Table 2.

Behavioral and Educational Reasons for Poor Responses

Confirm proper skin care Ensure proper technique with bathing, skin emollients, and TCS under supervision Consider TCIs or another anti-inflammatory nonsteroidal for steroid refractory AD Institute proactive TCS or TCI for chronic relapsing AD Inadequate quantity of applied topical medication Write clear therapy home management plan Patient education on skin care Provide hands on education to show how much topical therapy to use and how exactly to apply Ensure proper placement of emollients on unaffected areas and TCS or TCIs on affected areas Do not mix or layer emollients and topical anti-inflammatory therapy Patient education related to behavioral health Address psychosocial stressors that may affect habitual scratching, sleep, and adherence Educate on sleep hygiene and consider sedating antihistamines at night Provide methods to prevent habitual scratching such as habit reversal or relaxation techniques Provide clear school or day care guidelines to help facilitate treatment success away from home

Abbreviations: AD, atopic dermatitis; TCI, topical calcineurin inhibitor; TCS, topical corticosteroid.