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THE

ACADEMY

This report reflects the best available data at the time the report was prepared, but caution should be exercised in interpreting the data; the results of future studies may require alteration of the conclusions or recommendations set forth in this report.

Guidelines of care for atopic dermatitis
Work group: Jon M. Hanifin, MD, Chair Work Group, Kevin D. Cooper, MD,Vincent C. Ho, MD, Sewon Kang, MD, Bernice R. Krafchik, MD, David J. Margolis, MD, Lawrence A. Schachner, MD, Robert Sidbury, MD, Susan E. Whitmore, MD, Carol K. Sieck, RN, MSN, and Abby S. Van Voorhees, MD, Chair Guideline/Outcomes Task Force

DISCLAIMER
Adherence to these guidelines will not ensure successful treatment in every situation. Furthermore these guidelines should not be deemedinclusive of all proper methods of care or exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific therapy must be made by the physician and the patient in light of all the circumstances presented by the individual patient.

INTRODUCTION/METHODOLOGY*
A work group of recognized experts was convened to determinethe audience for the guideline, define the scope of the guideline, and identify nine clinical questions to structure the primary issues in diagnosis and management. Work group members were asked to complete a disclosure of commercial supports and this information is in the technical report. They employed an evidence-based model and the evidence was obtained primarily from a search of MEDLINE andEMBASE databases spanning the
Guidelines/Outcomes Task Force: Abby Van Voorhees, MD, Chair Task Force, Mark A. Bechtel, MD, Boni E. Elewski, MD, Steven R. Feldman, MD, Cindy Francyn Hoffman, MD, Robert S. Kirsner, MD, Lawrence M. Lieblich, MD, David J. Margolis, MD, Yves P. Poulin, MD, Barbara R. Reed, MD, Dirk B. Robertson, MD, Erin W. Warshaw, MD, Daniel A. Smith, MD, and Carol K. Sieck, RN, MSN.A full technical report that provides a complete description of the methodology is available at our Web site, www.aad.org, or by request at the reprint request address. Reprint requests: American Academy of Dermatology, PO Box 4014, Schaumburg, IL 60168-4014. J Am Acad Dermatol 2004;50:391-404. 0190-9622/$30.00 © 2004 by the American Academy of Dermatology, Inc. doi:10.1016/j.jaad.2003.08.003years 1990 to June 3, 2003. Additional searches were done by hand searching publications, including reviews, meta analysis and correspondence. Only English-language publications were reviewed. Statistical assistance was provided by Hayes, Inc, a health technology assistance assessment service. Also, there was reliance on the comprehensive “Systematic Review of Treatments for Atopic Eczema”published as a Health Technology Assessment 2000 and listed in the bibliography.1 The available evidence was evaluated using a method described by Goodman (1998). Evidence was graded on a five-point scale based on the quality of methodology. In a document on healthcare technology assessment prepared for the National Information Center on Health Services Research and Health Care Technology (NICHSR) at theNational Library of Medicine,1 grading of the level of evidence was done as follows: I Properly designed randomized controlled trial. II-1 Well-designed controlled trial without randomization. II-2 Well-designed cohort or case-control analytic study, preferably from more than one center or research group. II-3 Time series with or without the intervention. Dramatic results in uncontrolledexperiments could also be regarded as this type of evidence. III Clinical experience, descriptive studies, or reports of expert committees. Individual tables are included in the technical report but are also integrated into some of the discussions to illustrate recommendations. Every attempt was made to present a balanced approach to clinical recommendations; however, high-quality randomized clinical...