Guidelines for diagnostic testing in adults with presumed atopic dermatitis refractory to treatment

While many adults diagnosed with atopic dermatitis (AD) achieve disease control with standard treatments, a subset of patients remains refractory to optimal management. In these cases, misdiagnosis or the presence of concomitant conditions may be contributing to treatment failure.

To provide evidence-informed guidance for the diagnostic workup of presumed adult AD unresponsive to optimized treatment.

An expert multidisciplinary workgroup applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for issuing guidance on approaching suspected AD refractory to treatment by reviewing the indirect evidence, assessing the balance of benefits and harms, and reaching consensus.

The workgroup developed a Good Practice Statement on the diagnostic workup of adults with presumed AD unresponsive to therapy.

This guidance is based on indirect evidence and expert consensus, as direct empirical data on diagnostic workup strategies for treatment-resistant AD are lacking. Applicability may vary depending on access to dermatologic and allergy specialist care.

The Good Practice Statement supports consideration of diagnostic reassessment in cases of presumed AD in adults not responding to optimized treatment.