Consensus document APAIR: atopic dermatitis in children - update 2019 (short version) Part 2
Atopic dermatitis (AD) is a diagnosis with precise criteria described by Hanifin & Rajka. A differential diagnosis shouldbe considered at the discrepancy of the symptoms or torpid eczema. The list of diseases is genetic syndromes with theimpaired epidermal barrier, metabolic diseases, skin infections, psoriasis and others. Skin infections in the diagnostic searchshould be considered the first time. The basis of therapy allergic eczema is the elimination of allergenic and non-allergenic triggers, topical steroids and inhibitorscalcineurin with uses of emollients in the skincare process. This therapy is sufficient for most patients.Systemic therapy of dermatitis consists of short courses of steroids (up to 1 week) with the ineffectiveness of external preparation. If long-term therapy is necessary, it is proposed to consider the possibility of prescribing dupilumab and cyclosporin A. Antihistamines can be considered as a drug for stopping itching in the early days of the disease. With a sufficient effect ofexternal anti-inflammatory drugs, the use of antihistamines is not required.Exclusion of culpable food allergens leads to rapid remission of the disease. Non-specific hypoallergenic diets reduce thequality of life of patients and should not be used for a long time. The main formula for feeding children with allergies tocow's milk protein is extensively hydrolysed formula. The amino acid-based formula is reserved for severe cases.During the period of remission, it is important to provide skincare and regular use of emollients, as well as a complex to eliminate causative allergens from the patient’s environment.Specific immunotherapy can be recommended for patients with a proven role of the allergen in the development of exacerbation AD and with a combination of eczema with allergic rhinoconjunctivitis and asthma.