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Atopic Dermatitis

General Information


  • chronic, relapsing, pruritic inflammatory skin disease associated with epidermal barrier defects1,5
    • occurs most frequently in children, but also affects about 10% of adults
    • associated with elevated serum immunoglobulin E levels and personal or family history of type I allergies, allergic rhinitis, and asthma

Also called

  • atopic eczema
  • eczema


General references used

  1. Eichenfield LF, Tom WL, Chamlin SL, et al. Guidelines of care for the management of atopic dermatitis: Section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014 Feb;70(2):338-51full-text
  2. Eichenfield LF, Tom WL, Berger TG, et al. Guidelines of care for the management of atopic dermatitis: Section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014 Jul;71(1):116-32full-text
  3. Sidbury R, Davis DM, Cohen DE, et al. Guidelines of care for the management of atopic dermatitis: Section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol. 2014 Aug;71(2):327-49full-text
  4. Sidbury R, Tom WL, Bergman JN, 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):1218-33full-text
  5. Weidinger S, Novak N. Atopic dermatitis. Lancet. 2016 Mar 12;387(10023):1109-22

Recommendation grading systems used

  • European Dermatology Forum (EDF), European Academy of Dermatology and Venereology (EADV), European Academy of Allergy and Clinical Immunology (EAACI), European Task Force on Atopic Dermatitis (ETFAD), European Federation of Allergy and Airways Diseases Patients' Associations (EFA), European Society for Dermatology and Psychiatry (ESDaP) European Society of Pediatric Dermatology (ESPD), Global Allergy and Asthma European Network (GA2LEN), and European Union of Medical Specialists (UEMS) consensus based European guideline grading system for recommendations
    • Strength of recommendation
      • Grade A - based on levels of evidence 1a or 1b
      • Grade B - based on levels of evidence 2a, 2b, 3a, or 3b
      • Grade C - based on level of evidence
      • Grade D - based on expert opinion
    • Level of evidence
      • 1a - meta‐analysis of randomized clinical trials (RCT)
      • 1b - single RCTs
      • 2a - systematic review of cohort studies
      • 2b - single cohort studies and RCTs of limited quality
      • 3a - systematic review of case-control studies
      • 3b - single case-control study
      • 4 - case series, case cohort studies, or cohort studies of limited quality
    • Reference - European Consensus recommendation on treatment of atopic dermatitis in adults and children (J Eur Acad Dermatol Venereol 2018 Jun;32(6):850)
  • American Academy of Dermatology (AAD) quality of evidence ratings
    • strength of recommendation
      • Strength of Recommendation A - recommendation based on consistent and good-quality patient-oriented evidence
      • Strength of Recommendation B - recommendation based on inconsistent or limited-quality patient-oriented evidence
      • Strength of Recommendation C - recommendation based on consensus, opinion, case studies, or disease-oriented evidence
    • levels of evidence
      • Level I - good-quality patient-oriented evidence
      • Level II - limited-quality patient-oriented evidence
      • Level III - other evidence, including consensus guidelines, opinion, case studies, or disease-oriented evidence
    • Reference - AAD guideline on atopic dermatitis (24290431J Am Acad Dermatol 2014 Feb;70(2):338)
  • Japanese Dermatological Association (JDA) grading system
    • grades of recommendation
      • Grade A - strongly recommended to perform (at least 1 level I or II study showing effectiveness)
      • Grade B - recommended to perform (at least 1 level II low quality, level III good quality, or level IV extremely good quality showing effectiveness)
      • Grade C1 - consider for use bur insufficient (level III-IV of low quality, levels V or IV of good quality)
      • Grade C2 - not recommended for use (no evidence that indicates effectiveness or evidence indicates no effect)
      • Grade D - recommended to avoid (good evidence that no effect or harmful effects)
    • levels of evidence
      • I - systematic reviews or meta-analysis
      • II - ≥ 1 randomized controlled trials
      • III - controlled study without randomizations
      • IV - cohort or case control study
      • V - case report or case accumulation study
      • VI - expert committee reports or opinions from individual specialist
    • Reference - JDA guidelines on management of atopic dermatitis (mnh19785716pmdc19785716pJ Dermatol 2009 Oct;36(10):563)

Synthesized Recommendation Grading System for DynaMed Content

  • The DynaMed Team systematically monitors clinical evidence to continuously provide a synthesis of the most valid relevant evidence to support clinical decision-making (see 7-Step Evidence-Based Methodology).
  • Guideline recommendations summarized in the body of a DynaMed topic are provided with the recommendation grading system used in the original guideline(s), and allow users to quickly see where guidelines agree and where guidelines differ from each other and from the current evidence.
  • In DynaMed content, we synthesize the current evidence, current guidelines from leading authorities, and clinical expertise to provide recommendations to support clinical decision-making in the Overview & Recommendations section.
  • We use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to classify synthesized recommendations as Strong or Weak.
    • Strong recommendations are used when, based on the available evidence, clinicians (without conflicts of interest) consistently have a high degree of confidence that the desirable consequences (health benefits, decreased costs and burdens) outweigh the undesirable consequences (harms, costs, burdens).
    • Weak recommendations are used when, based on the available evidence, clinicians believe that desirable and undesirable consequences are finely balanced, or appreciable uncertainty exists about the magnitude of expected consequences (benefits and harms). Weak recommendations are used when clinicians disagree in judgments of relative benefit and harm, or have limited confidence in their judgments. Weak recommendations are also used when the range of patient values and preferences suggests that informed patients are likely to make different choices.
  • DynaMed synthesized recommendations (in the Overview & Recommendations section) are determined with a systematic methodology:
    • Recommendations are initially drafted by clinical editors (including ≥ 1 with methodological expertise and ≥ 1 with content domain expertise) aware of the best current evidence for benefits and harms, and the recommendations from guidelines.
    • Recommendations are phrased to match the strength of recommendation. Strong recommendations use "should do" phrasing, or phrasing implying an expectation to perform the recommended action for most patients. Weak recommendations use "consider" or "suggested" phrasing.
    • Recommendations are explicitly labeled as Strong recommendations or Weak recommendations when a qualified group has explicitly deliberated on making such a recommendation. Group deliberation may occur during guideline development. When group deliberation occurs through DynaMed Team-initiated groups:
      • Clinical questions will be formulated using the PICO (Population, Intervention, Comparison, Outcome) framework for all outcomes of interest specific to the recommendation to be developed.
      • Systematic searches will be conducted for any clinical questions where systematic searches were not already completed through DynaMed content development.
      • Evidence will be summarized for recommendation panel review including for each outcome, the relative importance of the outcome, the estimated effects comparing intervention and comparison, the sample size, and the overall quality rating for the body of evidence.
      • Recommendation panel members will be selected to include at least 3 members that together have sufficient clinical expertise for the subject(s) pertinent to the recommendation, methodological expertise for the evidence being considered, and experience with guideline development.
      • All recommendation panel members must disclose any potential conflicts of interest (professional, intellectual, and financial), and will not be included for the specific panel if a significant conflict exists for the recommendation in question.
      • Panel members will make Strong recommendations if and only if there is consistent agreement in a high confidence in the likelihood that desirable consequences outweigh undesirable consequences across the majority of expected patient values and preferences. Panel members will make Weak recommendations if there is limited confidence (or inconsistent assessment or dissenting opinions) that desirable consequences outweigh undesirable consequences across the majority of expected patient values and preferences. No recommendation will be made if there is insufficient confidence to make a recommendation.
      • All steps in this process (including evidence summaries which were shared with the panel, and identification of panel members) will be transparent and accessible in support of the recommendation.
    • Recommendations are verified by ≥ 1 editor with methodological expertise, not involved in recommendation drafting or development, with explicit confirmation that Strong recommendations are adequately supported.
    • Recommendations are published only after consensus is established with agreement in phrasing and strength of recommendation by all editors.
    • If consensus cannot be reached then the recommendation can be published with a notation of "dissenting commentary" and the dissenting commentary is included in the topic details.
    • If recommendations are questioned during peer review or post publication by a qualified individual, or reevaluation is warranted based on new information detected through systematic literature surveillance, the recommendation is subject to additional internal review.

DynaMed Editorial Process

  • DynaMed topics are created and maintained by the DynaMed Editorial Team and Process.
  • All editorial team members and reviewers have declared that they have no financial or other competing interests related to this topic, unless otherwise indicated.
  • DynaMed content includes Practice-Changing Updates, with support from our partners, McMaster University and F1000.

Special acknowledgements

On behalf of the American College of Physicians
  • Barbara Turner, MD, MSEd, MACP, ACP Deputy Editor, Clinical Decision Resource, as part of the ACP-EBSCO Health collaboration, managed the ACP peer review of the Overview and Recommendations section and related clinical content in this topic.
  • DynaMed topics are written and edited through the collaborative efforts of the above individuals. Deputy Editors, Section Editors, and Topic Editors are active in clinical or academic medical practice. Recommendations Editors are actively involved in development and/or evaluation of guidelines.
  • Editorial Team role definitions
    Topic Editors define the scope and focus of each topic by formulating a set of clinical questions and suggesting important guidelines, clinical trials, and other data to be addressed within each topic. Topic Editors also serve as consultants for the internal DynaMed Editorial Team during the writing and editing process, and review the final topic drafts prior to publication.
    Section Editors have similar responsibilities to Topic Editors but have a broader role that includes the review of multiple topics, oversight of Topic Editors, and systematic surveillance of the medical literature.
    Recommendations Editors provide explicit review of Overview and Recommendations sections to ensure that all recommendations are sound, supported, and evidence-based. This process is described in "Synthesized Recommendation Grading."
    Deputy Editors oversee DynaMed internal publishing groups. Each is responsible for all content published within that group, including supervising topic development at all stages of the writing and editing process, final review of all topics prior to publication, and direction of an internal team.

How to cite

National Library of Medicine, or "Vancouver style" (International Committee of Medical Journal Editors):

  • DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115212, Atopic Dermatitis; [updated 2018 Nov 30, cited place cited date here]. Available from Registration and login required.

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EBSCO Information Services accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional.


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