Recommendations for emollients, bathing and topical corticosteroids for the treatment of atopic dermatitis: a systematic review of guidelines

Background Emollients and topical corticosteroids are key elements in treating atopic dermatitis. However, there is variation in treatment recommendations as stated in international and national guidelines. To optimize the treatment of atopic dermatitis, insight into the differences between guideline recommendations is essential. Objectives The aim of this systematic review is to provide an overview of recommendations and the evidence supporting recommendations on the use of emollients, bathing and topical corticosteroids for atopic dermatitis in treatment guidelines. Materials & Methods A systematic literature search and additional search was performed with a focus on guidelines, consensus statements and care protocols. Twenty-nine guidelines were reviewed. Results Significant variation was found in the AGREE score for rigour of development. There is agreement among guidelines concerning selection criteria for type of emollient (season/climate [n = 9] and patient preference [n = 12]) and selection criteria for type topical corticosteroid (area [n = 25], severity [n = 17] and age [n = 20]). Twenty-four guidelines recommend maintenance therapy with topical corticosteroid to increase the flare-free period. The recommendations for maintenance therapy are based on evidence, in contrast to the selection criteria for type of emollient and topical corticosteroid. Recommendations for the initial treatment strategy vary despite being based on the same evidence. Furthermore, recommendations diverged on bathing and the follow-up strategy for topical corticosteroids. Conclusion The available guidelines on the management of atopic dermatitis vary in quality and contain remarkable differences in therapeutic recommendations. Due to the lack of evidence, recommendations are often formulated on the basis of expert opinion. More evidence is needed for the key treatment strategies for this common skin disorder.