Table I.
Strategies to minimize atopic dermatitis flares during the coronavirus disease 2019 pandemic
| Strategy | Practical recommendations |
|---|---|
| Reinforce proper skin care regimen | Advise patients to follow proper hand-washing techniques (preferred over hand sanitizers if accessible) as described by the CDC; use warm water and soap and wash hands for at least 20 s; then gently pat skin until mostly dry Instruct patients to apply moisturizer to hands immediately after washing hands each time Counsel that hand sanitizer may be used if no access to water and soap; for example, when patient is outdoors or if patient without access to running water Gentle cleansers and hand sanitizers that do not contain high-risk sensitizing ingredients (such as fragrance or unnecessary antiseptic ingredients) should be recommended to minimize risk of allergic contact dermatitis Recommend applying a thick layer of a nonfragranced moisturizing cream or ointment such as petroleum jelly to hands every night Gloves should be worn when washing dishes or when cleaning with products such as disinfectant sprays Counsel patients to wear cloth face coverings (surgical masks should be reserved for health care workers) in public settings according to CDC guidelines, and the masks should be made from cotton (instead of irritating fabrics such as wool) and be free of synthetic dyes The cloth masks should be laundered regularly along with other clothing items, using fragrance-free detergent∗ that does not cause skin reactions in patients |
| Provide access to telehealth encounters | Instruct patients to take photographs of areas of concern for asynchronous store-and-forward visit, or examine areas during synchronous video visit Prioritize patients with complaint of AD flare to potentially diagnose and treat secondary infections (such as impetigo or eczema herpeticum) early Reinforce eczema action plans to empower patients to self-manage mild AD flares at home |
| Optimize AD treatment regimen† | Taper broad immunosuppressants such as prednisone, methotrexate, mycophenolate, azathioprine, and cyclosporine to lowest effective dose; consider discontinuing these medications in patients when viral symptoms are present2 Appropriate patients may continue receiving dupilumab‡; consider discontinuation if upper respiratory tract viral infection symptoms present For patients with moderate to severe AD whose disease requires a new systemic agent during this time, starting dupilumab may be preferable to starting a traditional immunosuppressant, although more data are needed Discontinuation of Janus kinase inhibitors during initial infection may be beneficial, although their potential treatment role for the cytokine release syndrome is being investigated3 Maximize pillars of AD treatment, including bleach baths, moisturizers, and topical therapeutics |
AD, Atopic dermatitis; CDC, Centers for Disease Control and Prevention.
∗
Studies on optimal frequency of washing cloth masks and optimal fabric to use for cloth masks to specifically protect against COVID-19 exposure are lacking.
†
Decisions on whether to continue immunosuppressant or immunomodulating agents if patients show symptoms concerning for COVID-19 should be made on a case-by-case basis.2
‡
A recent meta-analysis that pooled data from seven randomized, placebo-controlled dupilumab trials found that dupilumab does not increase overall infections rates versus placebo.4