Comparison of treatment standards in Atopic Dermatitis management across selected geographies prior to emerging targeted therapies onset

Figures & data

Table 1. The summary of guidelines for AD treatment in the US, Europe, Poland, Germany, and Ukraine.

Selected treatment methods for AD	AAD^1	ETFAD/EADV^5	Polish guidelines^6^,^7	German guidelines^8	Ukrainian guidelines^9
Non-pharmacologic interventions
Bathing practices		Basic therapy	Not discussed	Basic therapy	Not determined
Moisturizers		Basic therapy		Basic therapy
Pharmacologic interventions
Topical pharmacotherapies
Topical corticosteroids (TCS)	1st line treatment	Mild AD	1st line treatment	Short-term use;  1st line treatment
Topical calcineurin inhibitors (TCI)	2nd line treatment (i.a. tacrolimus, pimecrolimus)	Mild and moderate AD	2nd line treatment  (not reimbursed)	2nd line treatment	Tacrolimus
Wet wrap therapy	In combination with TCS for refractory AD	In combination with TCS for moderate AD	Alternative treatment	Discussed—in combination with TCS	Not discussed
Topical antimicrobials	To be avoided due to widespread antimicrobial resistance	Mild AD	Adjuvant therapy	In serious infection; Short-term use	Not determined
Systemic therapy
Phototherapy	In AD refractory to topical treatments	AD chronic phase in adults	3rd line treatment	Adjuvant treatment
Systemic immunosuppressants	In severe AD refractory to topical treatments and phototherapy (i.a. cyclosporine, methotrexate, mycophenolate mofetil, azathioprine)	Severe AD (i.a. cyclosporine, methotrexate, mycophenolate mofetil, azathioprine)	3rd line treatment in severe AD (cyclosporine) Off-label use: • methotrexate, • Mycophenolate mofetil • Azathioprine	Chronic, severe AD (cyclosporine) Off-label use: • mycophenolate mofetil • Methotrexate • azathioprine	i.a. ciclosporin, mycophenolate mofetil
Systemic corticosteroids	To be avoided in acute severe exacerbations or as a bridge therapy	Short course for severe AD	Short course for severe AD	Short course for severe AD	In case of ongoing therapy is ineffective
Systemic antihistamines	To be avoided; short-term use in patients with disturbed sleep	To decrease pruritus in patients with disturbed sleep; long-term use not recommended	Not discussed	Generally not recommended	(2nd generation recommended)
Systemic antimicrobials	In case of bacterial infection only;  alongside other therapies	Overt secondary infection	In infections with clinical symptoms	In infections with clinical symptoms	In case of AD complications or overt secondary bacterial infection
Immunotherapy	Dupilumab	Discussed; dupilumab—promising efficiency and safety profile	Not authorized, not reimbursed, not discussed	Dupilumab: not authorized, not reimbursed, not discussed omalizumab: Not recommended	Not authorized, not reimbursed, not discussed
Other	N/A	N/A	N/A	N/A	• Plasmapheresis • Antidepressants

Abbreviations. AAD, American Academy of Dermatology; AD, atopic dermatitis; ETFAD/EADV, European Task Force on Atopic Dermatitis (ETFAD)/European Academy of Dermatology and Venerology (EADV).

Eichenfield LF, Ahluwalia J, Waldman A, et al. Current guidelines for the evaluation and management of atopic dermatitis: A comparison of the Joint Task Force Practice Parameter and American Academy of Dermatology guidelines. J Allergy Clin Immunol. 2017;139(4S):S49–S57.

 PubMed Web of Science ®Google Scholar

Wollenberg A, Barbarot S, Bieber T, et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I. J Eur Acad Dermatol Venereol. 2018;32(5):657–682.

 PubMed Web of Science ®Google Scholar

FDA. Dupixent – highlights of prescribing information. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/761055lbl.pdf.

 Google Scholar

Statement of the experts of the Dermatological Section, Polish Society of Allergology, and the Allergology Section, Polish Society of Dermatology.

 Google Scholar

Leitlinie (S2k) Neurodermitis Langversion Version. 2014. [atopisches Ekzem; atopische Dermatitis].

 Google Scholar

Order of the Ministry of Health of Ukraine. No. 670 – Unified clinical protocol for 1st line, 2nd line (specialized), and 3rd line (high-specialized) medical aid in Atopic dermatitis. 2016 July 6. Available from: http://mtd.dec.gov.ua/images/dodatki/2016_670_AtopDerm/2016_670_YKPMD_AD.pdf.

 Google Scholar