Recent developments in the management of patients with atopic dermatitis.

Management of most patients with AD should be directed toward basic therapy--lubricants, moderate potency topical steroids, and antihistamines. Only the severe or unresponsive patient should be considered for management with some of the techniques that have been discussed previously. In part, this is because the addition of extra therapy will substantially decrease long-term compliance, increase the cost of medical care, and produce a dissatisfied patient. There are, however, definite situations in which dietary manipulation, topical and systemic antiseptics, dietary supplementation, and ultraviolet light may be useful. The uses of environmental control, biofeedback, and coal tar were not discussed but may also be useful in certain situations. Finally, all physicians should realize that Herpes simplex infection in patients with AD can be a serious and sometimes life-threatening problem. Rapid, accurate diagnosis is the key to effective management with the newer anti-viral agents.