Atopic dermatitis: an evidence-based treatment update.
BACKGROUND
Atopic dermatitis (AD) is a common inflammatory disorder of skin with significant comorbidities. AD care often requires a combination of treatment approaches, including emollients, topical steroids, systemic immunosuppressants and/or phototherapy.


OBJECTIVE
Our purpose was to review recent randomized controlled trials (RCT) and systematic reviews of AD treatments.


METHODS
A MEDLINE search was performed focusing on RCTs of AD treatments, with a sample size ≥ 15, and systematic reviews published from 2011 to 2013, limited to the English language. A total of 53 manuscripts met the inclusion/exclusion criteria, including 44 RCTs and nine systematic reviews.


RESULTS
Investigator-initiated RCTs support the use of the systemic agents cyclosporine, methotrexate, azathioprine and mycophenolate mofetil. In one RCT, petrolatum was found to be as effective as creams containing ceramides or glycyrrhetinic acid. Additional therapeutic approaches supported by RCTs include balneotherapy, oral and/or topical probiotics, nutritional interventions, vitamin D with or without vitamin E supplementation, as well as several new topical and complementary medicines.


CONCLUSIONS
Advances have been made with respect to AD treatment in the past few years through the use of well designed RCTs and comparative efficacy studies. However, more well designed RCTs and investigator-initiated studies are needed in order to improve the care of AD patients.
Departments of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University, Suite 1400, 680 Lake Shore Drive, Chicago, IL, 60611, USA, jonathanisilverberg@gmail.com.
Jonathan I
JI
Silverberg
D000279:Administration, Cutaneous; D003131:Combined Modality Therapy; D003876:Dermatitis, Atopic / Q000473:pathology / Q000628:therapy*; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004643:Emollients / Q000008:administration & dosage; D019317:Evidence-Based Medicine; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D010789:Phototherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic
D003879:Dermatologic Agents; D004643:Emollients; D005938:Glucocorticoids; D007166:Immunosuppressive Agents