Clinicians are often challenged in the primary care setting with children who present with moderate-severe recalcitrant atopic dermatitis. Many patients present at the subspecialist level grossly undertreated with topical medications and emollients. Recently, numerous clinical investigations have evolved our understanding of the pathogenesis of atopic dermatitis, and the American Academy of Dermatology released new atopic dermatitis guidelines in 2014. Understanding the groundbreaking discoveries in disease pathogenesis and implementing up-to-date management guidelines in clinical practice are critical for pediatricians.

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Atopic dermatitis (AD) is a chronic pruritic inflammatory skin disease with a frequently remitting and relapsing course. It is postulated as the first manifestation of the “atopic march”—often preceding the later development of food allergies, allergic rhinitis, and asthma. The terms atopic dermatitis and eczema are commonly used interchangeably to describe eczematous dermatitis, although technically there are eczemas other than AD, including allergic...

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