These issues may warrant an earlier referral to

Dermatology or Allergy/Immunology:

Atopic Dermatitis (AD)

(pruritus, characteristic morphology, typical
anatomic distribution)

INFECTION

History
Physical Exam

Review Atopic skincare

(bathing, emollients,
avoid triggers)

Obtain bacterial culture and consider HSV PCR

Mild or limited infection
Topical bacitracin, mupirocin, or retapamulin
Moderate infection
Oral clindamycin or cephalexin for empiric therapy unless
sensitivities indicate otherwise

Poor growth, decreasing velocity, or failure to thrive

Recurrent skin or systemic infections, particularly if unusually
prolonged or severe (including ear infections, sinus infections,
pneumonia, cellulitis, furuncles)
Symptoms of poor feeding or dysphagia
Recurrent or chronic nausea or vomiting
Recurrent or chronic diarrhea, especially with blood
Abnormal blood testing: leukopenia, anemia, thrombocytopenia,
marked eosinophilia, hypogammaglobulinemia, significantly
elevated IgE

Is there
evidence of infection?

YES

(fever, pustules, oozing, crust,

erosions?)

Severe infection
Hospital admission for intravenous antistaphylococcal antibiotic
therapy with clindamycin or vancomycin

NO

*Add acyclovir (PO or IV) depending on clinical context

Is the AD
Mild, Moderate or
Severe?

Mild
Atopic
Dermatitis

Moderate
Atopic
Dermatitis

Face / Folds

Body

Class 6-7 topical

steroid BID up to 4
weeks

Severe
Atopic
Dermatitis

Face / Folds

Body

Face / Folds

Body

Class 6 topical
steroid BID for 2-4
weeks (4wks max)
or TCI BID

Class 4-5 topical

steroid BID up to 4
weeks

Class 5 topical
steroid BID for 1-2
weeks (4 wks max)
or TCI BID

Class 2-3 topical

steroid BID up to 4
weeks

Treatment
effective at follow
up visit

YES

Mild: 1-3 months (may be an RN phone call)

Moderate: 1-2 months
Severe: 2-4 weeks

NO

MAINTENANCE
Is adherence to
treatment plan
suboptimal?

Re-emphasize atopic skin care and continue emollient use 1-2 times daily
Therapy Choices:
Proactive Intermittent Therapy
Use treatment medication twice weekly
Proactive Continuous Therapy
Petrolatum mixed 1:1 by parent with hydrocortisone 2.5% ointment BID
OR
A-Mantle cream 454 grams mixed with hydrocortisone acetate powder 5 grams used BID
Calcineurin Inhibitor Maintenance
Pimecrolimus 1% cream or tacrolimus 0.03% or 0.1% ointment twice daily initially, tapering to
twice weekly

YES

NO

Reassess severity
Re-educate patient and
family and repeat
original treatment plan
for Mild/Moderate/
Severe Atopic
Dermatitis

Discontinue therapy as appropriate if re-flares do not occur

Move to next level of

treatment:
Mild Moderate
Moderate Severe
(consider referral)
Severe REFER to
Dermatology or Allergy

NO
Does patient have
re-flares?

YES
Assess severity and reenter treatment
pathway for Mild/
Moderate/Severe
Atopic Dermatitis

Atopic Dermatitis Evaluation, Prevention & Treatment (ADEPT) Program

Last Revision: March 2012