In this episode of Topical Conversations, David Rosmarin, MD, joins Mary Gail Mercurio, MD, to discuss practical approaches to treating atopic dermatitis (AD) with dupilumab. The conversation covers treatment selection, patient counseling, insurance navigation, and evolving data on safety and adjunctive options.
When to initiate systemic therapy
Both note that the threshold for initiating systemic therapy, particularly dupilumab, has decreased as confidence in its safety and efficacy continues to grow. The broad range of FDA-approved indications, including approval down to 6 months of age, can help reassure patients who are hesitant to begin biologic therapy. The lack of lab monitoring requirements is also a significant benefit for both patients and clinicians.
Patient counseling and injection hesitancy
Patient hesitation around injectables can often be addressed through hands-on education and support from office staff. Dr Mercurio highlights the importance of in-office instruction in the use of the injection device. The growing body of safety data in pregnancy is also discussed, with both clinicians emphasizing the importance of forthcoming registry data and growing real-world evidence supporting dupilumab’s use during pregnancy.
Follow-up and documentation
Follow-up frequency varies based on patient preference and disease severity, often extending to 6 to 12 months once stable. Both clinicians document body surface area (BSA), symptom severity, and impact on quality of life, such as interference with sleep or daily functioning.
Insurance considerations
While dupilumab is typically approved without significant barriers, both clinicians note challenges when BSA is below 10%. Documenting involvement of high-impact areas like the face and hands and the broader impact on quality of life can aid in securing coverage.
Assessing response and treatment duration
The decision to continue or switch therapy is patient-specific. Some improvement may be expected within 3 months; if no response is observed by 3 to 4 months, a change in therapy may be warranted, especially in more severe cases. Mild cases may allow for a longer trial period before considering alternative options.
Adjunctive therapies and managing residual disease
For patients with residual symptoms despite dupilumab, both clinicians use topical therapies—steroids or nonsteroidals—based on body site. Phototherapy is viewed as a beneficial option but may be inaccessible due to cost or insurance limitations. Tapinarof and roflumilast are emerging nonsteroidal options, though access can be restricted by formulary status.
Approach to acute flares
In select cases, a short course of oral corticosteroids may be used to control acute flares while initiating dupilumab, helping to bridge the gap until biologic response is achieved.
Looking ahead
The discussion concludes with anticipation for new therapeutic options, including oral JAK inhibitors, oral STAT6 inhibitors, and other novel mechanisms. Dupilumab remains a foundational therapy in AD management, with new data, particularly regarding pregnancy safety and additional indications, expected to further shape clinical practice.
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.