In the final segment 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 2 here, where Dr Lio comments on the guidelines regarding nonsteroidal agents and bleach baths, along with notable recommendations on topical ruxolitinib and elimination diets.
Remission and proactive therapy
Dr Lio begins by summarizing the guidelines’ conclusions on remission and proactive therapy, which he considers to be the most important framework shift in treating atopic dermatitis.
The guidelines strongly recommend the use of proactive therapy with a calcineurin inhibitor or a mid-potency topical corticosteroid in areas that frequently flare as opposed to applying topical treatments only in response to flares. Intermittent use of steroidal or nonsteroidal topical therapies, 2 to 3 times weekly, can potentially maintain remission and reduce the frequency of flareups.
Systemic therapies
The guidelines also address systemic options for patients who are refractory to topical therapies, which is usually those with moderate-to-severe disease. These options include biologics such as dupilumab, tralokinumab, and lebrikizumab (currently available in Europe), oral JAK inhibitors upadacitinib, abrocitinib, and baricitinib (currently approved for use with atopic dermatitis outside the US), as well as phototherapy. The biologics and JAK inhibitors are all recommended in their proper context, as is cyclosporine.
Interestingly, the guidelines recommend against the use of legacy immunosuppressants like azathioprine, methotrexate, and mycophenolate, noting that most well-informed patients prefer to avoid the potential harms and burdens they pose in exchange for modest benefits.
Similarly, the guidelines recommend against the use of systemic corticosteroids. The panel inferred that patients place a higher value on avoiding harm and poor long-term control of atopic dermatitis than on the uncertain benefit conferred by systemic corticosteroids, with the often transient benefit and low-certainty evidence driving the conditional recommendation.
Importantly, the overuse of systemic corticosteroids weighed against their routine use for flare management or bridge therapy.
Exciting time, new guidelines, new ways of thinking about things, and a rich pipeline, which means our work is far from over.
Dr Lio concludes with his excitement for the guideline’s fresh perspectives and the rich pipeline ahead for atopic dermatitis treatment.
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.