Atopic Dermatitis Referral Guidelines

When to Initiate Referral

  • Mild or moderate AD not responding to treatment after 2 months
  • Severe or poorly controlled AD despite management recommendations (topical steroids, wet wrap therapy, and oral antihistamines)

Treatment Basics

  • EDUCATION: Families should know that AD is a chronic and relapsing disease. Gentle skin care and medication instructions should be reviewed in detail. The skin should be moisturized immediately after bathing to “lock in” moisture.
  • AD severity and locations determine medications used in addition to the frequency and duration of treatment.
  • Topical steroids are typically used to treat a flare twice daily until clear, usually for 1 to 3 weeks, no longer than 15 days per month in order to minimize risk of steroid side effects (striae, telangiectasias, hypopigmentation).
  • You should dispense enough medication when prescribing topicals.
  • Ointments are often preferable to creams due to increased efficacy and reduced irritation. Use creams if this will increase compliance.
  • COMPLIANCE: Make sure patients are using the medications as prescribed before switching to another regimen.

Mild AD on the Face or Body

  • Desonide 05% ointment or hydrocortisone 2.5% ointment twice daily as needed for flares
  • For AD involving the eyelids, neck, axillae or inguinal folds, consider topical immunomodulators (calcineurin inhibitors).
    • Tacrolimus 0.03% or 0.1% ointment or pimecrolimus 1% cream once or twice daily as needed for flares (medications are approved for children 2 years or older)
    • You can also consider using these medications on steroid free days for patients that flare during steroid breaks.

Moderate to Severe AD on the Body

  • Triamcinolone 1% ointment or similar class III-IV topical corticosteroid twice daily as needed for flares
  • Wet wraps for flares or persistent areas
    • Apply topical steroids to affected areas, cover entire body with bland moisturizer of choice, apply cotton long johns or pajamas soaked with warm water and wrung out for 15 to 20 minutes 1 to 2 times per day for flares. If localized, may use gauze, cotton towels or cotton socks as an alternative.
  • For associated pruritus, particularly at bedtime, initiate systemic antihistamines as appropriate for weight.
    • Diphenhydramine
    • Hydroxyzine

Dry and Sensitive Skin Care Recommendations

Soap

  • Dove for Sensitive Skin (bar or liquid) CeraVe Cleanser
  • Cetaphil Gentle Skin Cleanser or Bar (not face wash)
  • Oil of Olay for Sensitive Skin (bar or liquid) Vanicream Cleansing Bar
  • Aveeno Advanced Care Wash

Detergent

  • Tide Free Cheer Free
  • All Free and Clear Purex Free

Fabric Softener

  • Bounce Free
  • Downy Free and Clear

Moisturizer

  • Aquaphor Ointment
  • Vaseline Ointment (no fragrance!) Vaniply Ointment
  • Cetaphil or Cetaphil Restoraderm Cream
  • CeraVe Cream Vanicream Cream
  • Aveeno Advanced Care Cream
  • Aveeno Eczema Cream Eucerin Cream

Sunblock

  • Vanicream Sensitive Skin SPF = 30 or 60
  • Neutrogena Sensitive Skin SPF = 60+ Neutrogena Pure & Free Baby SPF = 60+

Diaper Cream

  • Triple Paste
  • Aquaphor Ointment Vaseline Ointment