Optimal management of atopic dermatitis.

Optimal treatment of patients with atopic dermatitis requires the knowledge of its pathogenetic factors and the often time-consuming attention to the course of the disease in each individual patient. In the therapeutic attempt, altered skin barrier function, possible provocation factors and psychological matters have to be taken into account. Basic therapy should comprise optimal skin care and the strict avoidance of triggering factors if possible. During periods of acute exacerbation, topical glucocorticosteroids in combination with classic antihistamines with sedative effects are still the drugs of first choice and will result in the rapid relief of symptoms in most patients. UVA1 phototherapy has proven to be a glucocorticoid-equivalent alternative therapy for exacerbated atopic dermatitis. If superinfection with Staphylococcus aureus is evident, topical antiseptics are useful in treating localized lesions, while a general superinfected eczema should be treated with systemic staphylococcal-effective antibacterials. Cyclosporin or extracorporeal photochemotherapy are reserved for patients with very severe atopic dermatitis that is unresponsive to conventional treatment protocols. Promising future therapeutic approaches consist of an improvement in the antipruritic treatment options, the topical application of immunomodifying treatment modalities or phosphodiesterase inhibitors, and possibly Chinese herbal therapies and psychological intervention strategies.