In this episode of Topical Conversations, Kristine Kucera, PA-C, and Aaron Farberg, MD, discuss the challenges of managing moderate atopic dermatitis (AD). This segment offers insights into how clinicians define moderate AD, set treatment goals, and decide when to move beyond topical therapies to systemic treatments.
Defining moderate atopic dermatitis
Dr Farberg highlights that defining the moderate AD patient can vary depending on the context. In clinical trials or insurance approvals, moderate to severe AD is often based on scoring systems like the EASI score. However, in practice, the definition relies on a more personal approach—talking to the patient and assessing the impact of the disease on their daily life.
For clinicians, body surface area (BSA) is often used to classify AD severity, but Dr Farberg emphasizes that the location of eczema can sometimes be more telling than the extent of coverage. For example, AD affecting sensitive areas like the scalp or groin may have a significant impact on quality of life even if it doesn’t affect a large area of skin. He suggests that the key is understanding how AD affects the patient, which helps determine whether a patient should remain on topical treatments or transition to more systemic options.
Treatment goals for moderate atopic dermatitis
According to Kristine Kucera, setting clear treatment goals is critical, starting with patient education. Patients need to understand their condition and the rationale behind the treatment approach. Kucera advocates for shared decision-making to establish patient-specific treatment goals, ensuring both the clinician and patient are aligned on expectations.
Patients may not always realize what is achievable with appropriate treatment. Kucera emphasizes that even if patients feel they are "doing okay," clinicians should probe deeper to assess if lingering flares or other symptoms remain. Better control of symptoms can significantly improve a patient’s quality of life, and patients often don’t realize how much improvement is possible.
Dr Farberg highlights the importance of aiming for near-complete clearance. Studies in related conditions like psoriasis have shown that getting a patient from 75% to 90% or more clearance can lead to meaningful improvements in quality of life. This goal should be communicated clearly to patients, ensuring they understand that optimal control can be within reach.
Skin care and basic advice for moderate AD patients
Both Dr Farberg and Kucera stress the importance of providing patients with advice on basic skin care routines. Clinicians should not overlook recommending gentle skin care practices, including using gentle cleansers, moisturizing frequently, trimming nails to prevent scratching, and using a humidifier.
These foundational steps can complement medical treatments, helping patients maintain better control over their symptoms.
Transitioning to systemic treatments: when and why
The decision to move from topical treatments to systemic therapies is pivotal in managing moderate AD. According to Dr Farberg, the conversation about systemic treatments should happen early, even during the first visit. Discussing options like JAK inhibitors and cytokine inhibitors, such as dupilumab (Dupixent), helps patients understand their choices upfront, reducing the likelihood of patients questioning why certain treatments weren’t offered sooner.
For moderate AD, Dr Farberg emphasizes the importance of treating the disease as systemic from the outset. While topical therapies are useful, many patients require a systemic approach to achieve meaningful control.
Dupilumab: a go-to treatment option
When it comes to systemic therapies, dupilumab has emerged as a strong option in the treatment of moderate atopic dermatitis. Dr Farberg explains that dupilumab is well-tolerated, with a safety profile supported by years of use across various conditions.
Patients are increasingly open to the idea of injections, particularly with the rising familiarity of injectables like GLP-1 inhibitors for other health conditions. Dupilumab’s every-two-week injection schedule, with the possibility of extending to once a month in certain cases, appeals to many patients who prefer fewer interventions compared to daily oral medications.
Personalized care for moderate AD patients
Both Kucera and Dr Farberg highlight the importance of personalized treatment approaches for moderate AD. Every patient is different, and clinicians need to be flexible in tailoring treatments to individual needs. With an array of available options, from topicals to systemics like dupilumab and JAK inhibitors, the goal is to find the right combination that maximizes each patient’s comfort and quality of life.
By engaging in open discussions with patients, setting realistic treatment goals, and considering early transitions to systemic therapies, clinicians can help patients achieve better disease control and improve their daily lives.
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.