, Italie, Pays-Bas, Suisse, Suède
- Aquitaine, Basse-Saxe, Bavière, Canton de Berne, District de Haute-Bavière, Hollande-Méridionale, Lombardie, Nouvelle-Aquitaine
- Berne, Bordeaux, Hanovre, Milan, Munich, Rotterdam
- Université technique de Munich
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Darsow</name><affiliation wicri:level="4"><country>Allemagne</country><placeName><settlement type="city">Munich</settlement><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region></placeName><orgName type="university">Université technique de Munich</orgName></affiliation><affiliation wicri:level="3"><country xml:lang="fr">Allemagne</country><wicri:regionArea>Division of Environmental Dermatology and Allergy Helmholtz Center/TUM, Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement></placeName></affiliation><affiliation wicri:level="1"><country wicri:rule="url">Allemagne</country></affiliation></author><author><name sortKey="Wollenberg, A" sort="Wollenberg, A" uniqKey="Wollenberg A" first="A" last="Wollenberg">A. 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Oranje</name><affiliation wicri:level="3"><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Pediatrics (Pediatric Dermatology Unit), ERASMUS MC, Rotterdam</wicri:regionArea><placeName><settlement type="city">Rotterdam</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author><author><name sortKey="Gelmetti, C" sort="Gelmetti, C" uniqKey="Gelmetti C" first="C" last="Gelmetti">C. Gelmetti</name><affiliation wicri:level="3"><country xml:lang="fr">Italie</country><wicri:regionArea>Instituto di clinica dermatologica prima e dermatologia pediatrica, Milan</wicri:regionArea><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Svensson, A" sort="Svensson, A" uniqKey="Svensson A" first="A" last="Svensson">A. Svensson</name><affiliation wicri:level="1"><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Dermatology, University Hospital UMAS, Malmö</wicri:regionArea><wicri:noRegion>Malmö</wicri:noRegion></affiliation></author><author><name sortKey="Deleuran, M" sort="Deleuran, M" uniqKey="Deleuran M" first="M" last="Deleuran">M. Deleuran</name><affiliation wicri:level="1"><country xml:lang="fr">Danemark</country><wicri:regionArea>Department of Dermatology, Aarhus University Hospital, Aarhus</wicri:regionArea><wicri:noRegion>Aarhus</wicri:noRegion></affiliation></author><author><name sortKey="Calza, A" sort="Calza, A" uniqKey="Calza A" first="A-M" last="Calza">A-M Calza</name><affiliation wicri:level="1"><country xml:lang="fr">Suisse</country><wicri:regionArea>Clinique de Dermatologie, Hôpital Cantonal Universitaire, Genève</wicri:regionArea><wicri:noRegion>Genève</wicri:noRegion></affiliation></author><author><name sortKey="Giusti, F" sort="Giusti, F" uniqKey="Giusti F" first="F" last="Giusti">F. Giusti</name><affiliation wicri:level="1"><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Dermatology, University of Modena and Reggio Emilia, Modena</wicri:regionArea><wicri:noRegion>Modena</wicri:noRegion></affiliation></author><author><name sortKey="Lubbe, J" sort="Lubbe, J" uniqKey="Lubbe J" first="J" last="Lübbe">J. Lübbe</name><affiliation wicri:level="1"><country xml:lang="fr">Suisse</country><wicri:regionArea>Clinique de Dermatologie, Hôpital Cantonal Universitaire, Genève</wicri:regionArea><wicri:noRegion>Genève</wicri:noRegion></affiliation></author><author><name sortKey="Seidenari, S" sort="Seidenari, S" uniqKey="Seidenari S" first="S" last="Seidenari">S. Seidenari</name><affiliation wicri:level="1"><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Dermatology, University of Modena and Reggio Emilia, Modena</wicri:regionArea><wicri:noRegion>Modena</wicri:noRegion></affiliation></author><author><name sortKey="Ring, J" sort="Ring, J" uniqKey="Ring J" first="J" last="Ring">J. Ring</name><affiliation wicri:level="4"><country>Allemagne</country><placeName><settlement type="city">Munich</settlement><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region></placeName><orgName type="university">Université technique de Munich</orgName></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">Journal of the European Academy of Dermatology and Venereology</title><title level="j" type="alt">JOURNAL OF EUROPEAN ACADEMY DERMATOLOGY VENEREOLOGY</title><idno type="ISSN">0926-9959</idno><idno type="eISSN">1468-3083</idno><imprint><biblScope unit="vol">24</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="317">317</biblScope><biblScope unit="page" to="328">328</biblScope><biblScope unit="page-count">12</biblScope><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="2010-03">2010-03</date></imprint><idno type="ISSN">0926-9959</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0926-9959</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="Teeft" xml:lang="en"><term>Acad</term><term>Acad dermatol</term><term>Adult patients</term><term>Aeroallergens</term><term>Allergen</term><term>Allergy</term><term>Allergy clin immunol</term><term>Antihistamine</term><term>Arch dermatol</term><term>Ares</term><term>Asthma</term><term>Atopic</term><term>Atopic dermatitis</term><term>Atopic eczema</term><term>Atopic patients</term><term>Atopy</term><term>Atopy patch test</term><term>Aureus</term><term>Authors journal compilation</term><term>Bath oils</term><term>Calcineurin</term><term>Clin</term><term>Clinical trials</term><term>Colonization</term><term>Contact allergy</term><term>Contact derm</term><term>Contact sensitization</term><term>Corticosteroid</term><term>Cutaneous</term><term>Darsow</term><term>Dermatitis</term><term>Dermatol</term><term>Dermatology</term><term>Eczema</term><term>Eczema herpeticum</term><term>Eczema molluscatum</term><term>Educational programmes</term><term>Emollient</term><term>European academy</term><term>Food allergens</term><term>Food allergy</term><term>Germany department</term><term>House dust mites</term><term>Immunol</term><term>Inhibitor</term><term>Irritant</term><term>Jeadv</term><term>Lesion</term><term>Objective scorad</term><term>Ointment</term><term>Patch testing</term><term>Phototherapy</term><term>Pilot study</term><term>Pimecrolimus</term><term>Pimecrolimus cream</term><term>Proactive</term><term>Proactive therapy</term><term>Probiotic</term><term>Programme</term><term>Pruritus</term><term>Randomized</term><term>Regimen</term><term>Reitamo</term><term>Remission</term><term>Seidenari</term><term>Sensitization</term><term>Severe atopic dermatitis</term><term>Skin cancer</term><term>Skin folds</term><term>Staphylococcus</term><term>Staphylococcus aureus</term><term>Steroid</term><term>Systematic review</term><term>Systemic treatment</term><term>Tacrolimus</term><term>Tacrolimus ointment</term><term>Topical</term><term>Topical calcineurin inhibitors</term><term>Topical corticosteroids</term><term>Topical steroids</term><term>Topical therapy</term><term>Topical treatment</term><term>Uva1</term><term>Venereology</term><term>Venereology darsow</term><term>Venereology treatment</term><term>Werfel</term><term>Wollenberg</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background The diagnosis of atopic dermatitis (AD) is made using evaluated clinical criteria. Management of AD must consider the symptomatic variability of the disease. Methods EADV eczema task force developed its guideline for atopic dermatitis diagnosis and treatment based on literature review and repeated consenting group discussions. Results and Discussion Basic therapy relies on hydrating topical treatment and avoidance of specific and unspecific provocation factors. Anti‐inflammatory treatment based on topical glucocorticosteroids and topical calcineurin antagonists is used for exacerbation management and more recently for proactive therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, but the topical calcineurin inhibitors, tacrolimus and pimecrolimus are preferred in certain locations. Systemic anti‐inflammatory treatment is an option for severe refractory cases. Microbial colonization and superinfection may induce disease exacerbation and can justify additional antimicrobial/antiseptic treatment. Systemic antihistamines (H1) can relieve pruritus, but do not have sufficient effect on eczema. Adjuvant therapy includes UV irradiation preferably of UVA1 wavelength or UVB 311 nm. Dietary recommendations should be specific and given only in diagnosed individual food allergy. Allergen‐specific immunotherapy to aeroallergens may be useful in selected cases. Stress‐induced exacerbations may make psychosomatic counselling recommendable. ‘Eczema school’ educational programmes have been proven to be helpful.</div></front></TEI><affiliations><list><country><li>Allemagne</li><li>Danemark</li><li>France</li><li>Italie</li><li>Pays-Bas</li><li>Suisse</li><li>Suède</li></country><region><li>Aquitaine</li><li>Basse-Saxe</li><li>Bavière</li><li>Canton de Berne</li><li>District de Haute-Bavière</li><li>Hollande-Méridionale</li><li>Lombardie</li><li>Nouvelle-Aquitaine</li></region><settlement><li>Berne</li><li>Bordeaux</li><li>Hanovre</li><li>Milan</li><li>Munich</li><li>Rotterdam</li></settlement><orgName><li>Université technique de Munich</li></orgName></list><tree><country name="Allemagne"><region name="Bavière"><name sortKey="Darsow, U" sort="Darsow, U" uniqKey="Darsow U" first="U" last="Darsow">U. Darsow</name></region><name sortKey="Darsow, U" sort="Darsow, U" uniqKey="Darsow U" first="U" last="Darsow">U. Darsow</name><name sortKey="Darsow, U" sort="Darsow, U" uniqKey="Darsow U" first="U" last="Darsow">U. Darsow</name><name sortKey="Ring, J" sort="Ring, J" uniqKey="Ring J" first="J" last="Ring">J. Ring</name><name sortKey="Werfel, T" sort="Werfel, T" uniqKey="Werfel T" first="T" last="Werfel">T. Werfel</name></country><country name="Suisse"><noRegion><name sortKey="Wollenberg, A" sort="Wollenberg, A" uniqKey="Wollenberg A" first="A" last="Wollenberg">A. Wollenberg</name></noRegion><name sortKey="Calza, A" sort="Calza, A" uniqKey="Calza A" first="A-M" last="Calza">A-M Calza</name><name sortKey="Lubbe, J" sort="Lubbe, J" uniqKey="Lubbe J" first="J" last="Lübbe">J. Lübbe</name><name sortKey="Simon, D" sort="Simon, D" uniqKey="Simon D" first="D" last="Simon">D. Simon</name></country><country name="France"><region name="Nouvelle-Aquitaine"><name sortKey="Taieb, A" sort="Taieb, A" uniqKey="Taieb A" first="A" last="Taïeb">A. Taïeb</name></region></country><country name="Pays-Bas"><region name="Hollande-Méridionale"><name sortKey="Oranje, A" sort="Oranje, A" uniqKey="Oranje A" first="A" last="Oranje">A. Oranje</name></region></country><country name="Italie"><region name="Lombardie"><name sortKey="Gelmetti, C" sort="Gelmetti, C" uniqKey="Gelmetti C" first="C" last="Gelmetti">C. Gelmetti</name></region><name sortKey="Giusti, F" sort="Giusti, F" uniqKey="Giusti F" first="F" last="Giusti">F. Giusti</name><name sortKey="Seidenari, S" sort="Seidenari, S" uniqKey="Seidenari S" first="S" last="Seidenari">S. Seidenari</name></country><country name="Suède"><noRegion><name sortKey="Svensson, A" sort="Svensson, A" uniqKey="Svensson A" first="A" last="Svensson">A. Svensson</name></noRegion></country><country name="Danemark"><noRegion><name sortKey="Deleuran, M" sort="Deleuran, M" uniqKey="Deleuran M" first="M" last="Deleuran">M. 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