A multidisciplinary American Academy of Dermatology workgroup used GRADE methods to address adults with presumed atopic dermatitis that does not respond to optimised treatment. Published on 31 August 2026, it issued a Good Practice Statement supporting diagnostic reassessment in these patients.
The reasoning is that misdiagnosis or a coexisting condition often explains failure. The statement rests on indirect evidence and expert consensus, because direct comparisons of work-up strategies do not exist, and the authors note that applicability depends on access to specialist services.
In practice, the differential for apparently resistant adult eczema includes allergic contact dermatitis, scabies, tinea, psoriasis, drug eruptions and cutaneous T-cell lymphoma. Adult-onset disease without an atopic history should raise the index of suspicion.
The change is in sequence: confirm the diagnosis before moving to systemic or biologic therapy, rather than escalating on the assumption that the diagnosis is right.
- Re-examine the diagnosis in adult eczema that fails optimised treatment.
- Consider patch testing for allergic contact dermatitis.
- Check for scabies and tinea, including skin scrapings where appropriate.
- Biopsy atypical or persistent plaques to exclude cutaneous T-cell lymphoma.
- Be more suspicious when eczema starts in adulthood without an atopic history.
Why it matters
Escalating to systemic therapy on the wrong diagnosis delays the right treatment and exposes patients to unnecessary drugs.
Don't overread it
This is a Good Practice Statement based on indirect evidence, not a tested diagnostic algorithm.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for dermatology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free