Atopic Dermatitis Clinical Pathway — All Settings

Discharge/Follow-up Recommendations

General Skin Care	Skin care recommendations Bathe in lukewarm water for 5-10 minutes, unless irritated skin Emollients twice daily Wet wraps Bleach baths Decrease irritation Trigger avoidance General skin care recommendations for all children with AD
Acute Flare Plan	Acute Flare Treatment based on AD Severity Prescribe 60-80 g tube for 14 days of treatment Atopic Dermatitis Flare Plan
Maintenance Plan	Goal to use least amount of medication to keep child symptom-free Decrease use of topical steroids to 1-2 times weekly in hot-spot areas as needed Consider medicated moisturizer if AD is widespread Combine hydrocortisone 2.5% ointment with petroleum jelly or emollient 1:1 Apply twice daily, can decrease to once daily If concern about use of topical steroids for maintenance Eyelids, face, genital area Areas of steroid atrophy Can substitute: Pimecrolimus: (Elidel^®) 1% cream Tacrolimus: (Protopic^®) 0.03% and 0.1% ointment Crisaborole (Eucrisa^®) 2% ointment May require pre-authorization
Follow-up Recommendations	PCP Follow-up Mild: As needed Moderate, Severe: 2-4 weeks Dermatology within 2-3 days Uncertain diagnosis Possibility of: Contact dermatitis Psoriasis Fungal Infection History of recurrent skin infections Extensive/severe disease Management to date has not controlled symptoms Suspect need for Class 1 topical steroids Allergy Mod/severe atopic dermatitis and known/suspected food allergies/asthma Environmental triggers suspected Concomitant moderate or severe asthma Infants with severe atopic dermatitis Immunology Immunodeficiency History of recurrent fractures or infections in older children Infants with severe atopic dermatitis and growth concerns, infections

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Atopic Dermatitis Clinical Pathway — All Settings

Discharge/Follow-up Recommendations

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Atopic Dermatitis — Discharge/Follow-up Recommendations — Clinical Pathway: All Settings

Atopic Dermatitis Clinical Pathway — All Settings

Discharge/Follow-up Recommendations