. Author manuscript; available in PMC: 2015 Jul 1.

Published in final edited form as: J Am Acad Dermatol. 2014 May 9;71(1):116–132. doi: 10.1016/j.jaad.2014.03.023

Table VIII.

Strength of recommendations for the use of topical therapies in the treatment of atopic dermatitis

Recommendation	Strength of Recommendation	Level of Evidence	References
Use of moisturizers	A	I	^{9–16, 18–21, 126}
Bathing and bathing practices	C	III	^{23, 24, 26, 28, 30}
Application of moisturizers after bathing	B	II	^{24, 25}
Limited use of non-soap cleansers	C	III	^27–30
Against use of bath additives, acidic spring water	C	III	^{31, 32, 127}
Wet wrap therapy	B	II	^34–41
Use of topical corticosteroids (TCS)	A	I	^42–46
Consideration of a variety of factors in TCS selection	C	III	^{49, 128, 129}
Frequency of application	B	II	^51–53
Proactive use of TCS for maintenance	B	II	^54–56
Need for consideration of side effects with use	A	I	^{57, 58, 66}
Need for monitoring for cutaneous side effects with potent TCS	B	III	^{57, 58, 66}
Specific routine monitoring for systemic side effects with TCS not needed	C	III	^{57, 58, 62, 66}
Addressing fears with use	B	III	^67–69
Use of topical calcineurin inhibitors (TCIs)	A	I	^{70, 76, 81}
Use as steroid-sparing agents	A	I	^{82, 83}
Off-label use of TCIs in those under 2 years of age	A	I	^{76, 89}
Counseling on local reactions with TCIs and the preceding use of TCS	B	II	^{81, 85, 96}
Proactive use of TCIs for maintenance	A	I	^{54, 93–95}
Concomitant TCS and TCI use	B	II	^{82, 83, 106–109}
Informing patients regarding theoretical risk of cutaneous viral infections with use	C	III	^{82, 98}
Awareness of black box warning of TCIs	C	III	^98–101
Routine monitoring of TCI blood levels not needed	A	I	^{102, 103}
Against routine use of topical antistaphylococcal treatments	A	I	^110–112
Bleach baths and intranasal mupirocin for those with moderate to severe AD and clinical infection	B	II	¹¹³
Against use of topical antihistamines	B	II	^{42, 115–117}