Expert Recommendations for Personalized AD Treatment

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Atopic dermatitis (AD) follows a relapsing-remitting course and significantly impacts the quality of life of patients and caregivers.¹ Recent research provided an unbiased review of the management of mild to moderate AD with topical therapies based on recent research findings and expert panel insights.²

Initial Management and Skin Care Practices

The study noted initial management of AD involves good skin care practices, including the use of emollients, gentle non-soap cleansers, and warm baths. Avoiding known triggers is also essential. When these measures fail to control the disease, topical anti-inflammatory therapies are introduced.

Topical Anti-Inflammatory Treatments

Topical corticosteroids (TCSs) are the mainstay of treatment for mild to moderate AD. TCSs are categorized into different potency levels, ranging from low to high, with treatment choice depending on the severity and location of the disease. Alternatives to TCSs include topical calcineurin inhibitors (TCIs), phosphodiesterase 4 (PDE4) inhibitors (e.g., crisaborole), and topical Janus kinase inhibitors (JAKis), such as ruxolitinib and delgocitinib. Ruxolitinib cream has been included in the American Academy of Dermatology guidelines for short-term and noncontinuous chronic treatment of AD in patients aged 12 years and older.

Proactive vs. Reactive Treatment Approaches

Traditionally, AD management has followed a reactive approach, where topical anti-inflammatory therapies are reintroduced during disease flares. However, recent guidelines advocate a proactive approach for patients with recurrent flares. Proactive treatment involves the long-term intermittent application of topical anti-inflammatory agents alongside good skin care to maintain disease control and reduce flare frequency.

Individualized Treatment Considerations

The study emphasized that clinical guidelines provide general recommendations, but individualized treatment plans are necessary. Factors influencing treatment decisions include patient age, disease severity, body region involvement, prior adverse effects, response to therapy, and frequency of flares. Additionally, drug availability, cost, patient education, and healthcare provider experience impact treatment selection.

Expert Panel Findings on AD Management

A study involving 17 board-certified dermatologists from various geographic regions assessed the management of mild to moderate AD with topical therapies. The expert panel provided insights into their clinical practice based on patient age groups (<2 years, 2–12 years, and >12 years) and disease severity (mild vs. moderate AD). The findings revealed the following key points:

• Differentiation of Mild vs. Moderate AD: Most dermatologists considered multiple factors, including body surface area involvement, pruritus severity, and lesion extent, to differentiate between mild and moderate AD.
• Daily Skin Care: Nearly all participants recommended daily skin care with moisturizers and mild cleansers.
• First-Line Pharmacologic Treatment: TCSs were the preferred first-line treatment across all age groups. Non-TCS treatments were less commonly used as primary options.
• Treatment Based on Body Region: Lower-potency TCSs and/or non-TCSs were preferred for sensitive areas like the face and groin.
• Length of Initial Treatment: Most dermatologists recommended treatment for up to four weeks, with adjustments based on disease severity.
• Time Until Re-Evaluation: More severe cases required earlier follow-ups (1 to 4 weeks), while milder cases were re-evaluated within 1 to 4 months.
• Maintenance Treatment: Many dermatologists employed a proactive treatment approach, incorporating non-TCSs for maintenance therapy to minimize relapses.
• Treatment of Flares: TCSs were the primary choice for flare management, often combined with non-TCSs depending on patient-specific factors.
• Safety Concerns and Limitations: Corticophobia, potential skin atrophy, cost, and adverse effects (e.g., burning sensations from TCIs and PDE4 inhibitors) were key concerns.

Discussion

Clinical guidelines play a crucial role in guiding AD management; however, real-world treatment decisions depend on individual patient characteristics and accessibility to therapies. The findings from the expert panel align with guideline recommendations, reinforcing the importance of TCSs as first-line therapy while acknowledging the role of non-TCSs in specific situations.

Safety concerns, particularly regarding TCS use and corticophobia, remain significant factors affecting treatment choices. Addressing these concerns through patient education can improve adherence to prescribed therapies. Additionally, alternative therapies, such as non-TCS treatments, offer valuable options for patients who cannot tolerate or prefer to avoid TCSs.

The proactive approach to AD management appears to be gaining traction, as it has been shown to prolong disease-free intervals and reduce flare severity. However, treatment strategies must be tailored to individual patients, considering disease severity, treatment response, and potential adverse effects.

Conclusion

The study stated that mild-to-moderate AD management involves a combination of good skin care practices, topical anti-inflammatory therapies, and a choice between reactive and proactive treatment approaches. While TCSs remain the primary treatment, alternative options such as TCIs, PDE4 inhibitors, and JAKis provide additional strategies for specific patient needs. Researchers suggested future research should continue exploring optimized treatment regimens and strategies to enhance patient adherence and long-term disease control.

Want to hear more pearls and expert insights on AD? Join us at the annual Revolutionizing Atopic Dermatitis Conference this June in Nashville, TN.

Reference

1. Silverberg JI, Gelfand JM, Margolis DJ, et al. Patient burden and quality of life in atopic dermatitis in US adults: A population-based cross-sectional study. Ann Allergy Asthma Immunol. 2018;121(3):340-347. doi:10.1016/j.anai.2018.07.006
2. Eichenfield LF, Stein Gold LF, Hebert AA, et al. Management of miild-to-moderate atopic dermatitis with topical treatments by dermatologists: A questionnaire-based study. JEADV Clinical Practice. 2025. doi:10.1002/jvc2.611