Evidence-to-Recommendation Framework for 2026 ACE Clinical Guideline on mild and moderate atopic dermatitis (eczema) - a journey from flare to care

This Evidence-to-Recommendation (EtR) framework underpins the ACE Clinical Guideline (ACG) for the management of mild and moderate atopic dermatitis (AD), providing rationale and justifications for the guideline recommendations. Atopic dermatitis is highly prevalent in Singapore, with a significant impact on quality of life, psychological burden and healthcare utilisation costs. The ACG addresses management gaps, including diagnostic uncertainty, inappropriate prescribing and suboptimal treatment adherence, that contribute to unnecessary specialist referrals and poor clinical outcomes. The Grading of Recommendations Assessment, Development and Evaluation framework was followed to develop nine evidence-based recommendations that cover AD diagnosis, severity assessment, trigger management and pharmacological interventions, including the use of topical anti-inflammatories and proactive therapy strategies. This EtR framework summarises the factors that have informed the direction and strength of the ACG recommendations, including balance of benefits and risks, certainty of evidence, patient preferences and values, resources and feasibility considerations, and acceptability.