Introduction: Numerous guidelines have been published for atopic dermatitis management in children in recent years. To date, the quality of the newest guidelines has not been appraised. This study aimed to identify and evaluate guidelines for the management of atopic dermatitis in children. Methods: We reviewed the literature retrieved from PubMed, Web of Science, Ovid, ScienceDirect, Embase, China National Knowledge Infrastructure, WanFang Data, and guidelines websites. Search period from January 1, 2016, to December 31, 2021. The following keywords were used for searching: “atopic dermatitis,” “atopic eczema,” “eczema,” “guideline,” and “consensus.” The quality of the guidelines was assessed by two assessors using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument independently, and domain scores >60% were considered to have sufficient quality. The guideline recommendations were reviewed. Results: Nineteen guidelines were included in the study. Three guidelines had a graded A level, which was recommended for use in practice. Eleven guidelines had a graded B level, which was recommended for use in revision. The remaining five guidelines were rated with C level, which was not recommended. The average score of six domains of AGREE II was 64.76%, 48.53%, 42.35%, 73.83%, 32.23%, and 70.17%, respectively. A consistency test showed an intraclass correlation coefficient range of 0.497 (95% CI: 0.105, 0.705) to 0.970 (95% CI: 0.93, 0.987) based on the two assessors’ test results for the guidelines. Conclusions: Most guidelines were recommended for use with revision. No significant changes were observed in the primary management of atopic dermatitis in children compared to previous evidence. New biological agents and complementary alternative medicine are increasingly available, but the evidence for the treatment of atopic dermatitis in children is still limited.

Thormann K, Aubert H, Barbarot S, Britsch-Yilmaz A, Chernyshov P, Deleuran M, et al. Position statement on the role of nurses in therapeutic patient education in atopic dermatitis. J Eur Acad Dermatol Venereol. 2021;35(11):2143–8.
Mohan GC, Lio PA. Comparison of dermatology and allergy guidelines for atopic dermatitis management. JAMA Dermatol. 2015;151(9):1009–13.
Siegels D, Heratizadeh A, Abraham S, Binnmyr J, Brockow K, Irvine AD, et al. Systemic treatments in the management of atopic dermatitis: a systematic review and meta-analysis. Allergy. 2021;76(4):1053–76.
Young TK, Glick AF, Yin HS, Kolla AM, Velazquez JJ, Nicholson J, et al. Management of pediatric atopic dermatitis by primary care providers: a systematic review. Acad Pediatr. 2021;21(8):1318–27.
Patruno C, Amerio P, Chiricozzi A, Costanzo A, Cristaudo A, Cusano F, et al. Optimizing a clinical guidance for diagnosis of atopic dermatitis in adults: joint recommendations of the Italian Society of Dermatology and Venereology (SIDeMaST), Italian Association of Hospital Dermatologists (ADOI), and Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA). G Ital Dermatol Venereol. 2020;155(1):1–7.
de María Díaz Granados L, Quijano MA, Ramírez PA, Aguirre N, Sanclemente G. Quality assessment of atopic dermatitis clinical practice guidelines in ≤ 18 years. Arch Dermatol Res. 2018;310(1):29–37.
Mao W, Mao J, Zhang J, Wang L, Cao D, Qu Y. Atopic eczema: a disease modulated by gene and environment. Front Biosci. 2014;19(4):707–17.
Kim JE, Kim JS, Cho DH, Park HJ. Molecular mechanisms of cutaneous inflammatory disorder: atopic dermatitis. Int J Mol Sci. 2016;17(8):1234.
Danso MO, van Drongelen V, Mulder A, van Esch J, Scott H, van Smeden J, et al. TNF-α and Th2 cytokines induce atopic dermatitis-like features on epidermal differentiation proteins and stratum corneum lipids in human skin equivalents. J Invest Dermatol. 2014;134(7):1941–50.
Czarnowicki T, Esaki H, Gonzalez J, Malajian D, Shemer A, Noda S, et al. Early pediatric atopic dermatitis shows only a cutaneous lymphocyte antigen (CLA)(+) TH2/TH1 cell imbalance, whereas adults acquire CLA(+) TH22/TC22 cell subsets. J Allergy Clin Immunol. 2015;136(4):941–e3.
Bieber T. Atopic dermatitis. N Engl J Med. 2008;358(14):1483–94.
Lack G. Clinical practice. Food allergy. N Engl J Med. 2008;359(12):1252–60.
De Benedetto A, Agnihothri R, McGirt LY, Bankova LG, Beck LA. Atopic dermatitis: a disease caused by innate immune defects? J Invest Dermatol. 2009;129(1):14–30.
Niebuhr M, Werfel T. Innate immunity, allergy and atopic dermatitis. Curr Opin Allergy Clin Immunol. 2010;10(5):463–8.
Narla S, Silverberg JI. Dermatology for the internist: optimal diagnosis and management of atopic dermatitis. Ann Med. 2021;53(1):2165–77.
Ständer S. Atopic dermatitis. N Engl J Med. 2021;384(12):1136–43.
Akan A, Dibek-Mısırlıoğlu E, Civelek E, Vezir E, Kocabaş CN. Diagnosis of atopic dermatitis in children: comparison of the Hanifin-Rajka and the United Kingdom Working Party criteria. Allergol Immunopathol. 2020;48(2):175–81.
Vakharia PP, Chopra R, Silverberg JI. Systematic review of diagnostic criteria used in atopic dermatitis randomized controlled trials. Am J Clin Dermatol. 2018;19(1):15–22.
Langan SM, Irvine AD, Weidinger S. Atopic dermatitis. Lancet. 2020;396(10247):758345–360.
Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ. 2010;182(18):E839–42.
Werfel T, Heratizadeh A, Aberer W, Ahrens F, Augustin M, Biedermann T, et al. S2k guideline on diagnosis and treatment of atopic dermatitis--short version. J Dtsch Dermatol Ges. 2016;14(1):92–106.
Galli E, Neri I, Ricci G, Baldo E, Barone M, Belloni Fortina A, et al. Consensus conference on clinical management of pediatric atopic dermatitis. Ital J Pediatr. 2016;42:26.
Wong ITY, Tsuyuki RT, Cresswell-Melville A, Doiron P, Drucker AM. Guidelines for the management of atopic dermatitis (eczema) for pharmacists. Can Pharm J. 2017;150(5):285–97.
Boguniewicz M, Alexis AF, Beck LA, Block J, Eichenfield LF, Fonacier L, et al. Expert perspectives on management of moderate-to-severe atopic dermatitis: a multidisciplinary consensus addressing current and emerging therapies. J Allergy Clin Immunol Pract. 2017;5(6):1519–31.
Wollenberg A, Barbarot S, Bieber T, Christen-Zaech S, Deleuran M, Fink-Wagner A, et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I. J Eur Acad Dermatol Venereol. 2018;32(5):1436657–682.
Katoh N, Ohya Y, Ikeda M, Ebihara T, Katayama I, Saeki H, et al. Clinical practice guidelines for the management of atopic dermatitis 2018. J Dermatol. 2019;46(12):1053–101.
Chow S, Seow CS, Dizon MV, Godse K, Foong H, Chan V, et al. A clinician’s reference guide for the management of atopic dermatitis in Asians. Asia Pac Allergy. 2018;8(4):e41.
Kent KA, Clark CA. Skin deep: simplifying practice guidelines for children with atopic dermatitis. J Pediatr Health Care. 2018;32(5):507–14.
Malaysian Health Technology Assessment Section (MaHTAS). Management of atopic eczema; 2018. Available from:
Aoki V, Lorenzini D, Orfali RL, Zaniboni MC, Oliveira ZNP, Rivitti-Machado MC, et al. Consensus on the therapeutic management of atopic dermatitis: Brazilian Society of Dermatology. An Bras Dermatol. 2019;94(2 Suppl 1):67–75.
Damiani G, Calzavara-Pinton P, Stingeni L, Hansel K, Cusano F. Italian guidelines for therapy of atopic dermatitis-Adapted from consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis). Dermatol Ther. 2021;3432(56):e15091–e13121.
Chiricozzi A, Belloni Fortina A, Galli E, Girolomoni G, Neri I, Ricci G, et al. Current therapeutic paradigm in pediatric atopic dermatitis: practical guidance from a national expert panel. Allergol Immunopathol. 2019;47(2):194–206.
Rajagopalan M, De A, Godse K, Krupa Shankar DS, Zawar V, Sharma N, et al. Guidelines on management of atopic dermatitis in India: an evidence-based review and an expert consensus. Indian J Dermatol. 2019;64(3):166–81.
Katoh N, Ohya Y, Ikeda M, Ebihara T, Katayama I, Saeki H, et al. Japanese guidelines for atopic dermatitis 2020. Allergol Int. 2020;69(3):356–69.
Chan TC, Wu NL, Wong LS, Cho YT, Yang CY, Yu Y, et al. Taiwanese Dermatological Association consensus for the management of atopic dermatitis: a 2020 update. J Formos Med Assoc. 2021;120(1 Pt 2):429–42.
Atopic Dermatitis Working Group, Immunology Group, Chinese Society of Dermatology. Chinese guideline for diagnosis and treatment of atopic dermatitis (2020). Chin J Dermatol. 2020;53(2):81–8.
Lee JH, Kim JE, Park GH, Bae JM, Byun JY, Shin MK, et al. Consensus update for systemic treatment of atopic dermatitis. Ann Dermatol. 2021;33(6):497–514.
Standardization project group of clinical application guide for dominant diseases of Chinese patent medicine treatment. International clinical practice guidelines in traditional Chinese medicine: atopic dermatitis. Chin J Integrated Traditional West Med. 2020;41(2), 133–42.
Kulthanan K, Tuchinda P, Nitiyarom R, Chunharas A, Chantaphakul H, Aunhachoke K, et al. Clinical practice guidelines for the diagnosis and management of atopic dermatitis. Asian Pac J Allergy Immunol. 2021;39(3):145–55.
Weil C, Sugerman PB, Chodick G, Liang H, Wang H, Calimlim BM, et al. Epidemiology and economic burden of atopic dermatitis: real-world retrospective data from a large nationwide Israeli healthcare provider database. Adv Ther. 2022;39(6):2502–14.
Abuabara K, Yu AM, Okhovat JP, Allen IE, Langan SM. The prevalence of atopic dermatitis beyond childhood: a systematic review and meta-analysis of longitudinal studies. Allergy. 2018;73(3):696–704.
Katibi OS, Cork MJ, Flohr C, Danby SG. Moisturizer therapy in prevention of atopic dermatitis and food allergy: to use or disuse? Ann Allergy Asthma Immunol. 2022;128(5):512–25.
Cacciapuoti S, Luciano MA, Megna M, Annunziata MC, Napolitano M, Patruno C, et al. The role of thermal water in chronic skin diseases management: a review of the literature. J Clin Med. 2020;9(9):3047.
Simpson EL, Bruin-Weller M, Flohr C, Ardern-Jones MR, Barbarot S, Deleuran M, et al. When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council. J Am Acad Dermatol. 2017;77(4):623–33.
Wojcikowski K, Johnson DW, Gobé G. Medicinal herbal extracts: renal friend or foe? Part one: the toxicities of medicinal herbs. Nephrology. 2004;9(5):313–8.
Kojima R, Fujiwara T, Matsuda A, Narita M, Matsubara O, Nonoyama S, et al. Factors associated with steroid phobia in caregivers of children with atopic dermatitis. Pediatr Dermatol. 2013;30(1):29–35.
Mehl A, Rolinck-Werninghaus C, Staden U, Verstege A, Wahn U, Beyer K, et al. The atopy patch test in the diagnostic workup of suspected food-related symptoms in children. J Allergy Clin Immunol. 2006;118(4):923–9.
van Gool CJ, Zeegers MP, Thijs C. Oral essential fatty acid supplementation in atopic dermatitis-a meta-analysis of placebo-controlled trials. Br J Dermatol. 2004;150(4):728–40.
Makrgeorgou A, Leonardi-Bee J, Bath-Hextall FJ, Murrell DF, Tang ML, Roberts A, et al. Probiotics for treating eczema. Cochrane Database Syst Rev. 2018;11(11):CD006135.
Bath-Hextall FJ, Jenkinson C, Humphreys R, Williams HC. Dietary supplements for established atopic eczema. Cochrane Database Syst Rev. 2012;2:CD005205.
Blauvelt A, de Bruin-Weller M, Gooderham M, Cather JC, Weisman J, Pariser D, et al. Long-term management of moderate-to-severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): a 1-year, randomised, double-blinded, placebo-controlled, phase 3 trial. Lancet. 2017;389(10086):2287–303.
de Bruin-Weller M, Thaçi D, Smith CH, Reich K, Cork MJ, Radin A, et al. Dupilumab with concomitant topical corticosteroid treatment in adults with atopic dermatitis with an inadequate response or intolerance to ciclosporin A or when this treatment is medically inadvisable: a placebo-controlled, randomized phase III clinical trial (LIBERTY AD CAFÉ). Br J Dermatol. 2018;178(5):1083–101.
Agache I, Akdis CA, Akdis M, Brockow K, Chivato T, Del Giacco S, et al. EAACI Biologicals Guidelines-dupilumab for children and adults with moderate-to-severe atopic dermatitis. Allergy. 2021;76(4):988–1009.
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