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Clinical approach to the patient with refractory atopic dermatitis

2017; Elsevier BV; Volume: 120; Issue: 1 Linguagem: Inglês

10.1016/j.anai.2017.09.061

1534-4436

Neema Izadi, Donald Y.M. Leung,

Asthma and respiratory diseases

Key MessagesThe approach to refractory atopic dermatitis should include a step-wise approach to rule out other diagnoses, confirm adequate first-line therapy, and rule out exacerbating factors prior to implementing second-line therapies.•Immunodeficiencies and skin disorders can mimic atopic dermatitis•Topical skin care technique is paramount to prevent continual flares•It is difficult to identify triggers unless the patient is cleared first•Consider infection and allergens, but do not overlook scratching•Consider addressing behavioral factors using a multidisciplinary approachInstructionsCredit can now be obtained, free for a limited time, by reading the review article in this issue and completing all activity components. Please note the instructions listed below:•Review the target audience, learning objectives and all disclosures.•Complete the pre-test.•Read the article and reflect on all content as to how it may be applicable to your practice.•Complete the post-test/evaluation and claim credit earned. At this time, physicians will have earned up to 1.0 AMA PRA Category 1 CreditTM. Minimum passing score on the post-test is 70%.•Approximately 4-6 weeks later you will receive an online outcomes assessment regarding your application of this article to your practice. Once you have completed this assessment, you will be eligible to receive MOC Part II credit from the American Board of Allergy and Immunology.Overall PurposeParticipants will be able to demonstrate increased knowledge of the clinical treatment of allergy/asthma/immunology and how new information can be applied to their own practices.Learning ObjectivesAt the conclusion of this activity, participants should be able to:•Discuss diagnostic considerations in refractory atopic dermatitis•Describe an approach to the management of refractory atopic dermatitisRelease Date: January 1, 2018Expiration Date: December 31, 2019Target AudiencePhysicians involved in providing patient care in the field of allergy/asthma/immunologyAccreditationThe American College of Allergy, Asthma & Immunology (ACAAI) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.DesignationThe American College of Allergy, Asthma & Immunology (ACAAI) designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.Disclosure PolicyAs required by the Accreditation Council for Continuing Medical Education (ACCME) and in accordance with the American College of Allergy, Asthma and Immunology (ACAAI) policy, all CME planners, presenters, moderators, authors, reviewers, and other individuals in a position to control and/or influence the content of an activity must disclose all relevant financial relationships with any commercial interest that have occurred within the past 12 months. All identified conflicts of interest must be resolved and the educational content thoroughly vetted for fair balance, scientific objectivity, and appropriateness of patient care recommendations. It is required that disclosure be provided to the learners prior to the start of the activity. Individuals with no relevant financial relationships must also inform the learners that no relevant financial relationships exist. Learners must also be informed when off-label, experimental/investigational uses of drugs or devices are discussed in an educational activity or included in related materials. Disclosure in no way implies that the information presented is biased or of lesser quality. It is incumbent upon course participants to be aware of these factors in interpreting the program contents and evaluating recommendations. Moreover, expressed views do not necessarily reflect the opinions of ACAAI.Disclosure of Relevant Financial RelationshipsAll identified conflicts of interest have been resolved. Any unapproved/investigative uses of therapeutic agents/devices discussed are appropriately noted.Planning Committee•Jonathan A. Bernstein, MD (Annals CME Subcommittee): Consultant, Fees: Imedics; Consultant/Principal Investigator, Grants/Fees: Boehringer Ingelheim, GlaxoSmithKline; Consultant/Principal Investigator/Speaker, Grants/Fees: AstraZeneca, CSL Behring, Novartis/Genentech, Shire; Speaker, Fees: Baxalta•Guha Krishnaswamy, MD (Annals CME Subcommittee): Clinical Research, Grant: CSL Behring•Gailen D. Marshall, Jr, MD, PhD (Editor-in-Chief): Clinical Research, Grants: Sanofi, Stallergenes•Anna Nowak-Wegrzyn, MD (CME Series Editor, Deputy Editor): no relevant financial relationships to disclose.•John J. Oppenheimer, MD (Annals CME Subcommittee, Associate Editor): Consultant, Other financial gains: DBV Technologies, GlaxoSmithKline, Kaleo; Clinical Research, Grants: AstraZeneca, Boehringer Ingelheim, NovartisAuthor•Neema Izadi, MD, MS: has no relevant financial relationships to disclose.•Donald Y.M. Leung, MD, PhD: Advisory Board, Fees: Regeneron, Sanofi, Aimmune; Research, Grants: NIAMS, NIADIRecognition of Commercial Support: This activity has not received external commercial support.Copyright Statement: ©2015-2018 ACAAI. All rights reserved.CME Inquiries: Contact the American College of Allergy, Asthma & Immunology at [email protected]or 847-427-1200. The approach to refractory atopic dermatitis should include a step-wise approach to rule out other diagnoses, confirm adequate first-line therapy, and rule out exacerbating factors prior to implementing second-line therapies.•Immunodeficiencies and skin disorders can mimic atopic dermatitis•Topical skin care technique is paramount to prevent continual flares•It is difficult to identify triggers unless the patient is cleared first•Consider infection and allergens, but do not overlook scratching•Consider addressing behavioral factors using a multidisciplinary approach Credit can now be obtained, free for a limited time, by reading the review article in this issue and completing all activity components. Please note the instructions listed below:•Review the target audience, learning objectives and all disclosures.•Complete the pre-test.•Read the article and reflect on all content as to how it may be applicable to your practice.•Complete the post-test/evaluation and claim credit earned. At this time, physicians will have earned up to 1.0 AMA PRA Category 1 CreditTM. Minimum passing score on the post-test is 70%.•Approximately 4-6 weeks later you will receive an online outcomes assessment regarding your application of this article to your practice. Once you have completed this assessment, you will be eligible to receive MOC Part II credit from the American Board of Allergy and Immunology. Participants will be able to demonstrate increased knowledge of the clinical treatment of allergy/asthma/immunology and how new information can be applied to their own practices. At the conclusion of this activity, participants should be able to:•Discuss diagnostic considerations in refractory atopic dermatitis•Describe an approach to the management of refractory atopic dermatitis Release Date: January 1, 2018 Expiration Date: December 31, 2019 Physicians involved in providing patient care in the field of allergy/asthma/immunology The American College of Allergy, Asthma & Immunology (ACAAI) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The American College of Allergy, Asthma & Immunology (ACAAI) designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. As required by the Accreditation Council for Continuing Medical Education (ACCME) and in accordance with the American College of Allergy, Asthma and Immunology (ACAAI) policy, all CME planners, presenters, moderators, authors, reviewers, and other individuals in a position to control and/or influence the content of an activity must disclose all relevant financial relationships with any commercial interest that have occurred within the past 12 months. All identified conflicts of interest must be resolved and the educational content thoroughly vetted for fair balance, scientific objectivity, and appropriateness of patient care recommendations. It is required that disclosure be provided to the learners prior to the start of the activity. Individuals with no relevant financial relationships must also inform the learners that no relevant financial relationships exist. Learners must also be informed when off-label, experimental/investigational uses of drugs or devices are discussed in an educational activity or included in related materials. Disclosure in no way implies that the information presented is biased or of lesser quality. It is incumbent upon course participants to be aware of these factors in interpreting the program contents and evaluating recommendations. Moreover, expressed views do not necessarily reflect the opinions of ACAAI. All identified conflicts of interest have been resolved. Any unapproved/investigative uses of therapeutic agents/devices discussed are appropriately noted. •Jonathan A. Bernstein, MD (Annals CME Subcommittee): Consultant, Fees: Imedics; Consultant/Principal Investigator, Grants/Fees: Boehringer Ingelheim, GlaxoSmithKline; Consultant/Principal Investigator/Speaker, Grants/Fees: AstraZeneca, CSL Behring, Novartis/Genentech, Shire; Speaker, Fees: Baxalta•Guha Krishnaswamy, MD (Annals CME Subcommittee): Clinical Research, Grant: CSL Behring•Gailen D. Marshall, Jr, MD, PhD (Editor-in-Chief): Clinical Research, Grants: Sanofi, Stallergenes•Anna Nowak-Wegrzyn, MD (CME Series Editor, Deputy Editor): no relevant financial relationships to disclose.•John J. Oppenheimer, MD (Annals CME Subcommittee, Associate Editor): Consultant, Other financial gains: DBV Technologies, GlaxoSmithKline, Kaleo; Clinical Research, Grants: AstraZeneca, Boehringer Ingelheim, Novartis •Neema Izadi, MD, MS: has no relevant financial relationships to disclose.•Donald Y.M. Leung, MD, PhD: Advisory Board, Fees: Regeneron, Sanofi, Aimmune; Research, Grants: NIAMS, NIADI Recognition of Commercial Support: This activity has not received external commercial support. Copyright Statement: ©2015-2018 ACAAI. All rights reserved. CME Inquiries: Contact the American College of Allergy, Asthma & Immunology at [email protected] or 847-427-1200.