Table 1.

Comparison of global guidelines for treatment of atopic dermatitis (AD)

	Type of treatment
	Emollients and moisturizers	Topical corticosteroids (TCSs)	Topical calcineurin inhibitors (TCIs)	Systemic therapies	Other
AAD [16, 17]	• Moisturizers are essential components of therapy [16]	• For management of AD unresponsive to emollients [16] • May be applied up to twice daily (acute) or intermittently (maintenance) [16] • Duration and location of use should inform potency [16] • Can be used with wet wraps [16]	• For short-term/immediate and long-term treatment and maintenance with or without concurrent TCS [16] • May be preferable to TCS for sensitive skin sites (face, anogenital area, skin folds), in patients unresponsive to TCS, and as steroid-sparing therapy [16]	• Systemic immunomodulatory agents (cyclosporine, azathioprine, methotrexate, mycophenolate mofetil) at minimally effective dose for refractory AD unresponsive to topical and ultraviolet phototherapy [17] • Interferon gamma for AD unresponsive to other systemic therapies and ultraviolet phototherapy [17] • Systemic antibiotics and antiviral agents for infected AD [17] • Sedating antihistamines for sleep loss  [17]	• Wet wraps, bleach baths, and intranasal mupirocin (moderate to severe AD) [16] • UV phototherapy as second-line therapy after failure of emollients, TCS, TCI, or as maintenance therapy [17]
AAAAI/ACAAI [18]	• Moisturizers are first-line therapy	• For management of AD not adequately controlled by moisturizers • Low potency TCS: maintenance therapy • Higher potency TCS: flares • Can be used with wet wraps to increase effectiveness	• For AD on the face, eyelids, and skin folds that is unresponsive to TCS • For treatment and prevention of flares	• Antihistamines for pruritus, vitamin D supplementation • Immunomodulatory agents/biologics for severe refractory AD • Allergen immunotherapy for patients sensitive to aeroallergen • Systemic antibiotics and antiviral agents for infected AD	• Avoidance of allergens and AD triggers • Diluted bleach baths, tar preparations, and wet wraps • UV phototherapy for recalcitrant AD • Patient education and monitoring of QoL and psychological stress • Hospitalization
EADV [20, 21]	• Emollients should be used frequently and applied liberally [20]	• Important for acute treatment of AD and to control pruritus; may be used proactively or in conjunction with wet wraps [20]	• Especially recommended for the face, intertriginous sites, anogenital area [20] • May be used proactively and to control pruritus [20]	• Antihistamines for pruritus if TCS and emollients are insufficient  [21] • Systemic antibiotics and antiviral agents for infected AD [21] • Cyclosporine or methotrexate for severe AD [21]; azathioprine or mycophenolate mofetil if cyclosporine is ineffective [21] • Dupilumab for moderate to severe AD uncontrolled by topical therapy and where other systemic treatments are inadvisable  [21] • Mepolizumab, apremilast, or short-term use of oral glucocorticosteroids in select cases [21] • Alitretinoin for atopic hand eczema [21] • Immunoadsorption, allergen immunotherapy for select patients with severe AD [21]	• Avoidance of allergens and dietary triggers [20] • Childhood vaccination and introduction of diverse complementary foods; breastfeeding if possible for infants [20, 21] • Antiseptic baths for infected AD [20, 21]; thermal balneotherapy for mild to moderate AD [21] • UV phototherapy for chronic AD and pruritus relief [20] • Psychological counseling and educational programs [21]
South Africa [19]	• Moisturizers should be applied frequently	• Short-term application of mild/moderate (face and genital area) or moderate/potent (other areas of the body, flares) strength as monotherapy or in conjunction with other therapies • Can be used with wet wraps to increase effectiveness	• Intermittent application to affected areas as second-line therapy/when TCS is contraindicated (mild AD) or as maintenance therapy (moderate AD)	• Cyclosporine, azathioprine plus systemic corticosteroids, or mycophenolate mofetil for severe, refractory AD • Systemic antibiotics and antiviral agents for infected AD • Sedating antihistamines for moderate AD and acute flares	• Avoidance of inhaled and ingested allergens • Avoidance of irritating clothing and laundry practices • Wet wrap dressings, salt baths, antiseptics • Complementary/alternative therapies • Short-term UV phototherapy as second-line treatment • Patient education and psychological intervention

AAAAI American Academy of Allergy, Asthma, and Immunology, AAD American Academy of Dermatology, ACAAI American College of Allergy, Asthma, and Immunology, EADV European Academy of Dermatology and Venerology, QoL quality of life, UV ultraviolet