Atopic Dermatitis Guidelines

Updated: Aug 02, 2019
  • Author: Brian S Kim, MD, MTR, FAAD; Chief Editor: William D James, MD  more...
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Guidelines

Guidelines Summary

Guidelines on diagnosis and assessment, topical therapy, phototherapy and systemic agents, and disease flares and adjunctive therapy are available from the American Academy of Dermatology at Atopic dermatitis clinical guideline. [66]

Guidelines on the safe and effective prescribing of oral cyclosporine in dermatology by the British Association of Dermatologists  [67]

Cyclosporine is licensed for use in the following indications:

  • Atopic dermatitis (in persons aged 16 years or older)
  • Psoriasis (in persons aged 16 years or older)

Good evidence supports the use of cyclosporine outside its product license for the following indications:

  • Atopic dermatitis (in persons younger than 16 years)
  • Behçet disease
  • Chronic spontaneous (idiopathic) urticaria
  • Graft versus host disease
  • Palmoplantar pustulosis
  • Pyoderma gangrenosum

Cyclosporine should be used only as a last resort in the following indications, and current evidence shows it is unlikely to be beneficial:

  • Alopecia areata
  • Discoid lupus erythematosus
  • Pemphigus foliaceous
  • Pemphigus vulgaris

Continuous treatment may be considered for select patients with chronic skin disease in the appropriate situation; however, in an effort to reduce nephrotoxicity, use single or intermittent short courses of up to 16 weeks if possible. Cyclosporine dose titration during therapy also should be used to reduce nephrotoxicity.

If hypertension occurs, the cyclosporine dose should be reduced and/or the hypertension should be treated. If appropriate blood pressure cannot be maintained, discontinue cyclosporine.

If infection is suspected, consider obtaining consult on the safety of inducing immunosuppression; ensure all necessary treatment is being administered before beginning cyclosporine.

Patients should be advised to seek advice early if febrile illness occurs or their skin condition rapidly worsens.

Owing to a long‐term risk of developing nonmelanoma skin cancer, cyclosporine should not be administered concurrently with phototherapy.

Serum lipid levels should be measured for a baseline and should be monitored throughout treatment; this is especially important in patients considered high risk (eg, diabetics, those with preexisting hyperlipidemia).