松永 佳世子 先生（藤田保健衛生大学医学部皮膚科 教授）
Because atopic dermatitis (AD) is a disease for which sufficient patient explanations and compliance with treatment and adherence should be taken into consideration, standard guidelines for the management (diagnosis, severity classification and therapy) of AD have been established. Standard guidelines for the management of AD were developed by the Japanese Dermatological Association for the first time in 2000, with the latest versions being revised in 2009. The standard therapies for AD consist of topical corticosteroids and tacrolimus ointment, systemic antihistamines and anti-allergic drugs as well as topical application of emollients (skincare). Skincare plays a major role in the progress of AD treatment.
In my presentation, reference is made to the elements required for skincare products simultaneously with the explanation about how to use skincare products and the importance of communication with the AD patient. Since the main purpose of skincare is to complement dryness and skin barrier dysfunction, it is also required to keep the skin clean and to protect from ultraviolet rays in addition to basic moisturizing effects. To complement the effective treatment of AD, the skin care products are insufficient that it is just effective, and safety must be checked by clinical and patch testing. For type or formulation, I recommend products that meet basic patient needs. It is necessary to spend sufficient time on guiding patients, and explaining the cause, the mechanism of skin dryness, and the importance of skin care.
Kyu Han Kim 先生（ソウル国立大学 医学部皮膚科 教授）
We first recommend and educate patients or parents to pay special attention to general precautions to reduce or avoid aggravating factors and to take care of their dry skin. Then we prescribe topical corticosteroids (TCSs) as the first topical anti-inflammatory agent and then topical calcineurin inhibitors (TCIs) as the 2nd drug especially in head and neck lesions refractory to TCSs. To reduce the frequency of applications of TCSs, we strongly recommend patients that dryness of the skin be first managed with emollients as much as possible. These days much more emphasis is given on the proper skin care by frequent use of emollients. General recommendation is that emollients should be applied 2 times a day within 3 min after bath. There are many kinds of emollients, and some contain ceramide or ceramide with a specialized multi-lamellar structure similar to the physiologic lipid from the stratum corneum. Emollients made of special formula containing ceramide would be more promising for the treatment of AD, but the expecting superior efficacy over ordinary emollients has not been proved scientifically. Each skin care product (soaps, emollients and sunscreens) should not have any irritation or allergic potential, and have sufficient hydration or moisturizing capacity. Next we usually add antihistamines to reduce pruritus to a certain extent. Systemic antibiotics are used to treat acute flare up of AD occurred frequently after infection. In very severe patients other treatment modalities including immunosuppressants or immune modulators are tried.