Multidisciplinary Approaches to the Management of Atopic Dermatitis

Panelists discuss the pathophysiology of atopic dermatitis (AD), focusing on the role of type 2 inflammation, and explore how AD can serve as an entry point to the atopic march in children, leading to other allergic diseases such as food allergies, asthma, and allergic rhinitis, including early indicators that may predict future comorbidities.

Panelists discuss the diagnostic criteria for atopic dermatitis (AD), highlighting challenges in diagnosis due to the disease’s heterogeneity across factors like age, skin color, and other variables, and explore how this complexity can lead to misdiagnosis or late diagnosis; they also share tips for diagnosing AD, determining disease severity, and incorporating patient-reported outcomes into severity assessments, while examining how advances in treatment and understanding have shaped current perspectives on AD severity.

Panelists discuss the patient journey for patients with pediatric atopic dermatitis (AD) and their caregivers, from initial presentation through to diagnosis, emphasizing the challenges and emotional aspects that families experience throughout the process.

Panelists discuss the diagnosis and referral process for patients with pediatric atopic dermatitis (AD) from both the dermatologist and allergy perspectives, including when a child should be referred to a dermatologist and the importance of a multidisciplinary approach to care for optimizing AD management, with insights on the roles each team member plays in patient care.

Panelists discuss the goals of treating atopic dermatitis, focusing on symptom control and quality of life, with treatment differing for children and adults, and emphasize using assessment tools such as Eczema Area and Severity Index (EASI)-75/90, Investigator Global Assessment (IGA), and itch scores alongside patient-reported outcomes to guide decisions while also considering disease severity and the impact of atopic comorbidities in treatment approaches.

Panelists discuss the 2023 American Academy of Allergy, Asthma & Immunology/ American College of Allergy, Asthma & Immunology (AAAAI/ACAAI) Joint Task Force guidelines, highlighting treatment options with strong recommendations and high certainty of evidence, including biologics/monoclonal antibodies (dupilumab, tralokinumab, lebrikizumab) and Janus kinase (JAK) inhibitors (abrocitinib, baricitinib, upadacitinib) for atopic dermatitis management.

Panelists discuss the role of newer agents, including biologics/monoclonal antibodies (dupilumab, tralokinumab, lebrikizumab) and Janus kinase (JAK) inhibitors (abrocitinib, baricitinib, upadacitinib), in the treatment of moderate to severe atopic dermatitis, emphasizing their effectiveness in improving outcomes for patients who do not have adequate control with conventional therapies.

Panelists discuss managing comorbidities and mitigating atopic march in adolescent and adult patients, focusing on the importance of early intervention and coordinated care to prevent the progression of atopic diseases and improve long-term health outcomes.

Panelists discuss treatment expectations for newer systemic agents, highlighting data on efficacy onset and persistence, including rapid improvement in pruritus with dupilumab by week 2 (SOLO trials), early Investigator Global Assessment (IGA) and Eczema Area and Severity Index (EASI)-75 improvement with lebrikizumab by week 2 to 4 (ADvocate trials), and EASI-75 improvement with tralokinumab by week 4 (ECZTRA 6 trial), emphasizing the importance of setting realistic expectations with patients and caregivers regarding the onset of action and duration of treatment.

Panelists discuss the prevalence of treatment-refractory moderate to severe atopic dermatitis, noting factors such as intolerance or inability to use high-potency topical agents as common reasons for treatment failure, and emphasize the importance of considering alternative agents or switching treatments when necessary, particularly in pediatric patients, with biologics and Janus kinase (JAK) inhibitors being key options as evidenced by studies such as Blauvelt 2023, Keow & Abu-Hilal 2024 , and JADE EXTEND.

Panelists discuss when to consider adding or switching agents for atopic dermatitis, highlighting alternative treatments for pediatric patients such as biologics and Janus kinase (JAK) inhibitors, and emphasize the importance of tailoring treatment decisions based on efficacy and patient response, citing studies such as Blauvelt 2023, Keow & Abu-Hilal 2024, and JADE EXTEND. They also explore emerging systemic agents such as nemolizumab (IL-31 receptor antagonist) and rocatinlimab (anti-OX40), which have the potential to significantly affect treatment approaches based on promising early trial results.

Panelists discuss offering guidance to parents and caregivers experiencing atopic dermatitis for the first time, emphasizing the importance of education on managing flare-ups, proper skin care routines, and setting realistic treatment expectations while also seeking support from health care professionals to navigate the challenges of the condition.