In Part 2 of this Topical Conversations feature with Peter Lio, MD, FAAD, he continues his review of the latest updates to the atopic dermatitis management guidelines from the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force (AAAAI/ACAAI JTF).
As part of the multidisciplinary guideline panel, Dr Lio offers a dermatologist’s overview of the updated guidelines.
Watch Part 1 here, where Dr Lio details the guideline design and the recommendations issued for moisturizers and topical therapies.
Nonsteroidal agents
In patients with uncontrolled atopic dermatitis that is refractory to moisturization alone, the guidelines state there is high-quality evidence supporting the use of topical calcineurin inhibitors tacrolimus and pimecrolimus.
Crisaborole, a topical PDE-4 inhibitor, is recommended over usual care alone, supported by high-certainty evidence. While crisaborole is generally safe and well tolerated, patients may experience stinging and burning; considering this, Dr Lio emphasizes the importance of shared decision-making when selecting a treatment course.
Topical JAK inhibitors
Notably, the guidelines recommend against the use of the topical JAK inhibitor ruxolitinib, though it is a conditional recommendation with low-certainty evidence.
While topical ruxolitinib is shown to be safe for use in clinical practice, Dr Lio notes that the perceived safety profile contributed to the recommendation against use. While he does use topical ruxolitinib in his own practice, he notes that he has encountered patients who express concern with the drug’s boxed warning. This recommendation reflects the consideration of the patient voice throughout the development of these guidelines.
Bleach baths
The guidelines also cover treatment with dilute bleach baths, with Dr Lio noting that while there is now good evidence that they are not antibacterial, they may still confer benefits.
The guidelines conclude that dilute bleach baths may be potentially beneficial due to their anti-inflammatory and anti-itch properties and benefits to the skin barrier, but that they are best reserved for cases of moderate to severe atopic dermatitis.
Elimination diets
Elimination diets have been a point of contention in AD management. Many patients with AD undergo food allergy testing and elimination diets, but recent understanding challenges this approach, which is that avoiding foods may increase the risk of developing true IGE-mediated food allergies.
Consequently, the guidelines recommend against the use of elimination diets compared to an unrestricted diet, suggesting that most individuals employing such strategies may experience little to no benefit. This recommendation is seen as a powerful statement from allergists for both clinicians and patients.
Part 3
Stay tuned for Part 3 where Dr Peter Lio discusses the updated guidelines for remission and maintenance of remission using proactive therapies to prevent flareups and systemic therapies, including a noteworthy recommendation regarding systemic corticosteroids.
Key points
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.