Systemic Therapies Offer New Hope for Severe AD

In a recent interview with Dermatology Times, Peter Lio, MD, clinical assistant professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine and founding director of the Chicago Integrative Eczema Center, discussed the growing role of systemic therapies in treating moderate to severe atopic dermatitis, especially in pediatric patients.

“We understand that the systemic agents are really game changers, and they're transformative for the right patient,” Lio stated. While he emphasized a cautious and thoughtful approach to these treatments, he acknowledged their significant impact on quality of life when topicals are no longer enough. “I try not to use them unless we need them. And I think most of us feel the same way,” he added, reinforcing the idea that systemic agents are best reserved for those with uncontrolled or worsening disease.

A major concern in dermatology, Lio explained, is the overuse of topical corticosteroids. “We’ve now seen a whole epidemic of people who have overused them and sort of abused them, often no fault of their own,” he said. Patients are often repeatedly prescribed topical steroids without long-term success, leading to frustration and further skin barrier damage.

Systemic medications like dupilumab, though not without risks, can offer substantial improvements. “They don't fix everybody. They don't fix everybody perfectly. They're not perfectly safe either,” Lio cautioned. However, he noted that “the risk benefit ratio for so many patients is incredibly favorable,” particularly when compared to the toll of untreated eczema—sleep disruption, infections, and reduced overall well-being.

One of the most exciting developments Lio mentioned was a study showing improved height growth in children with atopic dermatitis treated with dupilumab. “They actually were able to get more height growth,” he said, explaining that chronic inflammation and poor sleep can stunt development. With proper systemic treatment, many children are finally able to thrive. “He's like a new kid… We can talk to him instead of just scratching and being miserable,” Lio shared, echoing what many grateful parents have reported.

Ultimately, systemic treatments represent more than symptom control—they offer a path to restoring normalcy, development, and quality of life for children and families battling severe eczema.

Want to hear more pearls and expert insights on AD? Join us at the annual Revolutionizing Atopic Dermatitis Conference this June in Nashville, TN. Use code DT40 for 40% off your RAD 2025 registration.