title: Difficult to control atopic dermatitis.
abstract: Difficult to control atopic dermatitis (AD) presents a therapeutic challenge and often requires combinations of topical and systemic treatment. Anti-inflammatory treatment of severe AD most commonly includes topical glucocorticosteroids and topical calcineurin antagonists used for exacerbation management and more recently for proactive therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, the topical calcineurin inhibitors tacrolimus and pimecrolimus are preferred in certain locations. Systemic anti-inflammatory treatment is an option for severe refractory cases. Microbial colonization and superinfection contribute to disease exacerbation and thus justify additional antimicrobial / antiseptic treatment. Systemic antihistamines (H1) may relieve pruritus but do not have sufficient effect on eczema. Adjuvant therapy includes UV irradiation preferably of UVA1 wavelength. "Eczema school" educational programs have been proven to be helpful.
authors.affiliation: Department of Dermatology and Allergy Biederstein, Technische Universität München, Munich, Germany. ulf.darsow@lrz.tum.de.
authors.forename: Ulf
authors.initials: U
authors.lastname: Darsow
authors.forename: Andreas
authors.initials: A
authors.lastname: Wollenberg
authors.forename: Dagmar
authors.initials: D
authors.lastname: Simon
authors.forename: Alain
authors.initials: A
authors.lastname: Taïeb
authors.forename: Thomas
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authors.lastname: Werfel
authors.forename: Arnold
authors.initials: A
authors.lastname: Oranje
authors.forename: Carlo
authors.initials: C
authors.lastname: Gelmetti
authors.forename: Ake
authors.initials: A
authors.lastname: Svensson
authors.forename: Mette
authors.initials: M
authors.lastname: Deleuran
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Calza
authors.forename: Francesca
authors.initials: F
authors.lastname: Giusti
authors.forename: Jann
authors.initials: J
authors.lastname: Lübbe
authors.forename: Stefania
authors.initials: S
authors.lastname: Seidenari
authors.forename: Johannes
authors.initials: J
authors.lastname: Ring