In this year-end episode of Topical Conversations, Dr Peter Lio provides an insightful overview of the evolving landscape of atopic dermatitis (AD) treatments and trends to watch in 2025. With advancements in AD care beginning to close the gap with psoriasis, Dr Lio shares practical recommendations to help dermatologists prioritize areas for education and optimize patient care. 

Advancements in atopic dermatitis treatments: catching up with psoriasis 

Dr Lio notes that AD care is undergoing a significant evolution, with a wave of new treatment options raising the bar for patient outcomes. He explains how the expanding therapeutic toolbox challenges dermatologists to reevaluate whether current treatments are meeting patients' needs—and whether there’s room to do better. 

The rise of nonsteroidal topicals 

For decades, corticosteroids were the cornerstone of topical AD therapy. However, the introduction of nonsteroidal options has shifted the paradigm: 

• Tacrolimus and pimecrolimus (approved in 2000–2001): These calcineurin inhibitors offered the first robust nonsteroidal options but are not suitable for everyone due to boxed warnings, stinging, and burning 
• Crisaborole (2016): As the first PDE4 inhibitor approved for dermatologic use, it paved the way for this class but faced challenges with tolerability 
• Topical ruxolitinib (2021): A JAK inhibitor, it is one of the most potent nonsteroidal options. While effective, its boxed warning requires cautious use, limiting application to less than 20% of body surface area and avoiding continuous treatment. 
• Topical roflumilast (2024): Previously approved for psoriasis and expanding into AD in 2024, this once-daily PDE4 inhibitor offers ease of use and no boxed warning, making it ideal for proactive, long-term management 
• Tapinarof (2024): Recently approved for AD, this aryl hydrocarbon receptor agonist shows promise for its potential remittive effect, allowing extended results even after treatment cessation. However, dermatologists must work toward defining remission and its distinction from cure. 

Biologics and systemic advances 

Dr Lio also reviews biologic therapies that are revolutionizing moderate-to-severe AD treatment, offering targeted solutions: 

• Lebrikizumab (2024): Targeting IL-13, this biologic binds differently than existing IL-13 inhibitors, demonstrating high affinity and potentially enhancing patient outcomes 
• Nemolizumab (2024): Approved for prurigo nodularis and now AD, it works via a novel pathway, further diversifying systemic options for dermatologists 

What 2025 holds for atopic dermatitis 

Dr Lio remarks that with a robust and diverse treatment toolbox, dermatologists are better equipped than ever to manage AD. This new era calls for: 

• Shared decision-making: Engaging patients in treatment planning to align with their goals and preferences 
• Stewardship of medications: Balancing efficacy, safety, cost, and access to deliver patient-centered care 
• Innovative approaches: Exploring new treatment strategies, including acute care, long-term maintenance, and proactive management 

Dr Lio emphasizes that the wealth of new options allows dermatologists to offer renewed hope to patients who previously felt they had exhausted their choices. By leveraging this expanded toolbox, dermatologists can provide more effective, tailored care in 2025 and beyond, potentially helping patients achieve better outcomes and sustained symptom control.