(Last Updated On: July 16, 2021)

Ma. Teresita Gabriel, MD, FPDS; Hester Gail Lim, MD, FPDS; Zharlah Gulmatico-Flores, MD,FPDS; Gisella U. Adasa, MD, FPDS; Ma. Angela M. Lavadia, MD, FPDS; Lillian L. Villafuerte, MD, FPDS; Blossom Tian Chan, MD, FPDS; Ma. Angela T. Cumagun, MD, FPDS; Carmela Augusta F. Dayrit-Castro, MD, FPDS; Maria Victoria C. Dizon, MD, FPDS; Angela Katrina Esguerra, MD, FPDS; Niña Gabaton, MD, FPDS; Cindy Jao Tan, MD, FPDS; Marie Eleanore O. Nicolas, MD, FPDS; Julie W. Pabico, MD, FPDS; Maria Lourdes H. Palmero, MD, FPDS; Noemie S. Ramos, MD, FPDS; Cecilia R. Rosete, MD, FPDS; Donna Marie L. Sarrosa, MD, FPDS; Jennifer Aileen Ang-Tangtatco, MD, FPDS; Wilsie Salas Walinsundin, MD, FPDS; Ma. Purita Paz-Lao, MD, FPDS

ABSTRACT

Introduction: Atopic dermatitis (AD) is a complex disease with an interplay of genetic and environmental factors. In the United States, AD affects 10.7% of children andyc 7.2% of adults. Similarly in the Philippines, the prevalence of AD is 12.7% in the under 18 population, and 2% in the over 18 population. While AD affects all ages, the burden of the disease is greater in the pediatric population. The pathogenesis of AD is multifactorial. Variations in genes responsible for epidermal barrier function, keratinocyte terminal differentiation, and the innate and adaptive immune responses have been linked
to AD. A null mutation involving the filaggrin gene is the strongest known risk factor for AD. This mutation results in a loss of filaggrin (FLG) protein by at least 50%. Filaggrin breakdown products form part of the natural moisturizing factor (NMF) of the skin, which is essential in skin hydration. A decrease in NMF and an increase in transepidermal water loss (TEWL) are observed in AD patients with FLG mutation. The defective barrier in AD patients decreases skin defenses against irritation and allergen penetration. Exposure to certain environmental chemicals like formaldehyde may worsen this barrier. This may lead to increased skin permeability to aeroallergens that leads to dermatitis in sensitized patients. Barrier defects may also play a role in epicutaneous sensitization and the subsequent development of other atopic conditions, such as bronchial asthma and allergic rhinitis. The Philippine Dermatological Society (PDS) consensus on AD aims to provide a comprehensive guideline and evidence-based recommendations in the management of this condition, with consideration of cultural factors that are often encountered in the Philippine setting. These guidelines are intended to provide practitioners with an overview of the holistic approach in the management of AD, ameliorating the negative effects of
the disease and improving overall quality of life..

Methodology: A group of 21 board-certified dermatologists from the Philippine Dermatological Society (PDS) convened to discuss aspects in the clinical management of AD. Database and literature search included the full-text articles of observational studies, randomized controlled clinical trials, and
observational studies using the Cochrane library, PubMed, Hardin (for Philippine based studies) as well as data from the PDS health information system. The terms used in combinations from the literature included “atopic dermatitis”, “atopic eczema”, “emollients”, “topical corticosteroids”, “topical
calcineurin inhibitors”, “anti-histamines” and “phototherapy”. A total of fifty (50) full text articles were reviewed and found applicable for the scope of the study. Articles were assessed using the modified Jadad scale, with score interpretations as follows: (5- excellent, 3- good, 1– poor). Consensus guidelines

for AD from within and outside of the region were also reviewed, from the 2013 Asia-Pacific guidelines,
2014 Taiwanese Dermatological Association consensus, 2016 guidelines in the management of AD in Singapore, 2014 American Academy of Dermatology guidelines, and the 2020 Japanese guidelines for AD. From the literature review, proposed consensus statements were developed, and a Delphi survey was conducted over two separate virtual meetings. Individual dermatologists provided Likert Scoring (1-
strongly disagree to 5- strongly agree) based on consensus statements. A consensus was deemed reached at mean scores of > 4.00, a near consensus at > 3.5, and no consensus at <3.5.

Summary: AD is a chronic relapsing condition with a significant burden of disease, most commonly affecting the pediatric population. The PDS AD Consensus Guidelines summarizes the standards of therapy and the therapeutic ladder in the management of AD based on published clinical trials and
literature review. While these modalities remain the cornerstone of therapy, an individualized approach is the key to the holistic management of an AD patient. Knowledge and awareness of frequently associated conditions, whether in the realm of food allergies, contact allergies, or secondary infections, is paramount. In addition to the standard therapeutic armamentarium, the physician must also consider cultural practices and be knowledgeable of alternative therapeutic options. Referral to a specialist is recommended for recalcitrant cases of AD, or when initiation of systemic immunosuppressive agents, phototherapy, or biologic agents is contemplated.

 

Citation:
Gabriel, MT, Lim, HG, Flores, ZG, et al. Guidelines for the management of Atopic Dermatitis: A literature review and consensus statement of the Philippine Dermatological Society. J Phil Dermatol Soc 2019, 29(2), 35-58

1.Shaw TE, Currie GP, Koudelka CW, Simpson EL. Eczema Prevalence in the
United States: Data from the 2003 National Survey of Children’s Health.
Journal of Investigative Dermatology. 2011 Jan;131(1):67-73.
2. Silverberg JI, Garg NK, Paller AS, Fishbein AB, Zee PC. Sleep Disturbances
in Adults with Eczema Are Associated with Impaired Overall Health: A US Population-Based Study. Journal of Investigative Dermatology. 2015 Jan;135(1):56-66.
3. PDS HIS Report: Atopic Dermatitis Incidence and Prevalence 2017. Philippine Dermatological Society; .
4. Paternoster L, Standl M, Waage J, Baurecht H, Hotze M, Strachan DP, et al. Multi-ethnic genome-wide association study of 21,000 cases and 95,000 controls identifies new risk loci for atopic dermatitis. Nature genetics. 2015 Dec;47(12):1449-56.
5. Compton JG, Munro CS, Palmer CNA, Lee SP, Goudie DR, Sandilands A, et al. Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis. Nature Genetics. 2006 Apr;38(4):441-6.
6. Riethmuller C, PhD, McAleer MA, MRCP, Koppes SA, MD, Abdayem R, MSc, Franz J, Haftek, Marek, MD, PhD, et al. Filaggrin breakdown products determine corneocyte conformation in patients with atopic dermatitis. Journal of Allergy and Clinical Immunology, The. 2015;136(6):1573,1580.e2.
7. Eberlein-König B, Przybilla B, Kühnl P, Pechak J, Gebefügi I, Kleinschmidt J, et al. Influence of airborne nitrogen dioxide or formaldehyde on parameters of skin function and cellular activation in patients with atopic eczema and control subjects. The Journal of Allergy and Clinical Immunology. 1998;101(1):141-3.
8. Werfel T, MD, Allam J, MD, Biedermann T, MD, Eyerich, Kilian, MD, PhD, Gilles S, PhD, Guttman-Yassky, Emma, MD, PhD, et al. Cellular and molecular immunologic mechanisms in patients with atopic dermatitis. Journal of Allergy and Clinical Immunology, The. 2016;138(2):336-49.
9. Han H, Roan F, Ziegler SF. The atopic march: current insights into skin barrier dysfunction and epithelial cell-derived cytokines. Immunological Reviews. 2017 Jul;278(1):116-30.
10. Leung DYM. Clinical implications of new mechanistic insights into atopic dermatitis. Current opinion in pediatrics. 2016 Aug;28(4):456-62.
11. Czarnowicki T, MD, Krueger, James G., MD, PhD, Guttman-Yassky, Emma, MD, PhD. Skin Barrier and Immune Dysregulation in Atopic Dermatitis: An Evolving Story with Important Clinical Implications. Journal of Allergy and Clinical Immunology: In Practice. 2014;2(4):371-9.
12. Rawlings AV, Canestrari DA, Dobkowski B. Moisturizer technology versus clinical performance. Dermatologic Therapy. 2004 Feb;17(s1):49-56.
13. Breternitz M, Kowatzki D, Langenauer M, Elsner P, Fluhr JW. Placebo-Controlled, Double-Blind, Randomized, Prospective Study of a Glycerol- Based Emollient on Eczematous Skin in Atopic Dermatitis: Biophysical and Clinical Evaluation. Skin Pharmacology and Physiology. 2008 Jan;21(1):39-45.
14. Peris K, Valeri P, Altobelli E, Fargnoli MC, Carrozzo AM, Chimenti S. Efficacy Evaluation of an Oil-in-Water Emulsion (Dermoflan) in Atopic Dermatitis. Acta Dermato-Venereologica. 2002 Nov 1,;82(6):465-6.
15. Korting H, Schöllmann C, Cholcha W, Wolff L. Efficacy and tolerability of pale sulfonated shale oil cream 4% in the treatment of mild to moderate atopic eczema in children: a multicentre, randomized vehicle- controlled trial. Journal of the European Academy of Dermatology and Venereology. 2010 Oct;24(10):1176-82.
16.Grimalt R, Mengeaud V, Cambazard F. The Steroid-Sparing Effect of an Emollient Therapy in Infants with Atopic Dermatitis: A Randomized Controlled Study. Dermatology. 2006 Dec;214(1):61-7.
17. Tan WP, Suresh S, Tey HL, Chiam LY, Goon AT. A randomized double- blind controlled trial to compare a triclosan-containing emollient with vehicle for the treatment of atopic dermatitis. Clinical & Experimental Dermatology. 2010 Jun;35(4):e109-12.
18. Msika P, De Belilovsky C, Piccardi N, Chebassier N, Baudouin C, Chadoutaud B. New Emollient with Topical Corticosteroid-Sparing Effect in Treatment of Childhood Atopic Dermatitis: SCORAD and Quality of Life Improvement. Pediatric Dermatology. 2008 Nov;25(6):606-12.
19. Boralevi F, Saint Aroman M, Delarue A, Raudsepp H, Kaszuba A, Bylaite M, et al. Long-term emollient therapy improves xerosis in children with atopic dermatitis. Journal of the European Academy of Dermatology and Venereology. 2014 Nov;28(11):1456-62.
20. Angelova-Fischer I, Neufang G, Jung K, Fischer TW, Zillikens D. A randomized, investigator-blinded efficacy assessment study of stand- alone emollient use in mild to moderately severe atopic dermatitis flares. Journal of the European Academy of Dermatology and Venereology.
2014 May;28(s3):9-15.
21. Szczepanowska J, Reich A, Szepietowski JC. Emollients improve treatment results with topical corticosteroids in childhood atopic dermatitis: a randomized comparative study. Pediatric Allergy and Immunology. 2008 Nov;19(7):614-8.
22. Eberlein B, Eicke C, Reinhardt H, Ring J. Adjuvant treatment of atopic eczema: assessment of an emollient containing N-palmitoylethanolamine (ATOPA study). Journal of the European Academy of Dermatology and Venereology. 2008 Jan;22(1):73-82.
23. Boulos S, MD, Yan AC, MD. Current concepts in the prevention of atopic dermatitis. Clinics in Dermatology. 2017;36(5):668-71.
24. Thyssen JP, Linneberg A, Engkilde K, Menné T, Johansen JD. Contact sensitization to common haptens is associated with atopic dermatitis: new insight. British Journal of Dermatology. 2012 Jun;166(6):1255-61.
25. Cerio R, Dohil M, Jeanine D, Magina S, Mahé E, Stratigos AJ. Mechanism of action and clinical benefits of colloidal oatmeal for dermatologic practice. Journal of drugs in dermatology. 2010 Sep;9(9):1116.
26. Peterson JD, Chan LS. A comprehensive management guide for atopic dermatitis. Dermatology nursing. 2006 Dec;18(6):531.
27. Vieira BL, Lim NR, Lohman ME, Lio PA. Complementary and Alternative Medicine for Atopic Dermatitis: An Evidence-Based Review. Am J Clin Dermatol. 2016;17(6):557-81.
28. Evangelista MTP, Abad-Casintahan F, Lopez-Villafuerte L. The effect of topical virgin coconut oil on SCORAD index, transepidermal water loss, and skin capacitance in mild to moderate pediatric atopic dermatitis: a randomized, double-blind, clinical trial. International journal of dermatology. 2014;53(1):100-8.
29. Dizon M, Sarrosa D, Nicolas ME, Tan C, Palmero M, Esguerra A. Pediatric Dermatology Subspecialty Core Group ‘A Guide To Understanding Moisturizers in Atopic Dermatitis 2nd Edition’. Philippine Dermatological Society; 2017.
30. Fowler JF, Nebus J, Wallo W, Eichenfield LF. Colloidal oatmeal formulations as adjunct treatments in atopic dermatitis. Journal of drugs in dermatology. 2012 Jul;11(7):804.
31.Eichenfield LF, Tom WL, Berger TG, Krol A, Paller AS, Schwarzenberger K, et al. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. Journal of the American Academy of Dermatology. 2014 Jul;71(1):116-32.
32. Rubel D, Thirumoorthy T, Soebaryo RW, Weng SCK, Gabriel TM, Villafuerte LL, et al. Consensus guidelines for the management of atopic dermatitis: An Asia–Pacific perspective. The Journal of Dermatology. 2013 Mar;40(3):160-71.
33. Katoh N, Ohya Y, Ikeda M, Ebihara T, Katayama I, Saeki H, et al. Japanese guidelines for atopic dermatitis 2020. Allergology international. 2020 Jul;69(3):356-69.
34. Blume-Peytavi U, Lavender T, Jenerowicz D, Ryumina I, Stalder J, Torrelo A, et al. Recommendations from a European Roundtable Meeting on Best Practice Healthy Infant Skin Care. Pediatric Dermatology. 2016 May;33(3):311-21.
35. Wollenberg A, Barbarot S, Bieber T, Christen-Zaech S, Deleuran M, Fink- Wagner A, et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I. Journal of the European Academy of Dermatology and Venereology. 2018;32(5):657-82.
36. Boguniewicz M, Fonacier L, Guttman-Yassky E, Ong PY, Silverberg J, Farrar JR. Atopic dermatitis yardstick: Practical recommendations for an evolving therapeutic landscape. Annals of allergy, asthma, & immunology. 2018;120(1):10,22.e2.
37. Chow S, Seow CS, Dizon MV, Godse K, Foong H, Chan V, et al. A clinician’s reference guide for the management of atopic dermatitis in Asians. Asia Pacific allergy. 2018;8(4):e41.
38. Schachner L, Hansen R, Krafchik B, Lucky AW, Paller AS, Rogers M, et al. Pediatric dermatology. 4th ed. London: Elsevier; 2010.
39. LePoidevin LM, Lee DE, Shi VY. A comparison of international management guidelines for atopic dermatitis. Pediatric dermatology. 2019;36(1):36-65.
40. Fukuie T, Hirakawa S, Narita M, Nomura I, Matsumoto K, Tokura Y, et al. Potential preventive effects of proactive therapy on sensitization in moderate to severe childhood atopic dermatitis: A randomized, investigator-blinded, controlled study. The Journal of Dermatology. 2016 Nov;43(11):1283-92.
41. Kohn LL, Kang Y, Antaya RJ. A randomized, controlled trial comparing topical steroid application to wet versus dry skin in children with atopic dermatitis (AD). Journal of the American Academy of Dermatology. 2016;75(2):306-11.
42. Frankel H, Qureshi A. Comparative Effectiveness of Topical Calcineurin Inhibitors in Adult Patients with Atopic Dermatitis. Am J Clin Dermatol. 2012 Apr;13(2):113-23.
43. Breuer K, Werfel T, Kapp A. Safety and Efficacy of Topical Calcineurin Inhibitors in the Treatment of Childhood Atopic Dermatitis. Am J Clin Dermatol. 2005;6(2):65-77.
44. Stuetz A, Baumann K, Grassberger M, Wolff K, Meingassner JG. Discovery of Topical Calcineurin Inhibitors and Pharmacological Profile of Pimecrolimus. International Archives of Allergy and Immunology. 2006 Oct;141(3):199-212.
45. Paller AS, Lebwohl M, Fleischer AB, Antaya R, Langley RG, Kirsner RS, et al. Tacrolimus ointment is more effective than pimecrolimus cream with a similar safety profile in the treatment of atopic dermatitis: Results from 3 randomized, comparative studies. Journal of the American Academy of Dermatology. 2005;52(5):810-22.
46. Fleischer AB, Abramovits W, Breneman D, Jaracz E. Tacrolimus ointment is more effective than pimecrolimus cream in adult patients with moderate to very severe atopic dermatitis. Journal of Dermatological Treatment. 2007;18(3):151-7.
47. Abramovits W, Fleischer J, Alan B, Jaracz E, Breneman D. Adult patients with moderate atopic dermatitis: tacrolimus ointment versus pimecrolimus cream. Journal of drugs in dermatology : JDD. 2008 Dec;7(12):1153.
48. Reitamo S, Ortonne JP, Sand C, Cambazard F, Bieber T, Folster-Holst R, et al. A multicentre, randomized, double-blind, controlled study of long-term treatment with 0.1% tacrolimus ointment in adults with moderate to severe atopic dermatitis. British Journal of Dermatology. 2005 Jun;152(6):1282-9.
49. FK506 ointment study group. Phase III comparative study of FK506 ointment versus betamethasone valerate ointment in atopic dermatitis (trunk/extremities) [in Japanese]. Nishinihon J Derm. 1997;59:870-9.
50. Luger T, Boguniewicz M, Carr W, Cork M, Deleuran M, Eichenfield L, et al. Pimecrolimus in atopic dermatitis: Consensus on safety and the need to allow use in infants. Pediatric Allergy and Immunology. 2015 Jun;26(4):306-15.
51. Siegfried E, Jaworski J, Hebert A. Topical Calcineurin Inhibitors and Lymphoma Risk: Evidence Update with Implications for Daily Practice. Am J Clin Dermatol. 2013 Jun;14(3):163-78.
52. Paller AS, Fölster-Holst R, Chen SC, Diepgen TL, Elmets C, Margolis DJ, et al. No evidence of increased cancer incidence in children using topical tacrolimus for atopic dermatitis. Journal of the American Academy of Dermatology. 2020 Aug;83(2):375-81.
53. Wollenberg A, Oranje A, Deleuran M, Simon D, Szalai Z, Kunz B, et al. ETFAD/EADV Eczema task force 2015 position paper on diagnosis and treatment of atopic dermatitis in adult and paediatric patients. JEADV : journal of the European Academy of Dermatology and Venereology. 2016;30(5):729-47.
54. George SA, Bilsland DJ, Johnson BE, Ferguson J. Narrow-band (TL-01) UVB air-conditioned phototherapy for chronic severe adult atopic dermatitis. British Journal of Dermatology. 1993 Jan;128(1):49-56.
55. Tan E, Lim D, Rademaker M. Narrowband UVB phototherapy in children: A New Zealand experience. Australasian Journal of Dermatology. 2010 Nov;51(4):268-73.
56. Patrizi A, Raone B, Ravaioli GM. Management of atopic dermatitis: safety and efficacy of phototherapy. Clinical, cosmetic and investigational dermatology. 2015;8:511-20.
57. Sidbury R, Davis DM, Cohen DE, Cordoro KM, Berger TG, Bergman JN, et al. Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents. Journal of the American Academy of Dermatology. 2014 Aug;71(2):327- 49.
58. Simpson EL, Bruin-Weller M, Flohr C, Ardern-Jones MR, Barbarot S, Deleuran M, et al. When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council. Journal of the American Academy of Dermatology. 2017 Oct;77(4):623-33.
59. Chan TC, Wu N, Wong L, Cho Y, Yang C, Yu Y, et al. Taiwanese Dermatological Association consensus for the management of atopicdermatitis: A 2020 update. Journal of the Formosan Medical Association. 2020 Jun.
60.LePoidevin LM, Lee DE, Shi VY. A comparison of international management guidelines for atopic dermatitis: Section 3. 10 Systemic immunomodulators. Pediatric Dermatology. 2019 Jan;36(1):50-5.
61. Roekevisch E, Spuls PI, Kuester D, Limpens J, Schmitt J. Efficacy and safety of systemic treatments for moderate-to-severe atopic dermatitis: A systematic review. Journal of allergy and clinical immunology. 2014;133(2):429-38.
62. Akhavan A, Rudikoff D. The treatment of atopic dermatitis with systemic immunosuppressive agents. Clinics in Dermatology. 2003;21(3):225-40.
63. Harper JI, Ahmed I, Barclay G, Lacour M, Hoeger P, Cork MJ, et al. Cyclosporin for severe childhood atopic dermatitis: short course versus continuous therapy. British Journal of Dermatology. 2000 Jan;142(1):52- 8.
64. Tay YK, Chan YC, Chandran NS, Ho MS, Koh MJ, Lim YL, et al. Guidelines for the Management of Atopic Dermatitis in Singapore. Annals of the Academy of Medicine, Singapore. 2016 Oct;45(10):439-50.
65. Nowicki R, Trzeciak M, Wilkowska A, Sokołowska-Wojdyło M, Ługowska- Umer H, Barańska-Rybak W, et al. Atopic dermatitis: current treatment guidelines. Statement of the experts of the Dermatological Section, Polish Society of Allergology, and the Allergology Section, Polish Society
of Dermatology. Postepy dermatologii i alergologii. 2015 Aug;32(4):239- 49.
66. Werfel T, Heratizadeh A, Aberer W, Ahrens F, Augustin M, Biedermann T, et al. S2k guideline on diagnosis and treatment of atopic dermatitis – short version. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2009;7(3):265-71.
67. Wollenberg A, Barbarot S, Bieber T, Christen-Zaech S, Deleuran M, Fink-Wagner A, et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part II. Journal of the European Academy of Dermatology and Venereology. 2018 Jun;32(6):850-78.
68. Jung Eun Kim, Hyun Jeong Kim, Bark-lynn Lew, Kyung Ho Lee, Seung Phil Hong, Yong Hyun Jang, et al. CONSENSUS GUIDELINE : Consensus Guidelines for the Treatment of Atopic Dermatitis in Korea (Part II): Systemic Treatment. Annals of Dermatology. 2015;27(5):578.
69. Galli E, Neri I, Ricci G, Baldo E, Barone M, Belloni Fortina A, et al. Consensus Conference on Clinical Management of pediatric Atopic Dermatitis. Italian journal of pediatrics. 2016 Mar 2,;42(1):26.
70. Chu C, Lee C, Shih I, Chen H, Huang P, Yang C, et al. Taiwanese Dermatological Association consensus for the management of atopic dermatitis. Dermatologica Sinica. 2015;33(4):220-30.
71. Popadić S, Gajić-Veljić M, Prćić S, Mijušković Ž, Jovanović D, Kandolf- Sekulović L, et al. National Guidelines for the Treatment of Atopic Dermatitis. Serbian Journal of Dermatology and Venereology. 2016 Sep 1,;8(3):129-53.
72. Paller AS, Kong HH, Seed P, Naik S, Scharschmidt TC, Gallo RL, et al. The microbiome in patients with atopic dermatitis. The Journal of Allergy and Clinical Immunology. 2019 Jan;143(1):26-35.
73. Nowicka D, Grywalska E. The Role of Immune Defects and Colonization of Staphylococcus aureus in the Pathogenesis of Atopic Dermatitis. Analytical cellular pathology (Amsterdam). 2018;2018:1956403-7.
74. Albanesi C, Fairchild HR, Madonna S, Scarponi C, De Pita O, Leung DYM, et al. IL-4 and IL-13 Negatively Regulate TNF-{alpha}- and IFN-{gamma}- Induced beta-Defensin Expression through STAT-6, Suppressor of Cytokine Signaling (SOCS)-1, and SOCS-3. The Journal of Immunology. 2007 Jul 15,;179(2):984.
75. Niebuhr M. Infections and Bacterial Colonization Including Treatment. In: Atopic Dermatitis in Childhood and Adolescence. Basel, Switzerland: S. Karger AG; 2011. p. 90-100.
76. Bunikowski R, Mielke MEA, Skarabis H, Worm M, Anagnostopoulos I, Kolde G, et al. Evidence for a disease-promoting effect of Staphylococcus aureus–derived exotoxins in atopic dermatitis. The Journal of Allergy and Clinical Immunology. 2000 Apr;105(4):814-9.
77. Salgado-Pabón W, Case-Cook LC, Schlievert PM. Molecular analysis of staphylococcal superantigens. Methods in molecular biology (Clifton, N.J.). 2014;1085:169.
78. Williams REA. The Antibacterial-Corticosteroid Combination: What is its Role in Atopic Dermatitis? Am J Clin Dermatol. 2000 Jul 1,;1(4):211-5.
79. National Institute for Health and Clinical Excellence. Atopic eczema in children: Management of atopic eczema in children from birth up to the age of 12 years. . 2007 December.
80. Bath-Hextall FJ, Birnie AJ, Ravenscroft JC, Williams HC. Interventions to reduce Staphylococcus aureus in the management of atopic eczema: an updated Cochrane review. British Journal of Dermatology. 2010 Jul;163(1):12-26.
81. Hetem DJ, Bonten MJM. Clinical relevance of mupirocin resistance in Staphylococcus aureus. Journal of Hospital Infection. 2013;85(4):249- 56.
82. Nguyen H, Nguyen H, Yiannias J, Yiannias J. Contact Dermatitis to Medications and Skin Products. Clinic Rev Allerg Immunol. 2019 Feb 15,;56(1):41-59.
83. Frisch S, Siegfried EC. The Clinical Spectrum and Therapeutic Challenge of Eczema Herpeticum. Pediatric Dermatology. 2011 Jan;28(1):46-52.
84. Waersted A, Hjorth N. Pityrosporum orbiculare–a pathogenic factor in atopic dermatitis of the face, scalp and neck? Acta dermato- venereologica. Supplementum. 1985;114:146.
85. Nahmias AJ, Froeschle JE, Feorino PM, McCord G. Generalized Eruption in a Child With Eczema Due to Coxsackievirus A16. Archives of Dermatology. 1968 Feb 1,;97(2):147-8.
86. Mathes EF, Oza V, Frieden IJ, Cordoro KM, Yagi S, Howard R, et al. “Eczema Coxsackium” and Unusual Cutaneous Findings in an Enterovirus Outbreak. Pediatrics. 2013 Jul 1,;132(1):e149.
87. Siegfried EC, Hebert AA. Diagnosis of Atopic Dermatitis: Mimics, Overlaps, and Complications. Journal of clinical medicine. 2015 May 6,;4(5):884-917.
88. Johnson VK, DO, Hayman JL, MD, McCarthy CA, MD, Cardona ID, MD. Successful treatment of eczema coxsackium with wet wrap therapy and low-dose topical corticosteroid. Journal of Allergy and Clinical Immunology: In Practice. 2014;2(6):803-4.
89. Chu C, Lee C, Shih I, Chen H, Huang P, Yang C, et al. Taiwanese Dermatological Association consensus for the management of atopic dermatitis. Dermatologica Sinica. 2015;33(4):220-30.
90. Barnes TM, Greive KA. Use of bleach baths for the treatment of infected atopic eczema. Australasian Journal of Dermatology. 2013 Nov;54(4):251-8.
91. Eichenfield LF, MD, Ahluwalia J, MD, Waldman A, MD, Borok J, BS, Udkoff J, MA, Boguniewicz M, MD. 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. Journal of Allergy and Clinical Immunology, The. 2017;139(4):S49-57.
92. Diepgen TL. Long-term treatment with cetirizine of infants with atopic dermatitis: A multi-country, double-blind, randomized, placebo- controlled trial (the ETACTM trial) over 18 months. Pediatric Allergy and Immunology. 2002 Aug;13(4):278-86.
93. Sher LG, Chang J, Patel IB, Balkrishnan R, Fleischer J, Alan B. Relieving the Pruritus of Atopic Dermatitis: A Meta-analysis. Acta dermato- venereologica. 2012 Sep;92(5):455-61.
94. Klein PA, Clark RAF. An Evidence-Based Review of the Efficacy of Antihistamines in Relieving Pruritus in Atopic Dermatitis. Archives of Dermatology. 1999 Dec 1,;135(12):1522-5.
95. Hannuksela M, Kalimo K, Lammintausta K, Mattila T, Turjanmaa K, Varjonen E, et al. Dose ranging study: cetirizine in the treatment of atopic dermatitis in adults. Annals of allergy. 1993 Feb;70(2):127.
96. van Zuuren EJ, Apfelbacher CJ, Fedorowicz Z, Jupiter A, Matterne U, Weisshaar E. No high level evidence to support the use of oral H1 antihistamines as monotherapy for eczema: a summary of a Cochrane systematic review. Systematic reviews. 2014;3(1):25.
97. Doherty V, Sylvester DG, Kennedy CT, Harvey SG, Calthrop JG, Gibson JR. Treatment of itching in atopic eczema with antihistamines with a low sedative profile. British Medical Journal. 1989 Jan;298(6666):96.
98. van Zuuren EJ, Apfelbacher CJ, Fedorowicz Z, Jupiter A, Matterne U, Weisshaar E. No high level evidence to support the use of oral H1 antihistamines as monotherapy for eczema: a summary of a Cochrane systematic review. Systematic reviews. 2014 Mar 13,;3(1):25.
99. He A, Feldman SR, Fleischer AB. An assessment of the use of antihistamines in the management of atopic dermatitis. Journal of the American Academy of Dermatology. 2018;79(1):92-6.
100. Schad CA, Skoner DP. Antihistamines in the pediatric population: Achieving optimal outcomes when treating seasonal allergic rhinitis and chronic urticaria. Allergy and Asthma Proceedings. 2008 Jan;29(1):7-13.
101. A C A Devillers, A P Oranje. Efficacy and safety of ‘wet-wrap’ dressings as an intervention treatment in children with severe and/or refractory atopic dermatitis: a critical review of the literature. British Journal of Dermatology. 2006 Apr 1,;154(4):579.
102. Nicol, Noreen Heer, PhD, RN, FNP, Boguniewicz M, MD. Wet Wrap Therapy in Moderate to Severe Atopic Dermatitis. Immunology and Allergy Clinics of North America. 2016;37(1):123-39.
103.Cooper CA, DeKlotz CMC. Warming up to the idea of wet wraps. Pediatric Dermatology. 2017 Nov;34(6):737-8.
104. Rajagopalan M, De A, Godse K, Krupa Shankar DS, Zawar V, Sharma N, et al. Guidelines on Management of Atopic Dermatitis in India: An Evidence-Based Review and an Expert Consensus. Indian journal of dermatology. 2019 May;64(3):166-81.
105. Cadmus SD, Sebastian KR, Warren D, Hovinga CA, Croce EA, Reveles LA, et al. Efficacy and patient opinion of wet-wrap dressings using 0.1% triamcinolone acetonide ointment vs cream in the treatment of pediatric atopic dermatitis: A randomized split-body control study.
Pediatric Dermatology. 2019 Jul;36(4):437-41.
106. Xu W, Li Y, Chen Z, Liu T, Wang S, Li L. Wet-wrap therapy with halometasone cream for severe adult atopic dermatitis. Postgraduate Medicine. 2018 Jul 4,;130(5):470-6.
107. González-López G, Ceballos-Rodríguez RM, González-López JJ, Feito Rodríguez M, Herranz-Pinto P. Efficacy and safety of wet wrap therapy for patients with atopic dermatitis: a systematic review and meta- analysis. British Journal of Dermatology. 2017 Sep;177(3):688-95.
108. National Institute for Health and Care Excellence [NICE]. Atopic eczema in under 12s: diagnosis and management (CG57) . 2007 December 12. Available from: https://nice.org.uk/guideance/cg57
109. Watson W, Kapur S. Atopic dermatitis. Allergy, Asthma and Clinical Immunology. 2011;7(S4).
110. British Association of Dermatologists. Atopic Eczema [Patient information leaflet]. British Association of Dermatologists; 2016 April . Available from: https://bad.org.uk
111. MIMS Philippines Online. [Internet]. [cited February 4, 2020]. Available from: https://www.mims.com/philippines.
112. Milam EC, Jacob SE, Cohen DE. Contact Dermatitis in the Patient with Atopic Dermatitis. The Journal of Allergy and Clinical Immunology: In Practice. 2019 Jan;7(1):18-26.
113. Kohli, Nita, MD, MPH, Nedorost S, MD. Inflamed skin predisposes to sensitization to less potent allergens. Journal of the American Academy of Dermatology. 2016;75(2):312,317.e1.
114. Machler BC, Sung CT, Darwin E, Jacob SE. Dupilumab use in allergic contact dermatitis. Journal of the American Academy of Dermatology. 2019 Jan;80(1):280,281.e1.
115. Kabashima K. New concept of the pathogenesis of atopic dermatitis: Interplay among the barrier, allergy, and pruritus as a trinity. Journal of Dermatological Science. 2013;70(1):3-11.
116. Jacob SE, Yang A, Herro E, Zhang C. Contact allergens in a pediatric population: association with atopic dermatitis and comparison with other north american referral centers. The Journal of clinical and aesthetic dermatology. 2010 Oct;3(10):29.
117. Lever R FA. Allergic contact dermatitis in atopic dermatitis. Acta Derma Venereol Suppl. 1992;172:95-8.
118 Mailhol C, Lauwers-Cances V, Rance F, Paul C, Giordano-Labadie F. Prevalence and risk factors for allergic contact dermatitis to topical treatment in atopic dermatitis: a study in 641 children. Allergy. 2009 May;64(5):801-6.
119. Hamann CR, MD, Hamann D, MD, Egeberg, Alexander, MD, PhD, Johansen, Jeanne D., MD, PhD, Silverberg, Jonathan, MD, PhD, MPH, Thyssen, Jacob P., MD, PhD. Association between atopic dermatitis and contact sensitization: A systematic review and meta-analysis. Journal of
the American Academy of Dermatology. 2017;77(1):70-8.
120. Klas PA, Corey G, Storrs FJ, Chan SC, Hanfin JM. Allergic and irritant patch test reactions and atopic disease. Contact Dermatitis. 1996 Feb;34(2):121-4.
121. Clemmensen KKB, Thomsen SF, Jemec GBE, Agner T. Pattern of contact sensitization in patients with and without atopic dermatitis in a hospital-based clinical database. Contact Dermatitis. 2014 Aug;71(2):75-81.
122. Owen J, Vakharia P, Silverberg J. The Role and Diagnosis of Allergic Contact Dermatitis in Patients with Atopic Dermatitis. Am J Clin Dermatol. 2018 Jun;19(3):293-302.
123. Kim JE, Kim HJ, Lew B, Lee KH, Hong SP, Jang YH, et al. Consensus Guidelines for the Treatment of Atopic Dermatitis in Korea (Part I): General Management and Topical Treatment. Annals of Dermatology. 2015 Oct 1,;27(5):563-77.
124. Hamann CR, BA, Bernard S, BS, Hamann D, MD, Hansen R, MD, Thyssen, Jacob P., MD, PhD. Is there a risk using hypoallergenic cosmetic pediatric products in the United States? Journal of Allergy and Clinical Immunology, The. 2014;135(4):1070-1.
125. Lammintausta K, Kalimo K, Fagerlund VL. Patch test reactions in atopic patients. Contact Dermatitis. 1992 Apr;26(4):234-40.
126. Thyssen JP, Linneberg A, Menné T, Johansen JD. The epidemiology of contact allergy in the general population – prevalence and main findings. Contact Dermatitis. 2007 Nov;57(5):287-99.
127. Simonsen AB, Deleuran M, Johansen JD, Sommerlund M. Contact allergy and allergic contact dermatitis in children – a review of current data. Contact Dermatitis. 2011 Nov;65(5):254 65.
128. Simonsen AB, Johansen JD, Deleuran M, Mortz CG, Sommerlund M. Contact allergy in children with atopic dermatitis: a systematic review. British Journal of Dermatology. 2017 Aug;177(2):395-405.
129. Schena D, Papagrigoraki A, Tessari G, Peroni A, Sabbadini C, Girolomoni G. Allergic Contact Dermatitis in Children With and Without Atopic Dermatitis. Dermatitis : contact, atopic, occupational, drug. 2012 Nov;23(6):275-80.
130. Giordano-Labadie F, Rancé F, Pellegrin F, Bazex J, Dutau G, Schwarze HP. Frequency of contact allergy in children with atopic dermatitis: results of a prospective study of 137 cases. Contact Dermatitis. 1999 Apr;40(4):192-5.
131. Belloni Fortina A, Fontana E, Peserico A. Contact Sensitization in Children: A Retrospective Study of 2,614 Children from a Single Center. Pediatric Dermatology. 2016 Jul;33(4):399-404.
132. Isaksson M, Olhardt S, Rådehed J, Svensson Å. Children with Atopic Dermatitis Should Always be Patch-tested if They Have Hand or Foot Dermatitis. Acta dermato-venereologica. 2015 May;95(5):583-6.
133. Sidbury R, Tom WL, Bergman JN, Cooper KD, Silverman RA, Berger TG, et al. Guidelines of care for the management of atopic dermatitis: Section 4. Prevention of disease flares and use of adjunctive therapies and approaches. Journal of the American Academy of Dermatology. 2014 Dec;71(6):1218-33.
134.Chen J, Jacob S, Nedorost S, Hanifin J, Simpson E, Boguniewicz M, et al. A Pragmatic Approach to Patch Testing Atopic Dermatitis Patients: Clinical Recommendations Based on Expert Consensus Opinion. Dermatitis. 2016 Jul;27(4):186-92.
135. Eigenmann PA, Sicherer SH, Borkowski TA, Cohen BA, Sampson HA. Prevalence of IgE-Mediated Food Allergy Among Children With Atopic Dermatitis. Pediatrics. 1998 Mar 1,;101(3):e8.
136. Arndt J, Smith N, Tausk F. Stress and atopic dermatitis. Curr Allergy Asthma Rep. 2008 Jul;8(4):312-7.
137. Bath-Hextall F, Delamere FM, Williams HC. Dietary exclusions for improving established atopic eczema in adults and children: systematic review. Allergy. 2009 Feb;64(2):258-64.
138. Sicherer SH, Sampson HA. Food hypersensitivity and atopic dermatitis: Pathophysiology, epidemiology, diagnosis, and management. The Journal of Allergy and Clinical Immunology. 1999;104(3):S114-22.
139. Akdis M, Akdis CA, Bieber T, Bindslev-Jensen C, Boguniewicz M, Eigenmann P, et al. Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report. The Journal of Allergy and Clinical Immunology. 2006;118(1):152-69.
140. Barbarot S, Bernier C, Deleuran M, Raeve L, Eichenfield L, El Hachem M, et al. Therapeutic Patient Education in Children with Atopic Dermatitis: Position Paper on Objectives and Recommendations. Pediatric Dermatology. 2013 Mar;30(2):199-206.
141. Mancini AJ, Paller AS, Simpson EL, Ellis CN, Eichenfield LF. Improving the Patient-Clinician and Parent-Clinician Partnership in Atopic Dermatitis Management. Seminars in cutaneous medicine and surgery. 2012 Sep;31(3 Suppl):S23-8.
142. Boyce JA, MD, Assa’ad A, MD, Burks AW, MD, Jones SM, MD, Sampson HA, MD, Wood RA, MD, et al. Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report. Nutrition Research. 2011;31(1):61-75.
143. Boyce JA, Assa’ad A, Burks AW, Jones SM, Sampson HA, Wood RA, et al. Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-Sponsored Expert Panel. Journal of Allergy and Clinical Immunology, The. 2010;126(6):S1-S58.
144. Fiocchi A, Pawankar R, Cuello-Garcia C, Ahn K, Al-Hammadi S, Agarwal A, et al. World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics. The World Allergy Organization journal. 2015;8(1):4.
145. Sivamaruthi B, Kesika P, Chaiyasut C. Probiotic based therapy for atopic dermatitis: Outcomes of clinical studies. Asian Pacific Journal of Tropical Biomedicine. 2018;8(6):328-32.
146. Kim S, Ah Y, Yu YM, Choi KH, Shin W, Lee J. Effects of probiotics for the treatment of atopic dermatitis: a meta-analysis of randomized controlled trials. Annals of Allergy, Asthma & Immunology. 2014;113(2):217-26.
147. Howell MD, Gallo RL, Boguniewicz M, Jones JF, Wong C, Streib JE, et al. Cytokine Milieu of Atopic Dermatitis Skin Subverts the Innate Immune Response to Vaccinia Virus. Immunity. 2006;24(3):341-8.
148. Ong PY, Ohtake T, Brandt C, Strickland I, Boguniewicz M, Ganz T, et al. Endogenous Antimicrobial Peptides and Skin Infections in Atopic Dermatitis. The New England Journal of Medicine. 2002 Oct 10,;347(15):1151-60.
149. Howell MD, Wollenberg A, Gallo RL, Flaig M, Streib JE, Wong C, et al. Cathelicidin deficiency predisposes to eczema herpeticum. The Journal of Allergy and Clinical Immunology. 2006;117(4):836-41.
150. Mallbris L, Carlén L, Wei T, Heilborn J, Nilsson MF, Granath F, et al. Injury downregulates the expression of the human cathelicidin protein hCAP18/LL-37 in atopic dermatitis. Experimental Dermatology. 2010 May;19(5):442-9.
151. Hata TR, MD, Kotol P, BS, Jackson M, MD, Nguyen M, BS, Paik A, MD, Udall D, MD, et al. Administration of oral vitamin D induces cathelicidin production in atopic individuals. Journal of Allergy and Clinical Immunology, The. 2008;122(4):829-31.
152. Boozalis E, Grossberg AL, Püttgen KB, Cohen BA, Kwatra SG. Itching at night: A review on reducing nocturnal pruritus in children. Pediatric Dermatology. 2018 Sep;35(5):560-5.
153. Deng S, May B, Zhang A, Lu C, Xue C. Topical herbal medicine combined with pharmacotherapy for psoriasis: a systematic review and meta- analysis. Arch Dermatol Res. 2013 Apr;305(3):179-89.
154. Reuter J, Merfort I, Schempp C. Botanicals in Dermatology. Am J Clin Dermatol. 2010 Aug;11(4):247-67.
155. Vieira B, Lim N, Lohman M, Lio P. Complementary and Alternative Medicine for Atopic Dermatitis: An Evidence-Based Review. Am J Clin Dermatol. 2016 Dec;17(6):557-81.
156. Traditional Chinese Medicine: What You Need To Know [Internet].; 2013 [updated October; ]. Available from: https://www.nccih.nih.gov/health/traditional-chinese-medicine-what-you-need-to-know.
157. Lee KC, Keyes A, Hensley JR, Gordon JR, Kwasny MJ, West DP, et al. Effectiveness of acupressure on pruritus and lichenification associated with atopic dermatitis: a pilot trial. Acupuncture in Medicine. 2012 Mar;30(1):8-11.
158. Kim K, Kang SH, Kim YK, Yeom M, Lee H, Jang H, et al. Acupuncture Improves Symptoms in Patients with Mild to Moderate Atopic Dermatitis: A Randomized, Sham-Controlled Preliminary Trial. Journal of Acupuncture and Meridian Studies. 2018 Aug;11(4):241.
159. Abad P, Tan M, Baluyot M, Villa A, Talapian G, Reyes M, et al. Cultural beliefs on disease causation in the Philippines: challenge and implications in genetic counseling. J Community Genet. 2014 Oct;5(4):399-407.
160. Tan ML. Revisiting usog, pasma, kulam. 2008.
161. Cork MJ, Danby SG, Vasilopoulos Y, Hadgraft J, Lane ME, Moustafa M, et al. Epidermal Barrier Dysfunction in Atopic Dermatitis. Journal of Investigative Dermatology. 2009 Aug;129(8):1892-908.
162. Gardiner P, MD, Riley DS, MD. Herbs to Homeopathy—Medicinal Products for Children. Pediatric Clinics of North America. 2007;54(6):859-74.
163. Gardiner P. Complementary, Holistic, and Integrative Medicine: Chamomile. Pediatrics in Review. 2007 Apr 1,;28(4):e16-8.
164. Climate of the Philippines [Internet].; 2021 [cited January 16, 2021]. Available from: http://bagong.pagasa.dost.gov.ph/information/climate-
philippines
165. Sargen, M. R., Hoffstad, O., & Margolis, D. J. Warm, Humid, and High Sun Exposure Climates Are Associated with Poorly Controlled Eczema: PEER (Pediatric Eczema Elective Registry) Cohort, 2004–2012. Journal of Investigative Dermatology. 2014; 134(1), 51–57.
166. Engebretsen KA, Johansen JD, Kezic S et al. The effect of environmental humidity and temperature on skin barrier function and dermatitis. JEADV Vol 30(2), October 2015. 223-249.
167. Ricci G, Patrizi A, Bellini F, Medri M. Use of textiles in atopic dermatitis: care of atopic dermatitis. Curr Probl Dermatol. 2006;33:127-43.
168. Jarnagin K, Chanda S, Coronado D, Ciaravino V, Zane LT, Guttman-Yassky E, et al. Crisaborole Topical Ointment, 2%: A Nonsteroidal, Topical, Anti-Inflammatory Phosphodiesterase 4 Inhibitor in Clinical Development for the Treatment of Atopic Dermatitis. Journal of drugs in dermatology :JDD. 2016 Apr;15(4):390.
169. Paller AS, Tom WL, Lebwohl MG, Blumenthal RL, Boguniewicz M, Call RS, Eichenfield LF, Forsha DW, Rees WC, Simpson EL, Spellman MC, Stein Gold LF, Zaenglein AL, Hughes MH, Zane LT, Hebert AA. Efficacy and safety of crisaborole ointment, a novel, nonsteroidal phosphodiesterase
4 (PDE4) inhibitor for the topical treatment of atopic dermatitis (AD) in children and adults. J Am Acad Dermatol. 2016 Sep;75(3):494-503. e6. doi: 10.1016/j.jaad.2016.05.046. Epub 2016 Jul 11. Erratum in: J Am Acad Dermatol. 2017 Apr;76(4):777.
170. FDA Approves Dupilumab for Atopic Dermatitis in Children [Internet].; 2020 [updated May 26; cited October 21 2020]. Available from: https://www.drugtopics.com/view/fda-approves-dupilumab-atopic-dermatitis-children.
171. Drug Trials Snapshots: DUPIXENT [Internet].; 2020 [updated July 7; cited October 21 2020]. Available from: https://www.fda.gov/drugs/drug-approvals-and-databases/drug-trials-snapshots dupixent#:~:text=The%20FDA%20approved%20DUPIXENT%20 based,moderate%20to%20severe%20atopic%20dermatitis.
172. Simpson EL, Bieber T, Guttman-Yassky E, Beck LA, Blauvelt A, Cork MJ, et al. Two Phase 3 Trials of Dupilumab versus Placebo in Atopic Dermatitis. The New England Journal of Medicine. 2016 Dec 15,;375(24):2335-48.

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