Indian Journal of Dermatology
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SPECIAL ARTICLE
Year : 2019  |  Volume : 64  |  Issue : 3  |  Page : 166-181

Guidelines on management of atopic dermatitis in India: An evidence-based review and an expert consensus


1 Department of Dermatology, Apollo Hospital, Chennai, Tamil Nadu, India
2 Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India
3 Department of Dermatology, D Y Patil Hospital, Navi Mumbai, Maharashtra, India
4 Department of Dermatology, Mallige Hospital, Bengaluru, Karnataka, India
5 Department of Dermatology, Skin Diseases Center, Nashik, Maharashtra, India
6 Department of Dermatology, The Medicity, Medanta Hospital, Gurugram, Haryana, India
7 Department of Dermatology, Cloud Nine Hospitals, Bengaluru, Karnataka, India
8 Department of Dermatology, Wizderm Specialty Skin and Hair Clinic, Kolkata, West Bengal, India
9 Department of Dermatology, Institute of Child Health, Kolkata, West Bengal, India

Correspondence Address:
Dr. Abhishek De
Flat Number 3 A, Arcadia 1, Dream Park, Sonarpur Station Road Kolkata - 700 103, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_683_18

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Background: Atopic dermatitis (AD) is a common and chronic, pruritic inflammatory skin condition that affects all age groups. There was a dearth of consensus document on AD for Indian practitioners. This article aims to provide an evidence-based consensus statement for the management of AD with a special reference to the Indian context. This guideline includes updated definition, etiological factors, classification, and management of atopic dermatitis. Methodology: The preparation of guidelines was done in multiple phases. Indian Dermatology Expert Board Members (DEBM), recommended by the Skin Allergy Society of India, prepared 26 evidence-based recommendations for AD. An extensive literature search was done in MEDLINE, Google scholar, Cochrane, and other resources. Articles published in the past 10 years were reviewed and recommendations were graded based on the quality of evidence as per GRADE. After forming the initial structure, DEBM met in Mumbai and gave their decisions on an agree and disagree scale with an Indian perspective. Finally, their suggestions were compiled for preparing the article. After DEBM finalized the draft, a treatment algorithm was formulated for the management of AD. Results: DEBM suggested a working definition for AD. The panel agreed that moisturizers should be used as mainstay of therapy and should be continued in all lines of therapy and in maintenance phase. Topical corticosteroids and topical calcineurin inhibitors should be considered as the first line of treatment. Among systemic therapies, cyclosporin should be considered first line, followed by azathioprine, methotrexate, and mycophenolate mofetil. Phototherapy can be an effecive alternative. Empirical food restriction was recommended against. Conclusion: These guidelines should form a reference for the management of patients with AD in an evidence-based manner.


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