Off the Rollercoaster: Rethinking Control in Atopic Dermatitis

There was a time when treating atopic dermatitis (AD) meant managing the peaks—calming a flare, then waiting for the next one to arrive. But as Elizabeth (Lisa) Swanson, MD, and E James Song, MD, describe, the disease doesn’t really turn off. AD settles, simmers, then resurfaces, more like a smoldering fire than something episodic. And once you start to see it that way, the goal becomes about stabilizing what’s happening over time instead of reacting to the moment.

In this conversation, Drs Swanson and Song work through their approaches in clinic: lowering the threshold for biologics, rethinking what “controlled” actually means, and recognizing how much of the disease lives outside of what’s visible. The aim is getting patients off the rollercoaster, reducing the constant negotiation with their skin, and moving toward something steadier, more livable, and more honest to the disease itself.