In this episode of Topical Conversations, Matthew Zirwas, MD, and Raj Chovatiya, MD, discuss one of the most important, and sometimes underappreciated, aspects of atopic dermatitis (AD) management: rapid itch relief. Despite the progress made with targeted therapies, many dermatologists may still overlook how profoundly itch drives disease burden, adherence, and patient trust. Drs Zirwas and Chovatiya share practical approaches for evaluating itch severity, setting realistic expectations, and understanding how new-generation therapies are impacting the conversation around early symptom improvement.
Why itch still warrants more attention in AD
Despite the numerous treatment options for AD, Drs Zirwas and Chovatiya agree that itch remains an under-discussed symptom during dermatology visits. Dr Chovatiya points out that while dermatologists often assume they’re addressing itch adequately, in practice, they may not be asking the right questions about itch severity or fully exploring its impact on quality of life.
Dr Zirwas adds that while the Numeric Rating Scale (NRS) for itch is useful in research, it’s less practical in routine clinical settings where patients are seen only every few months. Instead, he recommends a more straightforward, contextual approach: asking patients whether their itch is none, mild, moderate, or severe. He likens mild itch to a single mosquito bite, moderate to 20 mosquito bites or some poison ivy, and severe to widespread poison ivy or hundreds of bites. Framing the question this way, he explains, helps patients describe their experience more accurately and meaningfully.
The broader impact: itch as a holistic problem
Dr Chovatiya emphasizes that itch is not a surface-level symptom, but rather drives a cascade of issues including sleep disturbance, fatigue, mood changes, anxiety, and depression. Persistent itch can also erode trust between patients and providers when relief isn’t achieved quickly enough, leading to frustration with otherwise effective treatment plans.
Both dermatologists stress that understanding itch’s impact on quality of life is essential not only for patient empathy but also for maintaining long-term treatment adherence.
A new era of therapies and a shift in expectations
The landscape of AD therapy has evolved dramatically, introducing multiple biologic and small-molecule options that challenge old assumptions about speed and safety. Dr Chovatiya notes that dermatologists historically viewed biologics as “safe but slow,” but that perception no longer holds true. Today’s therapeutic arsenal includes IL-4/IL-13 inhibitors, IL-13 inhibitors, IL-31 inhibitors, and potentially soon, OX40 inhibitors, which are all capable of rapid and meaningful itch improvement.
When discussing the pace of itch relief, both agree that while oral JAK inhibitors may deliver the fastest onset, biologics now demonstrate impressive early itch improvement as well. Dr Chovatiya points to real-world data showing that many patients experience noticeable relief early in their biologic therapy, not just lesion improvement.
Tralokinumab and rapid itch relief
Dr Zirwas highlights that among available biologics, tralokinumab provides balanced performance across efficacy, safety, and speed. He notes that data from the ECZTRA trials demonstrated separation from placebo within the first few doses, confirming that tralokinumab delivers meaningful early itch relief while maintaining long-term control and a favorable safety profile.
While tralokinumab has sometimes been perceived as slow-acting, both dermatologists emphasize that this perception is not supported by clinical or real-world evidence. In practice, all approved biologics, including tralokinumab, can provide rapid and sustained itch improvement.
Early itch relief is foundational to effective care
Drs Zirwas and Chovatiya conclude that early itch relief is not just about comfort; it’s a cornerstone of patient satisfaction, adherence, and confidence in treatment. For patients with moderate to severe AD, agents like tralokinumab demonstrate that it’s possible to achieve rapid itch relief, visible skin improvement, and long-term disease control, all while maintaining a strong safety profile.
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.