key: cord-0888630-ksh02r5d authors: Shah, Monica; Sachdeva, Muskaan; Alavi, Afsaneh; Shi, Vivian Y.; Hsiao, Jennifer L. title: Optimizing Care for Atopic Dermatitis Patients During COVID-19 Pandemic date: 2020-05-13 journal: J Am Acad Dermatol DOI: 10.1016/j.jaad.2020.05.027 sha: 806d9710eeb1687a5412794fe9443a0787795113 doc_id: 888630 cord_uid: ksh02r5d nan States. 2 ED visits would currently place AD patients at high risk of contracting COVID-19, especially for 68 those on immunosuppressants. Continued outpatient care through telehealth platforms is vital to help 69 prevent and treat AD flares and to allow for early recognition and treatment of secondary bacterial 70 infections. Providers may examine patients' areas of concern via asynchronous or synchronous virtual 71 visits and reinforce eczema action plans that empower patients to self-treat mild flares, and to recognize 72 appropriate criteria to contact their provider. Reinforce proper skin care regimen • Advise patients to follow proper hand-washing techniques (preferred over hand sanitizers if accessible) as described by the CDC; use warm water and soap and wash hands for at least 20 seconds then gently pat skin until mostly dry • Instruct patients to apply moisturizer to hands immediately after washing hands each time • Counsel that hand sanitizer may be used if no access to water and soap, for example, when patient is outdoors or if patient without access to running water • Gentle cleansers and hand sanitizers that do not contain high-risk sensitizing ingredients (such as fragrance or unnecessary antiseptic ingredients) should be recommended to minimize risk of allergic contact dermatitis • Recommend applying a thick layer of a non-fragranced moisturizing cream or ointment like petroleum jelly to hands every night • Gloves should be worn when washing dishes or when cleaning with products such as disinfectant sprays • Counsel patients to wear cloth face coverings (surgical masks should be reserved for healthcare workers) in public settings as per CDC guidelines, and the masks should be made from cotton (instead of irritating fabrics such as wool) and free from synthetic dyes • The cloth masks should be laundered regularly along with other clothing items using fragrance-free detergent* that does not cause skin reactions in patients Provide access to telehealth encounters • Instruct patients to take photos of areas of concern for asynchronous store-andforward visit, or examine areas during synchronous video visit • Prioritize patients with complaint of AD flare to potentially diagnose and treat secondary infections (such as impetigo or eczema herpeticum) early • Reinforce eczema action plans to empower patients to self-manage mild AD flares at home Optimize AD treatment regimen*** • Taper broad immunosuppressants such as prednisone, methotrexate, mycophenolate, azathioprine, and cyclosporine to lowest effective dose; consider discontinuing these medications in patients when viral symptoms are present. 3 • Appropriate patients may be continued on dupilumab**; consider discontinuation if upper respiratory tract viral infection symptoms present • For patients with moderate to severe AD whose disease requires a new systemic agent during this time, starting dupilumab may be preferable to starting a traditional immunosuppressant, though more data is needed. • Discontinuation of Janus kinase inhibitors (JAKi) during the time of initial infection may be beneficial, though the potential role of JAKi treatment for the cytokine release syndrome is being investigated. 5 • Maximize pillars of AD treatment including bleach baths, moisturizers, and topical therapeutics Abbreviations: AD, atopic dermatitis; CDC, Centers for Disease Control and Prevention 136 *Studies on optimal frequency of washing cloth masks and optimal fabric to use for cloth masks to 137 specifically protect against COVID-19 exposure are lacking recent meta-analysis that pooled data from seven randomized, placebo-controlled dupilumab trials 139 found that dupilumab does not increase overall infections rates versus placebo 4 Decisions on whether to continue immunosuppressant or immunomodulating agents if patients show 141 symptoms concerning for COVID-19 should be made on a case None.