Figure legends
Figure 1 – Medical algorithm for the therapeutic management of
Atopic Dermatitis (AD) in early childhood, based on severity. Adapted
from: Wollenberg A et al, J Eur Acad Dermatol Venereol,
20183
AFor criteria, see part I of this medical algorithm.
BDisease severity scales can be used but might not be
practical. Severity (global assessment) can alternatively be assessed by
body surface area involvement, lesional features and locations, and
disease impact on quality of life.
CPlease refer to part I of this medical algorithm.
1In cases of recurrent skin infections sodium
hypochlorite can be added to the bathwater (1mL of 5% household bleach
per 1L of water) – conflicting data.
2Not commonly used in early childhood (feasibility).
Preference for narrowband ultraviolet B (311 nm) or ultraviolet A1.
3Cyclosporine is licensed from age 16 and dupilumab
from age 12 in Europe. All other systemic options are off-label.
#Choice depending on local cofactors. For
moderate-severe AD it is recommended to start with a corticosteroid.
Choice of corticosteroid class (European classification shown) depending
on age and local cofactors.
%Off-label treatment option.
*Special attention if age <3 months or recurring infections:
in early-onset severe AD, certain primary immunodeficiency syndromes
such as Omenn syndrome, selective IgA-deficiency, Hyper-IgE-syndromes
and Wiskott Aldrich syndrome, genetic disorders with an impaired barrier
function, such as Comel-Netherton syndrome and peeling skin syndrome,
and some inherited metabolic diseases such as biotin deficiency or
phenylketonuria should be considered as differential diagnoses.