Atopic Dermatitis: A Systemic Disease
In this episode of Topical Conversations, Michael Lewitt, MD, and James Song, MD, explore the systemic nature of atopic dermatitis (AD) and its far-reaching effects beyond the skin. Drawing comparisons to psoriasis, they discuss how inflammation in AD is not confined to lesional areas, but extends to non-lesional skin, the bloodstream, and other organ systems—making the need for early recognition and intervention increasingly urgent.
Comorbidities: Atopic and Beyond
Drs Lewitt and Song break down the diverse comorbidities associated with AD. Atopic conditions such as asthma, allergic rhinitis, eosinophilic esophagitis, and allergic conjunctivitis are common, but so are non-atopic burdens like sleep disturbance, reduced school and work productivity, and complications from systemic steroid use. They highlight the importance of recognizing both types of comorbidities to guide management strategies.
Prioritizing Conversations in a Short Visit
Given the time constraints of typical dermatology visits, both physicians emphasize using a "high-yield" mental checklist to screen for potential comorbidities. Asking simple questions about breathing, swallowing, nasal symptoms, and eye dryness can help uncover issues early. Dr Song underscores that while dermatologists cannot manage every comorbidity, timely recognition and referral are key.
The Role of Early Intervention
Early treatment of AD may do more than control current symptoms—it could potentially prevent the development of future comorbidities. They discuss how therapies targeting key cytokines like IL-4 and IL-13 might reduce barrier dysfunction and immune activation, ultimately altering the long-term trajectory of the disease. For pediatric patients especially, intervening early could disrupt the "atopic march" toward additional allergic diseases.
Collaborating Across Specialties
Both doctors advocate for strong collaboration with allergists, pulmonologists, gastroenterologists, and mental health providers when managing complex cases. Dr Lewitt likens it to having multiple cooks in the kitchen making the same dish—working together toward shared patient goals. Dermatologists, they agree, are often in the ideal position to recognize systemic signs first and initiate appropriate care pathways.
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.