BACKGROUND: Management of severe/recalcitrant atopic dermatitis (SRAD) is a difficult task for both patients and clinicians. METHOD: We developed this report to provide experts' opinion on the treatment of SRAD by a literature review and repeated group discussions made at the Work Group on Severe Recalcitrant Atopic Dermatitis in the Korean Academy of Asthma, Allergy and Clinical Immunology. RESULT: Specific aggravating factors, including inhalant allergens or food allergens, should be identified by laboratory tests in patients with SRAD. Patients should be educated about avoidance measures for specific aggravating factors, moisturization of the skin, and control of skin inflammation using low-potency topical corticosteroids and/or topical calcineurin inhibitors. For patients with SRAD who cannot be properly controlled by the above treatments, systemic immunoregulatory treatment such as cyclosporin could be effective. Allergen-specific immunotherapy has been attempted as a useful therapeutic option in selected patients with SRAD sensitized to aeroallergens. Psychological counseling and educational programs should be recommended for the management of patients with SRAD. CONCLUSION: Therapeutic approaches aimed at personalized medicine including stepwise treatment according to clinical severity, combination therapy, proactive therapy and multi-disciplinary approach should be tried to achieve the best outcome for SRAD.