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  should be considered at  the  discrepancy of  the  symptoms or torpid  eczema.  The  list  of  diseases  is genetic  syndromes with  the impaired epidermal barrier, metabolic diseases,  skin infections, psoriasis and others. Skin infections in the diagnostic search should be considered the first  time.

The basis of therapy allergic eczema is the elimination of allergenic and non-allergenic triggers, topical steroids and inhibitors calcineurin 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 of external 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  the quality of life  of patients and  should  not be used for a long time. The main  formula for feeding children  with  allergies to cow'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.

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