Dr Alexandra Golant provided an overview of the evolving landscape of atopic dermatitis (AD) treatment, focusing on new insights into AD pathogenesis and therapeutic advancements that are reshaping AD management. AD is recognized as a highly heterogeneous disease with phenotypes that can be correlated with the presence of specific helper T-cells (eg, Th1, Th2, Th17, Th22) and associated cytokines. 

Golant highlighted the critical question of when clinicians should consider the use of systemic agents in managing AD. Systemic treatments have been deemed appropriate for patients with moderate-to-severe disease. Most importantly, it is essential to understand the definition of “moderate-to-severe” disease as well as other factors that could qualify patients for systemic therapy. Patients who may be candidates for systemic therapies have the following characteristics: at least 10% body surface area (BSA) involvement, inadequate disease control after topicals, or a significant impact on quality of life (QoL)—affecting social, emotional, and school or professional functioning. Other indications include individual lesions with moderate-to-severe features or involvement of highly visible or functionally important areas (eg, the face, hands, or genitals). 

AD management has had significant strides, evolving from limited options to a range of targeted therapies, thanks to advances in drug development and a deeper understanding of AD cytokine pathways. 

Several new topical therapies for AD have emerged, including ruxolitinib, roflumilast, tapinarof, and delgocitinib. Systemic treatments targeting cytokines and JAK enzymes involved in AD pathogenesis include dupilumab, lebrikizumab, tralokinumab, nemolizumab, tofacitinib, ruxolitinib, baricitinib, delgocitinib, abrocitinib, and upadacitinib. 

The efficacy and side effect profile of newer treatments have led to recent updates to the American Academy of Dermatology (AAD) guidelines, which now recommend the newer systemic treatments for moderate-to-severe AD, while cautioning against the use of systemic corticosteroids due to serious side effects. Both the AAD and American Academy of Allergy, Asthma & Immunology (AAAAI) guidelines strongly recommend dupilumab and tralokinumab for managing moderate-to-severe AD in adults, with a high level of evidence. 

Despite the growing number of available therapies, new drugs in development still aim to more precisely target AD-associated molecules. Future treatments will focus on targeting immune pathways such as IL-22, OX40, and IL-18, with ongoing trials showing promising results.