AAD Atopic Dermatitis Guidelines 2024

Baseline Management — All Patients

Start here for every patient with AD

These three pillars apply regardless of severity — ensure optimised before escalating therapy

Severity Assessment

Assess clinical signs, symptom severity, quality of life impact, and comorbidities at every visit. Document EASI, POEM, and itch NRS.

Trigger Avoidance

Identify and counsel on trigger avoidance — allergens, irritants, sweat, stress, and climate. Patch test if contact dermatitis suspected.

Baseline Therapy

Moisturisers/emollients daily. Optimised bathing practices (lukewarm, brief, pat dry, apply emollient immediately after).

Step 1 — Disease Severity

What is the patient's current AD severity?

Select the severity that best reflects the patient's disease burden, quality of life impact, and response to baseline therapy

Mild to Moderate AD

Localised or moderate extent — manageable with topical therapies. Limited QOL impact. Topical corticosteroids (TCS) or calcineurin inhibitors (TCIs) appropriate as first step.

Moderate to Severe AD

Widespread disease, substantially impaired QOL, or inadequate response to optimised topical therapy — consider phototherapy or systemic treatment

Step 2 — Topical Therapy (Fig 1)

Current status with topical therapy?

Topical therapy is first-line for mild-moderate AD. All are FDA-approved for atopic dermatitis.

Adequate control with topicals

Symptoms well-managed with current topical regimen — continue maintenance and monitor

Refractory to optimised topicals

Inadequate control despite optimised TCS, TCIs, crisaborole, or ruxolitinib — consider escalation to phototherapy or systemic

Step 2 — Systemic Treatment History (Fig 1 + Table III)

What systemic therapies have been tried?

Select the current treatment stage — this determines which agents are appropriate and FDA-approved

No prior systemic therapy

Topical refractory — first systemic agent required. Biologics and phototherapy available as first-line options.

Failed or intolerant to biologic

Inadequate response to dupilumab or tralokinumab — JAK inhibitors (upadacitinib, abrocitinib) or alternative systemic indicated

On/considering older immunosuppressants

Cyclosporine, methotrexate, azathioprine, or mycophenolate — when newer agents unavailable, contraindicated, or cost-prohibitive

Acute severe exacerbation — bridge needed

Acute, severe flare requiring urgent short-term control while establishing or bridging to a corticosteroid-sparing therapy

Step 3 — Patient Factors & Contraindications

Check all applicable patient factors

These modify which agents are preferred or require additional caution — based on AAD 2024 safety guidance

Atopic Dermatitis AAD 2024