An update to the atopic dermatitis (AD) practice parameter was published in 2013 
using an established grading system for determining category of evidence and 
strength of recommendation. Since the previous update in 2004, a number of 
seminal observations regarding skin barrier and immune dysregulation in AD have 
been made with important therapeutic implications. A key addition to the 
treatment algorithm based on our understanding that normal-appearing skin in 
patients with AD is not normal is proactive therapy. Studies with both topical 
steroids and a topical calcineurin inhibitor have shown that in patients with 
relapsing AD, if they are able to clear or almost clear their eczema, then 
twice-weekly proactive treatment of normal-appearing skin that tends to flare 
leads to better disease control. For difficult-to-manage patients, the value of 
wet wrap therapy is reaffirmed in the practice parameter update. In addition, 
allergen immunotherapy is now a consideration in select patients with AD and 
aeroallergen sensitivity. Beyond the practice parameter, novel approaches to 
filaggrin deficiency are being evaluated. With respect to immune dysregulation, 
dupilumab, a fully human monoclonal antibody directed at the IL-4 receptor alpha 
subunit was recently shown to be effective in treating adults with 
moderate-to-severe AD.