GUIDELINES FOR TOPICAL TREATMENT OF PATIENTS WITH ATOPIC DERMATITIS AT THE UNIVERSITY CLINIC FOR DERMATOLOGY IN SKOPJE

Authors

  • Anita Najdova University Clinic for Dermatology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Tomche Popovski University Clinic for Dermatology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Nevenka Adjievska University Clinic for Dermatology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Natasa Jakovljevikj University Clinic for Dermatology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Kristina Risteska University Clinic for Dermatology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Gordana Viranova University Clinic for Dermatology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Sofija Ristevska University Clinic for Dermatology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Katerina Damveska University Clinic for Dermatology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia

Keywords:

atopic dermatitis, topical treatment, guidelines

Abstract

This Guideline was developed for the needs of the PHI University Clinic for Dermatology, Skopje, and is based on the European Guidelines for Local Therapy of Atopic Dermatitis (AD) from December 2020 and July 2021 (EuroGuiDerm Guideline). The process involved specialist physicians from the University Hospital for Dermatology with extensive experience in pediatric dermatology and the treatment of patients with atopic dermatitis (AD), as well as resident physicians involved in the technical preparation of the text. The Professional Board of the University Clinic for Dermatology in Skopje adopted the Guideline in February 2025. The first part of the Guideline contains general information about the goals and scope, the health issues covered in the Guideline, the target groups, and a methodology section. The Guideline provides guidelines for identifying patients who should be treated with topical therapy, recommendations, and information for each drug and emollient. This Guideline includes recommendations and information on essential therapy with emollients and moisturizers, topical anti-inflammatory, antimicrobial, and antipruritic treatment, UV phototherapy, techniques for avoiding provocative factors, and recommendations for nutrition, complementary medicine, and education for patients with AD.

References

Wollenberg A, Kinberger M, Arents B, Aszodi N, Avila Valle G, Barbarot S, et al. European Guideline (EuroGuiDerm) on atopic eczema – part II: non-systemic treatments and treatment recommendations for special AE patient populations. J Eur Acad Dermatol Venereol. 2022;36:1904–26. doi:10.1111/jdv.18429

Drucker AM, Lam M, Prieto-Merino D, et al. Systemic Immunomodulatory Treatments for Atopic Dermatitis: Living Systematic Review and Network Meta-Analysis Update. JAMA Dermatol. 2024 Sep 1;160(9):936-944. doi: 10.1001/jamadermatol.2024.2192. Erratum in: JAMA Dermatol. 2024 Sep 1;160(9):1012. doi: 10.1001/jamadermatol.2024.3600.

Drucker AM, Ellis AG, Bohdanowicz M, et al. Systemic immunomodulatory treatments for patients with atopic dermatitis: a systematic review and network meta-analysis. JAMA Dermatol. 2020;156(6):659–67. doi:10.1001/jamadermatol.2020.0729

Van Zuuren EJ, Fedorowicz Z, Christensen R, Lavrijsen A, Arents BWM. Emollients and moisturisers for eczema. Cochrane Database Syst Rev. 2017;2:CD012119. doi:10.1002/14651858.CD012119.pub2

Akerstrom U, Reitamo S, Langeland T, et al. Comparison of moisturizing creams for preventing atopic dermatitis relapse: a randomized double-blind controlled multicentre clinical trial. Acta Derm Venereol. 2015;95(5):587–92. doi:10.2340/00015555-1996

Chiang C, Eichenfield LF. Quantitative assessment of combination bathing and moisturizing regimens on skin hydration in atopic dermatitis. Pediatr Dermatol. 2009;26(3):273–8. doi:10.1111/j.1525-1470.2009.00890.x

Dinkloh A, Worm M, Geier J, Schnuch A, Wollenberg A. Contact sensitization in patients with suspected cosmetic intolerance: results of the IVDK 2006-2011. J Eur Acad Dermatol Venereol. 2015;29(6):1071–81. doi:10.1111/jdv.12692

Wollenberg A, Schnopp C. Evolution of conventional therapy in atopic dermatitis. Immunol Allergy Clin North Am. 2010;30(2):351–68. doi:10.1016/j.iac.2010.02.002

Gelmetti C, Wollenberg A. Atopic dermatitis– all you can do from the outside. Br J Dermatol. 2014;170(Suppl 1):19–24. doi:10.1111/bjd.13034

Mengeaud V, Phulpin C, Bacquey A, Boralevi F, Schmitt AM, Taieb A. An innovative oat-based sterile emollient cream in the maintenance therapy of childhood atopic dermatitis. Pediatr Dermatol. 2015;32(2):208–15. doi:10.1111/pde.12541

Gueniche A, Knaudt B, Schuck E, et al. Effects of nonpathogenic gram-negative bacterium Vitreoscilla filiformis lysate on atopic dermatitis: a prospective, randomized, double-blind, placebo-controlled clinical study. Br J Dermatol. 2008;159(6):1357–63. doi:10.1111/j.1365-2133.2008.08927.x

Aries MF, Hernandez-Pigeon H, Vaissiere C, et al. Anti-inflammatory and immunomodulatory effects of Aquaphilus dolomiae extract on in vitro models. Clin Cosmet Investig Dermatol. 2016;9:421–34. doi:10.2147/CCID.S111277

Simpson EL, Chalmers JR, Hanifin JM, et al. Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention. J Allergy Clin Immunol. 2014;134(4):818–23. doi:10.1016/j.jaci.2014.05.043

Uehara M, Takada K. Use of soap in managing atopic dermatitis. Clin Exp Dermatol. 1985;10(5):419–25. doi:10.1111/j.1365-2230.1985.tb00557.x

Denda M, Sokabe T, Fukumi-Tominaga T, Tominaga M. Effects of skin surface temperature on epidermal permeability barrier homeostasis. J Invest Dermatol. 2007;127(3):654–9. doi:10.1038/sj.jid.5700626

Wollenberg A, Frank R, Kroth J, et al. Proactive therapy of atopic eczema – an evidence-based concept with a behavioral background. J Dtsch Dermatol Ges. 2009;7(2):117–21. doi:10.1111/j.1610-0387.2008.07197.x

Wollenberg A, Ehmann LM. Long-term treatment concepts and proactive therapy for atopic eczema. Ann Dermatol. 2012;24(3):253–60. doi:10.5021/ad.2012.24.3.253

Gonzalez-Lopez G, Ceballos-Rodriguez RM, Gonzalez-Lopez JJ, Feito Rodriguez M, Herranz-Pinto P. Efficacy and safety of wet wrap therapy for patients with atopic dermatitis: a systematic review and meta-analysis. Br J Dermatol. 2016;177(3):688–95. doi:10.1111/bjd.14604

Hanifin J, Gupta AK, Rajagopalan R. Intermittent dosing of fluticasone propionate cream for reducing the risk of relapse in atopic dermatitis patients. Br J Dermatol. 2002;147(3):528–37. doi:10.1046/j.1365-2133.2002.04964.x

Niedner R. Therapie mit systemischen Glukokortikoiden. Hautarzt. 2001;52(11):1062–71.

Barnes L, Kaya G, Rollason V. Topical corticosteroid-induced skin atrophy: a comprehensive review. Drug Saf. 2015;38(6):493–509. doi:10.1007/s40264-015-0275-6

Reitamo S, Van Leent EJ, Ho V, et al. Efficacy and safety of tacrolimus ointment compared with that of hydrocortisone acetate ointment in children with atopic dermatitis. J Allergy Clin Immunol. 2002;109(3):539–46. doi:10.1067/mai.2002.121375

Queille-Roussel C, Paul C, Duteil L, et al. The new topical ascomycin derivative SDZ ASM 981 does not induce skin atrophy when applied to normal skin for 4 weeks: a randomized, double-blind controlled study. Br J Dermatol. 2001;144(3):507–13. doi:10.1046/j.1365-2133.2001.04128.x

Bissonnette R, Papp KA, Poulin Y, et al. Topical tofacitinib for atopic dermatitis: a phase IIa randomized trial. Br J Dermatol. 2016;175(5):902–11. doi:10.1111/bjd.14606

Kim BS, Howell MD, Sun K, Papp K, Nasir A, Kuligowski ME. Treatment of atopic dermatitis with ruxolitinib cream (JAK1/JAK2 inhibitor) or triamcinolone cream. J Allergy Clin Immunol. 2020;145(2):572–82. doi:10.1016/j.jaci.2019.07.034

Totte JE, van der Feltz WT, Hennekam M, van Belkum A, van Zuuren EJ, Pasmans SG. Prevalence and odds of Staphylococcus aureus carriage in atopic dermatitis: a systematic review and meta-analysis. Br J Dermatol. 2016;175(4):687–95. doi:10.1111/bjd.14633

Wollenberg A, Zoch C, Wetzel S, Plewig G, Przybilla B. Predisposing factors and clinical features of eczema herpeticum: a retrospective analysis of 100 cases. J Am Acad Dermatol. 2003;49(2):198–205. doi:10.1067/mjd.2003.93

Sher LG, Chang J, Patel IB, Balkrishnan R, Fleischer AB Jr. Relieving the pruritus of atopic dermatitis: a meta-analysis. Acta Derm Venereol. 2012;92(5):455–61. doi:10.2340/00015555-1400

Simpson EL, Bieber T, Guttman-Yassky E, et al. Two phase 3 trials of Dupilumab versus placebo in atopic dermatitis. N Engl J Med. 2016;375(24):2335–48. doi:10.1056/NEJMoa1610020

Garritsen FM, Brouwer MW, Limpens J, Spuls PI. Photo(chemo)therapy in managing atopic dermatitis: an updated systematic review with implications for practice and research. Br J Dermatol. 2014;170(3):501–13. doi:10.1111/bjd.12669

Matterne U, Böhmer MM, Weisshaar E, Jupiter A, Carter B, Apfelbacher CJ. Oral H1 antihistamines as ’add-on’ therapy to topical treatment for eczema. Cochrane Database Syst Rev. 2019;1:CD012167. doi:10.1002/14651858.CD012167.pub2

Church MK, Maurer M, Simons FE, et al. Risk of first-generation H(1)- antihistamines: a GA(2)LEN position paper. Allergy. 2010;65(4):459–66. doi:10.1111/j.1398-9995.2009.02257.x

Vermeulen FM, Gerbens LAA, Schmitt J, et al. The European TREatment of ATopic eczema (TREAT) registry taskforce survey: prescribing practices in Europe for phototherapy and systemic therapy in adult patients with moderate-to-severe atopic eczema. Br J Dermatol. 2020;183(6):1073–82. doi:10.1111/bjd.18700

Tsakok T, Marrs T, Mohsin M, et al. Does atopic dermatitis cause food allergy? A systematic review. J Allergy Clin Immunol. 2016;137(4):1071–8. doi:10.1016/j.jaci.2015.09.033

Sicherer SH, Sampson HA. Food hypersensitivity and atopic dermatitis: pathophysiology, epidemiology, diagnosis, and management. J Allergy Clin Immunol. 1999;104(6 Pt 1):S114–22. doi:10.1016/s0091-6749(99)70077-8

Makrgeorgou A, Leonardi-Bee J, Bath-Hextall FJ, et al. Probiotics for treating eczema. Cochrane Database Syst Rev. 2018;11:CD006135. doi:10.1002/14651858.CD006135.pub4

Bath-Hextall FJ, Jenkinson C, Humphreys R, Williams HC. Dietary supplements for established atopic eczema. Cochrane Database Syst Rev. 2012;2:CD005205. doi:10.1002/14651858.CD005205.pub3

Downloads

Published

2025-06-12

Issue

Section

Guidelines