From Environmental Triggers to Emotional Toll
In this episode of Topical Conversations, Michelle Tarbox, MD, and Peter Lio, MD, take a comprehensive look at the evolving landscape of atopic dermatitis (AD), a condition that continues to challenge patients, families, and clinicians alike. They explore the multifaceted burden of AD, from environmental triggers and treatment fatigue to the far-reaching impact on patients and their families.
Cold Weather, Wildfire Smoke, and the Skin Barrier
Dr Lio notes that winter often triggers AD flares due to dryness and disrupted skin barrier function. He highlights emerging research identifying isocyanates—components of wildfire smoke—as potential microbiome disruptors that may directly worsen AD. Dr Tarbox references data linking increased AD clinic visits and hospitalizations to wildfire exposure, reinforcing the importance of climate-related awareness in dermatology.
When Topicals Aren’t Enough
While mild AD can often be managed with topical therapies and gentle skin care, more severe cases require a different approach. They discuss treatment challenges such as poor adherence in children, fear of stinging medications, and the physical and emotional strain on families. Dr Lio breaks down why topicals sometimes fail and advocates for timely escalation to systemic therapy when appropriate.
The Family Burden and the Path Forward
The impact of AD extends beyond the skin. Dr Tarbox describes how the condition can dominate daily routines, strain marriages, and even disrupt childhood growth due to chronic inflammation and sleep loss. Both physicians emphasize the importance of moving from the vicious cycle of uncontrolled disease to a virtuous cycle of healing and how newer biologic and oral treatments are making this more achievable than ever before.
Biologics and the “Renaissance” in AD Treatment
With multiple systemic therapies now available, including biologics for children as young as 6 months, patients and providers are entering a long-awaited “renaissance” in AD care. Dr Tarbox draws comparisons to the revolution seen in psoriasis treatment, noting how gratifying it is to now have effective tools for patients with eczema. Dr Lio adds that some newer therapies may even allow for reduced dosing over time, a hopeful sign for long-term disease control.
Shared Decision-Making and Long-Term Trust
Treating AD means building relationships. Both physicians advocate for shared decision-making and patience when introducing systemic options, especially in pediatric cases. Dr Lio shares a helpful tool: the Atopic Dermatitis Control Tool (ADCT), which helps patients recognize how deeply AD affects their lives. They close by emphasizing the value of listening, following up, and guiding families toward relief without pressure, but with compassion and clear options.
Key Takeaways
In this 45-minute symposium, expert faculty cover the latest updates for JAK inhibitors, including head-to-head efficacy and safety data for JAK inhibitors and biologics, and share clinical pearls for using JAK inhibitors in dermatology practice for atopic dermatitis."I can say that in my clinic, I am reaching for those high bars. You have toput yourself in the position of the patient or imagine that patient is your family member. Would you want mediocre treatment for them or average treatment or moderate treatment? You’d want them to get the best possible treatment. In my practice I’m now counseling patients 'yes we want clear skin. Yes, we want minimal itch. Yes we want your skin pain gone and for you to sleep better.'”- David Cotter, MD, PhDFC25: Charting the Course to Higher Targets With JAK Inhibition in Atopic Dermatitis: An Online ActivityThis activity is supported by an educational grant from AbbVie.
Don’t miss this Satellite Symposium from the 2025 Fall Clinical Dermatology Conference®, as Dr. Alexandra Golant, Dr. Mona Shahriari, and Dr. G. Michael Lewitt discuss IL-13 targeting biologics in the treatment of atopic dermatitis as well as strategies for optimizing their use.“To me, coming into an exam room in 2025, when we have so many different treatment options for these patients, it's a unique opportunity to use what we know about the data of these therapeutics and walk patients though their options and how to understand their disease state, and how to best choose the therapy that feels right for them.” – Alexandra Golant, MD FC25: Illuminate the Role of IL-13 Inhibitors for the Management of Atopic DermatitisThis activity is supported by an educational grant from Lilly.
“Of course we’re always starting with our basics: we’re using our gentle cleansers, our moisturization, our avoidance of known allergens or triggers, and then we're doing our topicals. But it can be very difficult if you have heavy stuff on your face or you’re required to put it on over and over. It can be really tough. So this paves the way really nicely to say it is time to move up, it is time to think about the next level, and typically the next step up is going to be a biologic agent.” - Peter Lio, MDA ‘HowTo’ activity delivers a short burst of engaging and compact content for learners to study at their own convenience. This microlearning activity is intended to provide practical insights from two experts on ‘HowTo’ improve care in head and neck atopic dermatitis in 10 minutes.This activity is supported by an educational grant from LEO Pharma.
This 30-minute symposium from the 2025 Pediatrics360 Virtual Conference takes a closer look at biologic therapies that can address the immune pathophysiology, associated comorbidities, and progression of moderate-to-severe atopic dermatitis in pediatric patients.“A lot of them (children with atopic dermatitis) do have tactile sensitivities and don’t like the way any creams, ointments, anything, feel on their skin. Thinking about a shot, even though it hurts, doing a shot once or twice a month can actually often be so much easier than having the parents have to argue with the kid two to three times a day to get the topicals on. So, I actually think of injections very quickly for patients with tactile sensitivities.” – Dr. Elizabeth SwansonPEDS25: Controlling the Wolf in Sheep’s Clothing: Managing Pediatric Atopic Dermatitis with Biologic Therapies: An Online ActivityThis activity is supported by an educational grant from Sanofi and Regeneron Pharmaceuticals, Inc.