Adjunctive therapy: what do the guidelines recommend?

  • 10min
  • May. 2022
  • Supported by
    • La Roche-Posay

Most international dermatological societies issue regularly updated guidelines for the management of atopic dermatitis. Although the guidelines focus on medical treatments, the most recent emphasize the importance of adjunctive therapy, primarily moisturizers/emollients, to improve the skin’s barrier function.

Evolution of the guidelines between 2003 and 2015:

  • ICCAD – 20031: “As the barrier function of the skin in patients with atopic dermatitis is impaired, an adjuvant basic therapy is essential in the management of this disease consisting of the regular application of adequate moisturizers. Emollients keep the skin hydrated and can reduce itching.”
  • ICCAD – 20062: “A key feature of AD is severe dryness of the skin caused by a dysfunction of the skin barrier with increased transepidermal water loss. This is typically accompanied by intense pruritus and inflammation. The regular use of emollients is important for addressing this problem, and together with skin hydration, it represents the mainstay of the general management of AD.”
  • Asia–Pacific Consensus Group for Atopic Dermatitis – 20133: “Emollients are crucial to the successful management of AD. Emollients may contain both occlusives, which provide a layer of lipid on the surface of the skin to slow water loss and increase moisture content in the skin, and humectants, which are substances introduced into the stratum corneum to increase its moisture-retaining capacity. Regular emollient therapy is an important pillar in the management strategy of AD management.”
  • AAD – 20144: “Moisturizers should be an integral part of the maintenance treatment plan given their low risk and ability to improve skin hydration; some may also address the negative effects of epidermal barrier dysfunction.”
  • ETFAD / EADV – 20155: “AD is associated with skin barrier anomalies that facilitate an easier allergen penetration into the skin with an increased proneness to irritation and subsequent cutaneous inflammation. Use of emollients improves dryness and subsequently pruritus during the treatment of AD and especially improves the barrier function.”

However, the information and/or recommendations provided by the guidelines can vary. The table below outlines the differences:

Bibliography

  1. Ellis C., Luger T. On behalf of the ICCAD II Faculty. International Consensus Conference on Atopic Dermatitis II (ICCAD II*): clinical update and current treatment strategies. Br J of Dermatol. 2003;148 (Suppl. 63):3–10.
  2. Akdis C.A., Akdis M.B., Bieber T. et al. Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology /American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report. J Allergy Clin Immunol 2006;118:152–69.
  3. Rubel D., Thirumoorthy T., Soebaryo R.W. et al. Asia–Pacific Consensus Group for Atopic Dermatitis. Consensus guidelines for the management of atopic dermatitis: An Asia–Pacific perspective. Journal of Dermatology 2013;40:1–12.
  4. Sidbury R., Tom W.L., Bergman J.N. et al. Guidelines of care for the management of atopic dermatitis: Section 4. Prevention of disease flares and use of adjunctive therapies and approaches. J Am Acad Dermatol. 2014 Dec;71(6):1218–33.
  5. Wollenberg A., Oranje A., Deleuran M. et al. ETFAD/EADV Eczema task force 2015 position paper on diagnosis and treatment of atopic dermatitis in adult and paediatric patients. JEADV 2016;30:729–47.