Asia Pac Allergy.  2018 Oct;8(4):e41. 10.5415/apallergy.2018.8.e41.

A clinician's reference guide for the management of atopic dermatitis in Asians

• Chow S
• Seow CS
• Dizon MV
• Godse K
• Foong H
• Chan V
• Khang TH
• Xiang L
• Hidayat S
• Listiawan
• Triwahyudi D
• Gondokaryono SP
• Sutedja E
• Diana IA
• Suwarsa O
• Dharmadji
• Siswati AS
• Danarti R
• Soebaryo R
• Budianti W
• for the Asian Academy of Dermatology & Venereology

• KMID: 2423992
• DOI: http://doi.org/10.5415/apallergy.2018.8.e41

Abstract

BACKGROUND
Atopic dermatitis (AD) is a common skin condition among Asians. Recent studies have shown that Asian AD has a unique clinical and immunologic phenotype compared with European/American AD.
OBJECTIVE
The Asian Academy of Dermatology and Venereology Expert Panel on Atopic Dermatitis developed this reference guide to provide a holistic and evidence-based approach in managing AD among Asians.
METHODS
Electronic searches were performed to retrieve relevant systematic reviews and guidelines on AD. Recommendations were appraised for level of evidence and strength of recommendation based on the U.K. National Institute for Health and Care Excellence and Scottish Intercollegiate Guidelines Network guidelines. These practice points were based on the consensus recommendations discussed during the Asia Pacific Meeting of Experts in Dermatology held in Bali, Indonesia in October 2016 and April 2017.
RESULTS
The Expert Panel recommends an approach to treatment based on disease severity. The use of moisturizers is recommended across all levels of AD severity, while topical steroids are recommended only for flares not controlled by conventional skin care and moisturizers. Causes of waning efficacy must be explored before using topical corticosteroids of higher potency. Topical calcineurin inhibitors are recommended for patients who have become recalcitrant to steroid, in chronic uninterrupted use, and when there is steroid atrophy, or when there is a need to treat sensitive areas and pediatric patients. Systemic steroids have a limited role in AD treatment and should be avoided if possible. Educational programs that allow a patient-centered approach in AD management are recommended as an adjunct to conventional therapies. Recommendations on the use of phototherapy, systemic drugs, and emerging treatments are also included.
CONCLUSION
The management of AD among Asians requires a holistic approach, integrating evidence-based treatments while considering accessibility and cultural acceptability.

Keyword

Asians; Atopic dermatitis; Eczema; Atopy; Dermatology

MeSH Terms

Adrenal Cortex Hormones
Asia
Asian Continental Ancestry Group*
Atrophy
Calcineurin Inhibitors
Consensus
Dermatitis, Atopic*
Dermatology
Eczema
Humans
Indonesia
Phenotype
Phototherapy
Skin
Skin Care
Steroids
Venereology
Adrenal Cortex Hormones
Calcineurin Inhibitors
Steroids