Annals of dermatology

Korean Dermatological Association (대한피부과학회)
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Consensus Guidelines for the Treatment of Atopic Dermatitis in Korea (Part II): Systemic Treatment

  • Kim, Jung Eun (Department of Dermatology, College of Medicine, The Catholic University of Korea) ;
  • Kim, Hyun Jeong (Department of Dermatology, Seoul Medical Center, Kyung Hee University College of Medicine) ;
  • Lew, Bark-Lynn (Department of Dermatology, Kyung Hee University College of Medicine) ;
  • Lee, Kyung Ho (Department of Dermatology, College of Medicine, The Catholic University of Korea) ;
  • Hong, Seung Phil (Department of Dermatology, Dankook University Medical College) ;
  • Jang, Yong Hyun (Department of Dermatology, Kyungpook National University School of Medicine) ;
  • Park, Kui Young (Department of Dermatology, Chung-Ang University College of Medicine) ;
  • Seo, Seong Jun (Department of Dermatology, Chung-Ang University College of Medicine) ;
  • Bae, Jung Min (Department of Dermatology, College of Medicine, The Catholic University of Korea) ;
  • Choi, Eung Ho (Department of Dermatology, Yonsei University Wonju College of Medicine) ;
  • Suhr, Ki Beom (Department of Dermatology, SA Dermatology Clinic) ;
  • Lee, Seung Chul (Department of Dermatology, Chonnam National University Medical School) ;
  • Ko, Hyun Chang (Department of Dermatology, Pusan National University School of Medicine) ;
  • Park, Young Lip (Department of Dermatology, Soonchunhyang University Bucheon Hospital) ;
  • Son, Sang Wook (Department of Dermatology, Korea University College of Medicine) ;
  • Seo, Young Jun (Department of Dermatology, Chungnam National University College of Medicine) ;
  • Lee, Yang Won (Department of Dermatology, Konkuk University School of Medicine) ;
  • Cho, Sang Hyun (Department of Dermatology, College of Medicine, The Catholic University of Korea) ;
  • Park, Chun Wook (Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Roh, Joo Young (Department of Dermatology, Gachon University Gil Medical Center)
  • Received : 2015.05.27
  • Accepted : 2015.08.16
  • Published : 2015.10.31
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Abstract

Background: Since the treatment guidelines for atopic dermatitis (AD) were issued by the Korean Atopic Dermatitis Association (KADA) work group in 2006, there have been further advances in the systemic treatment of AD. Objective: We aimed to establish updated evidence- and experience-based systemic treatment guidelines for Korean AD. Methods: We compiled a database of references from relevant systematic reviews and guidelines regarding the systemic management of AD, including antihistamines, antimicrobials, systemic immunomodulators, allergen-specific immunotherapy, phototherapy, adjunctive treatment, and complementary and alternative medicines. Evidence for each statement was graded and classified based on the strength of the recommendation. Thirty-nine council members of KADA participated in the three rounds of votes and expert consensus recommendations were established. Results: The use of antihistamines is recommended to relieve pruritus and to prevent exacerbation due to scratching in AD patients. Infection should be controlled as needed and long-term medication should be avoided. For moderate to severe AD patients, concomitant active treatments with systemic immunomodulators are indicated. Cyclosporine is the first choice among systemic immunomodulators and others should be considered as second-line alternatives. Allergen-specific immunotherapy could be effective in AD patients with aeroallergen hypersensitivity. Phototherapy can be useful for moderate to severe AD patients and narrow-band ultraviolet B is the most effective option. Complementary and alternative medicines cannot be recommended for treating AD. Conclusion: We expect these recommendations to be a reference guide for physicians and AD patients in choosing the appropriate treatment to improve quality of life and decrease unnecessary social medical costs.

Keywords

Acknowledgement

Supported by : Korean Atopic Dermatitis Association

References

  1. Kim SY, Jee SM, Lee SJ, Lee YJ, Park JE, Nam MH, et al. Guidance for development of clinical practice guidelines. 1st ed. Seoul: National Evidence-Based Healthcare Collaborating Agency, 2011:607-608.
  2. Phillips B, Ball C, Sackett D, Badenoch D, Straus S, Haynes B, et al. Oxford Centre for Evidence-based Medicine-Levels of evidence [Internet]. Oxford: Centre for Evidence Based Medicine; 2001 May [updated 2009 March; cited 2014 March 4]. Available froom: http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/.
  3. Sidbury R, Davis DM, Cohen DE, Cordoro KM, Berger TG, Bergman JN, et al; American Academy of Dermatology. Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol 2014;71:327-349. https://doi.org/10.1016/j.jaad.2014.03.030
  4. Kawashima M, Tango T, Noguchi T, Inagi M, Nakagawa H, Harada S. Addition of fexofenadine to a topical corticosteroid reduces the pruritus associated with atopic dermatitis in a 1-week randomized, multicentre, double-blind, placebocontrolled, parallel-group study. Br J Dermatol 2003;148:1212-1221. https://doi.org/10.1046/j.1365-2133.2003.05293.x
  5. Ring J, Alomar A, Bieber T, Deleuran M, Fink-Wagner A, Gelmetti C, et al. Guidelines for treatment of atopic eczema (atopic dermatitis) part I. J Eur Acad Dermatol Venereol 2012;26:1045-1060. https://doi.org/10.1111/j.1468-3083.2012.04635.x
  6. Diepgen TL; Early Treatment of the Atopic Child Study Group. Long-term treatment with cetirizine of infants with atopic dermatitis: a multi-country, double-blind, randomized, placebo-controlled trial (the ETAC trial) over 18 months. Pediatr Allergy Immunol 2002;13:278-286. https://doi.org/10.1034/j.1399-3038.2002.01047.x
  7. Langeland T, Fagertun HE, Larsen S. Therapeutic effect of loratadine on pruritus in patients with atopic dermatitis. A multi-crossover-designed study. Allergy 1994;49:22-26. https://doi.org/10.1111/j.1398-9995.1994.tb00768.x
  8. La Rosa M, Ranno C, Musarra I, Guglielmo F, Corrias A, Bellanti JA. Double-blind study of cetirizine in atopic eczema in children. Ann Allergy 1994;73:117-122.
  9. Wahlgren CF, Hägermark O, Bergstrom R. The antipruritic effect of a sedative and a non-sedative antihistamine in atopic dermatitis. Br J Dermatol 1990;122:545-551. https://doi.org/10.1111/j.1365-2133.1990.tb14732.x
  10. Boguniewicz M, Sampson H, Leung SB, Harbeck R, Leung DY. Effects of cefuroxime axetil on Staphylococcus aureus colonization and superantigen production in atopic dermatitis. J Allergy Clin Immunol 2001;108:651-652. https://doi.org/10.1067/mai.2001.118598
  11. Bath-Hextall FJ, Birnie AJ, Ravenscroft JC, Williams HC. Interventions to reduce Staphylococcus aureus in the management of atopic eczema: an updated Cochrane review. Br J Dermatol 2010;163:12-26. https://doi.org/10.1111/j.1365-2133.2010.09727.x
  12. Eichenfield LF, Tom WL, Berger TG, Krol A, Paller AS, Schwarzenberger K, et al. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol 2014;71:116-132. https://doi.org/10.1016/j.jaad.2014.03.023
  13. Wollenberg A, Zoch C, Wetzel S, Plewig G, Przybilla B. Predisposing factors and clinical features of eczema herpeticum: a retrospective analysis of 100 cases. J Am Acad Dermatol 2003;49:198-205. https://doi.org/10.1067/S0190-9622(03)00896-X
  14. Lübbe J. Secondary infections in patients with atopic dermatitis. Am J Clin Dermatol 2003;4:641-654. https://doi.org/10.2165/00128071-200304090-00006
  15. Lintu P, Savolainen J, Kortekangas-Savolainen O, Kalimo K. Systemic ketoconazole is an effective treatment of atopic dermatitis with IgE-mediated hypersensitivity to yeasts. Allergy 2001;56:512-517. https://doi.org/10.1034/j.1398-9995.2001.056006512.x
  16. Mayser P, Kupfer J, Nemetz D, Schafer U, Nilles M, Hort W, et al. Treatment of head and neck dermatitis with ciclopiroxolamine cream--results of a double-blind, placebocontrolled study. Skin Pharmacol Physiol 2006;19:153-158. https://doi.org/10.1159/000092596
  17. Flohr C, Irvine AD. Systemic therapies for severe atopic dermatitis in children and adults. J Allergy Clin Immunol 2013;132:774-774.e6. https://doi.org/10.1016/j.jaci.2013.03.016
  18. Haeck IM, Knol MJ, Ten Berge O, van Velsen SG, de Bruin-Weller MS, Bruijnzeel-Koomen CA. Enteric-coated mycophenolate sodium versus cyclosporin A as long-term treatment in adult patients with severe atopic dermatitis: a randomized controlled trial. J Am Acad Dermatol 2011;64:1074-1084. https://doi.org/10.1016/j.jaad.2010.04.027
  19. Roekevisch E, Spuls PI, Kuester D, Limpens J, Schmitt J. Efficacy and safety of systemic treatments for moderateto- severe atopic dermatitis: a systematic review. J Allergy Clin Immunol 2014;133:429-438. https://doi.org/10.1016/j.jaci.2013.07.049
  20. Berth-Jones J, Graham-Brown RA, Marks R, Camp RD, English JS, Freeman K, et al. Long-term efficacy and safety of cyclosporin in severe adult atopic dermatitis. Br J Dermatol 1997;136:76-81. https://doi.org/10.1111/j.1365-2133.1997.tb08750.x
  21. Forte WC, Sumita JM, Rodrigues AG, Liuson D, Tanaka E. Rebound phenomenon to systemic corticosteroid in atopic dermatitis. Allergol Immunopathol (Madr) 2005;33:307-311. https://doi.org/10.1016/S0301-0546(05)73248-1
  22. Garnacho-Saucedo G, Salido-Vallejo R, Moreno-Gimenez JC. Atopic dermatitis: update and proposed management algorithm. Actas Dermosifiliogr 2013;104:4-16. https://doi.org/10.1016/j.ad.2011.12.008
  23. Rubel D, Thirumoorthy T, Soebaryo RW, Weng SC, Gabriel TM, Villafuerte LL, et al; Asia-Pacific Consensus Group for Atopic Dermatitis. Consensus guidelines for the management of atopic dermatitis: an Asia-Pacific perspective. J Dermatol 2013;40:160-171. https://doi.org/10.1111/1346-8138.12065
  24. Schmitt J, Schakel K, Folster-Holst R, Bauer A, Oertel R, Augustin M, et al. Prednisolone vs. ciclosporin for severe adult eczema. An investigator-initiated double-blind placebo-controlled multicentre trial. Br J Dermatol 2010;162:661-668. https://doi.org/10.1111/j.1365-2133.2009.09561.x
  25. Daley-Yates PT, Richards DH. Relationship between systemic corticosteroid exposure and growth velocity: development and validation of a pharmacokinetic/pharmacodynamic model. Clin Ther 2004;26:1905-1919. https://doi.org/10.1016/j.clinthera.2004.11.017
  26. Czech W, Brautigam M, Weidinger G, Schopf E. A body-weight-independent dosing regimen of cyclosporine microemulsion is effective in severe atopic dermatitis and improves the quality of life. J Am Acad Dermatol 2000;42:653-659.
  27. El-Khalawany MA, Hassan H, Shaaban D, Ghonaim N, Eassa B. Methotrexate versus cyclosporine in the treatment of severe atopic dermatitis in children: a multicenter experience from Egypt. Eur J Pediatr 2013;172:351-356. https://doi.org/10.1007/s00431-012-1893-3
  28. Hoare C, Li Wan Po A, Williams H. Systematic review of treatments for atopic eczema. Health Technol Assess 2000;4:1-191.
  29. Berth-Jones J, Finlay AY, Zaki I, Tan B, Goodyear H, Lewis-Jones S, et al. Cyclosporine in severe childhood atopic dermatitis: a multicenter study. J Am Acad Dermatol 1996;34:1016-1021. https://doi.org/10.1016/S0190-9622(96)90281-9
  30. Zurbriggen B, Wuthrich B, Cachelin AB, Wili PB, Kagi MK. Comparison of two formulations of cyclosporin A in the treatment of severe atopic dermatitis. Aa double-blind, single-centre, cross-over pilot study. Dermatology 1999;198:56-60. https://doi.org/10.1159/000018065
  31. Berth-Jones J, Takwale A, Tan E, Barclay G, Agarwal S, Ahmed I, et al. Azathioprine in severe adult atopic dermatitis: a double-blind, placebo-controlled, crossover trial. Br J Dermatol 2002;147:324-330. https://doi.org/10.1046/j.1365-2133.2002.04989.x
  32. Schram ME, Roekevisch E, Leeflang MM, Bos JD, Schmitt J, Spuls PI. A randomized trial of methotrexate versus azathioprine for severe atopic eczema. J Allergy Clin Immunol 2011;128:353-359. https://doi.org/10.1016/j.jaci.2011.03.024
  33. Schmedt N, Andersohn F, Garbe E. Signals of progressive multifocal leukoencephalopathy for immunosuppressants: a disproportionality analysis of spontaneous reports within the US Adverse Event Reporting System (AERS). Pharmacoepidemiol Drug Saf 2012;21:1216-1220. https://doi.org/10.1002/pds.3320
  34. Meggitt SJ, Gray JC, Reynolds NJ. Azathioprine dosed by thiopurine methyltransferase activity for moderate-to-severe atopic eczema: a double-blind, randomised controlled trial. Lancet 2006;367:839-846. https://doi.org/10.1016/S0140-6736(06)68340-2
  35. Caufield M, Tom WL. Oral azathioprine for recalcitrant pediatric atopic dermatitis: clinical response and thiopurine monitoring. J Am Acad Dermatol 2013;68:29-35. https://doi.org/10.1016/j.jaad.2012.07.001
  36. Ballester I, Silvestre JF, Perez-Crespo M, Lucas A. Severe adult atopic dermatitis: treatment with mycophenolate mofetil in 8 patients. Actas Dermosifiliogr 2009;100:883-887. https://doi.org/10.1016/S0001-7310(09)72917-5
  37. Heller M, Shin HT, Orlow SJ, Schaffer JV. Mycophenolate mofetil for severe childhood atopic dermatitis: experience in 14 patients. Br J Dermatol 2007;157:127-132. https://doi.org/10.1111/j.1365-2133.2007.07947.x
  38. Bae JM, Choi YY, Park CO, Chung KY, Lee KH. Efficacy of allergen-specific immunotherapy for atopic dermatitis: a systematic review and meta-analysis of randomized controlled trials. J Allergy Clin Immunol 2013;132:110-117. https://doi.org/10.1016/j.jaci.2013.02.044
  39. Cox L, Nelson H, Lockey R, Calabria C, Chacko T, Finegold I, et al. Allergen immunotherapy: a practice parameter third update. J Allergy Clin Immunol 2011;127(1 Suppl):S1-S55. https://doi.org/10.1016/j.jaci.2010.09.034
  40. Burks AW, Calderon MA, Casale T, Cox L, Demoly P, Jutel M, et al. Update on allergy immunotherapy: American Academy of Allergy, Asthma & Immunology/European Academy of Allergy and Clinical Immunology/PRACTALL consensus report. J Allergy Clin Immunol 2013;131:1288-1296.e3. https://doi.org/10.1016/j.jaci.2013.01.049
  41. Bussmann C, Bockenhoff A, Henke H, Werfel T, Novak N. Does allergen-specific immunotherapy represent a therapeutic option for patients with atopic dermatitis? J Allergy Clin Immunol 2006;118:1292-1298. https://doi.org/10.1016/j.jaci.2006.07.054
  42. Bussmann C, Maintz L, Hart J, Allam JP, Vrtala S, Chen KW, et al. Clinical improvement and immunological changes in atopic dermatitis patients undergoing subcutaneous immunotherapy with a house dust mite allergoid: a pilot study. Clin Exp Allergy 2007;37:1277-1285. https://doi.org/10.1111/j.1365-2222.2007.02783.x
  43. Werfel T, Breuer K, Rueff F, Przybilla B, Worm M, Grewe M, et al. Usefulness of specific immunotherapy in patients with atopic dermatitis and allergic sensitization to house dust mites: a multi-centre, randomized, dose-response study. Allergy 2006;61:202-205. https://doi.org/10.1111/j.1398-9995.2006.00974.x
  44. Novak N, Bieber T, Hoffmann M, Folster-Holst R, Homey B, Werfel T, et al. Efficacy and safety of subcutaneous allergen-specific immunotherapy with depigmented polymerized mite extract in atopic dermatitis. J Allergy Clin Immunol 2012;130:925-931.e4. https://doi.org/10.1016/j.jaci.2012.08.004
  45. Pajno GB, Caminiti L, Vita D, Barberio G, Salzano G, Lombardo F, et al. Sublingual immunotherapy in mitesensitized children with atopic dermatitis: a randomized, double-blind, placebo-controlled study. J Allergy Clin Immunol 2007;120:164-170. https://doi.org/10.1016/j.jaci.2007.04.008
  46. Garritsen FM, Brouwer MW, Limpens J, Spuls PI. Photo(chemo)therapy in the management of atopic dermatitis: an updated systematic review with implications for practice and research. Br J Dermatol 2014;170:501-513. https://doi.org/10.1111/bjd.12645
  47. Meduri NB, Vandergriff T, Rasmussen H, Jacobe H. Phototherapy in the management of atopic dermatitis: a systematic review. Photodermatol Photoimmunol Photomed 2007;23:106-112. https://doi.org/10.1111/j.1600-0781.2007.00291.x
  48. Tintle S, Shemer A, Suárez-Fariñas M, Fujita H, Gilleaudeau P, Sullivan-Whalen M, et al. Reversal of atopic dermatitis with narrow-band UVB phototherapy and biomarkers for therapeutic response. J Allergy Clin Immunol 2011;128:583-593.e1-4. https://doi.org/10.1016/j.jaci.2011.05.042
  49. Grundmann SA, Beissert S. Modern aspects of phototherapy for atopic dermatitis. J Allergy (Cairo) 2012;2012:121797.
  50. Suh KS, Kang JS, Baek JW, Kim TK, Lee JW, Jeon YS, et al. Efficacy of ultraviolet A1 phototherapy in recalcitrant skin diseases. Ann Dermatol 2010;22:1-8. https://doi.org/10.5021/ad.2010.22.1.1
  51. Tzaneva S, Seeber A, Schwaiger M, Honigsmann H, Tanew A. High-dose versus medium-dose UVA1 phototherapy for patients with severe generalized atopic dermatitis. J Am Acad Dermatol 2001;45:503-507. https://doi.org/10.1067/mjd.2001.114743
  52. Gambichler T, Othlinghaus N, Tomi NS, Holland-Letz T, Boms S, Skrygan M, et al. Medium-dose ultraviolet (UV) A1 vs. narrowband UVB phototherapy in atopic eczema: a randomized crossover study. Br J Dermatol 2009;160:652-658. https://doi.org/10.1111/j.1365-2133.2008.08984.x
  53. Majoie IM, Oldhoff JM, van Weelden H, Laaper-Ertmann M, Bousema MT, Sigurdsson V, et al. Narrowband ultraviolet B and medium-dose ultraviolet A1 are equally effective in the treatment of moderate to severe atopic dermatitis. J Am Acad Dermatol 2009;60:77-84. https://doi.org/10.1016/j.jaad.2008.08.048
  54. Panahi Y, Davoudi SM, Madanchi N, Abolhasani E. Recombinant human interferon gamma (Gamma Immunex) in treatment of atopic dermatitis. Clin Exp Med 2012;12:241-245. https://doi.org/10.1007/s10238-011-0164-3
  55. Hanifin JM, Schneider LC, Leung DY, Ellis CN, Jaffe HS, Izu AE, et al. Recombinant interferon gamma therapy for atopic dermatitis. J Am Acad Dermatol 1993;28:189-197. https://doi.org/10.1016/0190-9622(93)70026-P
  56. D'Erme AM, Milanesi N, Agnoletti AF, Maio V, Massi D, Gola M. Efficacy of treatment with oral alitretinoin in patient suffering from lichen simplex chronicus and severe atopic dermatitis of hands. Dermatol Ther 2014;27:21-23. https://doi.org/10.1111/dth.12035
  57. Stiller MJ, Shupack JL, Kenny C, Jondreau L, Cohen DE, Soter NA. A double-blind, placebo-controlled clinical trial to evaluate the safety and efficacy of thymopentin as an adjunctive treatment in atopic dermatitis. J Am Acad Dermatol 1994;30:597-602. https://doi.org/10.1016/S0190-9622(94)70068-0
  58. Taieb A, Seneschal J, Mossalayi MD. Biologics in atopic dermatitis. J Dtsch Dermatol Ges 2012;10:174-178.
  59. Kim DH, Park KY, Kim BJ, Kim MN, Mun SK. Antiimmunoglobulin E in the treatment of refractory atopic dermatitis. Clin Exp Dermatol 2013;38:496-500. https://doi.org/10.1111/j.1365-2230.2012.04438.x
  60. Simon D, Hosli S, Kostylina G, Yawalkar N, Simon HU. Anti-CD20 (rituximab) treatment improves atopic eczema. J Allergy Clin Immunol 2008;121:122-128. https://doi.org/10.1016/j.jaci.2007.11.016
  61. Moul DK, Routhouska SB, Robinson MR, Korman NJ. Alefacept for moderate to severe atopic dermatitis: a pilot study in adults. J Am Acad Dermatol 2008;58:984-989. https://doi.org/10.1016/j.jaad.2008.02.007
  62. Oldhoff JM, Darsow U, Werfel T, Katzer K, Wulf A, Laifaoui J, et al. Anti-IL-5 recombinant humanized monoclonal antibody (mepolizumab) for the treatment of atopic dermatitis. Allergy 2005;60:693-696. https://doi.org/10.1111/j.1398-9995.2005.00791.x
  63. Kim SO, Ah YM, Yu YM, Choi KH, Shin WG, Lee JY. Effects of probiotics for the treatment of atopic dermatitis: a meta-analysis of randomized controlled trials. Ann Allergy Asthma Immunol 2014;113:217-226. https://doi.org/10.1016/j.anai.2014.05.021
  64. Panduru M, Panduru NM, Salavastru CM, Tiplica GS. Probiotics and primary prevention of atopic dermatitis: a meta-analysis of randomized controlled studies. J Eur Acad Dermatol Venereol 2015;29:232-242. https://doi.org/10.1111/jdv.12496
  65. Mohajeri S, Newman SA. Review of evidence for dietary influences on atopic dermatitis. Skin Therapy Lett 2014;19:5-7.
  66. Bamford JT, Ray S, Musekiwa A, van Gool C, Humphreys R, Ernst E. Oral evening primrose oil and borage oil for eczema. Cochrane Database Syst Rev 2013;4:CD004416.
  67. Morse NL, Clough PM. A meta-analysis of randomized, placebo-controlled clinical trials of Efamol evening primrose oil in atopic eczema. Where do we go from here in light of more recent discoveries? Curr Pharm Biotechnol 2006;7:503-524. https://doi.org/10.2174/138920106779116946
  68. Camargo CA Jr, Ganmaa D, Sidbury R, Erdenedelger Kh, Radnaakhand N, Khandsuren B. Randomized trial of vitamin D supplementation for winter-related atopic dermatitis in children. J Allergy Clin Immunol 2014;134:831-835.e1. https://doi.org/10.1016/j.jaci.2014.08.002
  69. Hata TR, Audish D, Kotol P, Coda A, Kabigting F, Miller J, et al. A randomized controlled double-blind investigation of the effects of vitamin D dietary supplementation in subjects with atopic dermatitis. J Eur Acad Dermatol Venereol 2014;28:781-789. https://doi.org/10.1111/jdv.12176
  70. Bath-Hextall FJ, Jenkinson C, Humphreys R, Williams HC. Dietary supplements for established atopic eczema. Cochrane Database Syst Rev 2012;2:CD005205.
  71. Higgins E, Bennett M, Murphy A, Markham T. Disseminated parapox (orf) in a 13-year-old boy with atopic dermatitis following acupuncture. Clin Exp Dermatol 2011;36:809-811. https://doi.org/10.1111/j.1365-2230.2011.04077.x
  72. Tan HY, Zhang AL, Chen D, Xue CC, Lenon GB. Chinese herbal medicine for atopic dermatitis: a systematic review. J Am Acad Dermatol 2013;69:295-304. https://doi.org/10.1016/j.jaad.2013.01.019
  73. Perharic L, Shaw D, Leon C, De Smet PA, Murray VS. Possible association of liver damage with the use of Chinese herbal medicine for skin disease. Vet Hum Toxicol 1995;37:562-566.
  74. Oranje AP, Glazenburg EJ, Wolkerstorfer A, de Waard-van der Spek FB. Practical issues on interpretation of scoring atopic dermatitis: the SCORAD index, objective SCORAD and the three-item severity score. Br J Dermatol 2007;157:645-648. https://doi.org/10.1111/j.1365-2133.2007.08112.x
  75. Hanifin JM, Thurston M, Omoto M, Cherill R, Tofte SJ, Graeber M. The eczema area and severity index (EASI): assessment of reliability in atopic dermatitis. EASI Evaluator Group. Exp Dermatol 2001;10:11-18. https://doi.org/10.1034/j.1600-0625.2001.100102.x
  76. Choi WJ, Ko JY, Kim JW, Lee KH, Park CW, Kim KH, et al. Prevalence and risk factors for atopic dermatitis: a cross-sectional study of 6,453 Korean preschool children. Acta Derm Venereol 2012;92:467-471. https://doi.org/10.2340/00015555-1252
  77. Shin JY, Kim DW, Park CW, Seo SJ, Park YL, Lee JR, et al. An educational program that contributes to improved patient and parental understanding of atopic dermatitis. Ann Dermatol 2014;26:66-72. https://doi.org/10.5021/ad.2014.26.1.66
  78. Seo SJ. Research of understanding and social loss of atopic dermatitis in Korea. Seoul: Korean Center for Disease Control and Prevention (Korea); 2011 Feb. Report No.:2010 E 3302600.
  79. Kim JE, Lee YB, Lee JH, Kim HS, Lee KH, Park YM, et al. Disease awareness and management behavior of patients with atopic dermatitis: a questionnaire survey of 313 patients. Ann Dermatol 2015;27:40-47. https://doi.org/10.5021/ad.2015.27.1.40

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  8. A clinician's reference guide for the management of atopic dermatitis in Asians vol.8, pp.4, 2015, https://doi.org/10.5415/apallergy.2018.8.e41
  9. Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement vol.178, pp.3, 2015, https://doi.org/10.1111/bjd.15928
  10. Immediate Hypersensitivity Reactions Induced by Triamcinolone in a Patient with Atopic Dermatitis vol.33, pp.12, 2018, https://doi.org/10.3346/jkms.2018.33.e87
  11. 학령전기 아토피피부염 아동 어머니의 스트레스 경험 vol.24, pp.2, 2015, https://doi.org/10.4094/chnr.2018.24.2.166
  12. Association of Pediatric Atopic Dermatitis and Cataract Development and Surgery vol.136, pp.8, 2015, https://doi.org/10.1001/jamaophthalmol.2018.2166
  13. 2019 Consensus Korean Diagnostic Guidelines to Define Severity Classification and Treatment Refractoriness for Atopic Dermatitis: Objective and Subjective Assessment of Severity vol.31, pp.6, 2015, https://doi.org/10.5021/ad.2019.31.6.654
  14. A comparison of international management guidelines for atopic dermatitis vol.36, pp.1, 2015, https://doi.org/10.1111/pde.13678
  15. Wet wrap therapy in atopic dermatitis vol.7, pp.1, 2015, https://doi.org/10.4168/aard.2019.7.1.1
  16. The efficacy of wet wrap therapy in children with atopic dermatitis in a single center vol.7, pp.1, 2015, https://doi.org/10.4168/aard.2019.7.1.13
  17. 아토피피부염 및 건선 환자 증례를 통한 상한론 백호탕 조문의 '면구(面垢)'에 대한 새로운 해석 vol.34, pp.1, 2015, https://doi.org/10.15188/kjopp.2020.02.34.1.45
  18. Quality Indicators in Care of Patients With Atopic Dermatitis: Consensus Document of the Spanish Academy of Dermatology and Venereology vol.111, pp.7, 2015, https://doi.org/10.1016/j.adengl.2019.06.009
  19. A New Era in the Management of Atopic Dermatitis vol.13, pp.5, 2021, https://doi.org/10.1097/jdn.0000000000000634
  20. Consensus Update for Systemic Treatment of Atopic Dermatitis vol.33, pp.6, 2021, https://doi.org/10.5021/ad.2021.33.6.497
  21. Burden of Disease, Unmet Needs in the Diagnosis and Management of Atopic Dermatitis: An Indian Expert Consensus vol.14, pp.None, 2015, https://doi.org/10.2147/ccid.s327593
  22. Current treatments for atopic dermatitis in Japan vol.48, pp.2, 2015, https://doi.org/10.1111/1346-8138.15730
  23. Effect of a new cryotherapy device on an itchy sensation in patients with mild atopic dermatitis vol.20, pp.9, 2015, https://doi.org/10.1111/jocd.13975
  24. Corneal transplantation for keratoconus in South Korea vol.11, pp.1, 2015, https://doi.org/10.1038/s41598-021-92133-y
  25. Synergistic Effects of Korean Red Ginseng Extract and the Conventional Systemic Therapeutics of Atopic Dermatitis in a Murine Model vol.14, pp.1, 2015, https://doi.org/10.3390/nu14010133