How has the AAD atopic dermatitis guideline changed your threshold to start systemic therapy rather than rotating topicals in a child with persistent atopic dermatitis despite good adherence?

For me, this has not changed my practice as I have always started systemic therapy early in patients with atopic dermatitis. I find these new updated guidelines reinforce what I believe to be the correct practice. Although we don't have a perfectly matched set of guidelines for AD as we do with psor...