Red, Itchy, And AD Until Proven Otherwise

Raj Chovatiya, MD, PhD, clinical associate professor at the Rosalind Franklin University Medical School and founder of the Center for Medical Dermatology and Immunology Research in Chicago, Illinois, presented in the sessions “Itch Tales: Looking Beyond Atopic Dermatitis” and “Atopic Dermatitis” during the 2024 American Academy of Dermatology Annual Meeting in San Diego, California.¹ In, an interview with Dermatology Times, Chovatiya emphasized the importance of distinguishing atopic dermatitis (AD) from various other skin conditions, shed light on the evolving landscape of therapeutic options, and explained the significance of guidelines for all career stages.

Understanding AD and Differential Diagnosis

Chovatiya introduced the common saying in dermatology, "If it's red, if it's itchy, [if] it's scaly, it's AD until proven otherwise." He acknowledged the prevalence of AD affecting up to 10% of the entire US population.² However, he warned against misdiagnosing similar-looking conditions such as seborrheic dermatitis, psoriasis, urticaria, contact dermatitis, regional eczema, genetic or nutritional conditions, immunobullous conditions, and cutaneous lymphomas. Highlighting the importance of a comprehensive approach, Chovatiya expressed the need for all clinicians to build a broad differential diagnosis based on clinical clues and patient history.

Treatment Landscape and Recent Developments

Chovatiya also discussed the significant developments in the AD treatment landscape over the past few years. He explained, “I think that one of the challenges is that it's almost like been drinking from a fire hose the past couple years, given just the amount of analyses, posters, and presentations. And so these days, what I'm spending a lot of time trying to figure out is how to best educate...How do you take all that information, get comfortable with it, and then take that big boring prescribing information label in front of you and really translate that into a very quick hit of dos, don'ts, how, and when? I think that that is probably the most important thing all of us can do with AD therapy now before it gets even more crowded in short order.”

Notably, he points out the approval of several medications, including biologics, oral JAK inhibitors, topical JAK inhibitors, and topical PD4 inhibitors. He anticipates further expansions in therapeutic options, emphasizing the importance of staying updated on the latest research. He said, “There's a little bit of a lull now before another glut [of treatment approvals] is going to come our way.” 

Guidelines as a Roadmap 

Discussing the role of new AAD AD guidelines at this meeting, Chovatiya recognized their significance in providing a roadmap for dermatology clinicians. While guidelines offer flexibility, they serve as a crucial reference point for evidence-based treatments. He emphasized their role in instilling confidence in practitioners, allowing them to justify their treatment decisions based on a consensus of experts and the existing literature. “Guidelines are always helpful for us that are seeing patients on a day to day basis to understand what you do when now guidelines are not necessarily a strict rulebook that are written in black and white, they do allow for some clinical flexibility and there's a bit of gray. But the most important thing to take away from guidelines is that you have something to point to anytime there might be a question about a medical treatment because they do a good job of compiling the evidence to date,” Chovatiya concluded.

Chovatiya also participated in AAD sessions to prepare residents to take their board exams. Earlier in the meeting, he shared tips for success.

References

1. Chovatiya R. Itch tales: looking beyond atopic dermatitis. Presented at: 2024 American Academy of Dermatology Annual Meeting; March 8-12; San Diego, CA.
2. Hadi HA, Tarmizi AI, Khalid KA, Gajdács M, Aslam A, Jamshed S. The epidemiology and global burden of atopic dermatitis: anarrative review. Life (Basel). 2021;11(9):936. Published 2021 Sep 9. doi:10.3390/life11090936