Atopic dermatitis (AD), the commonest chronic inflammatory skin disease, significantly impacts patients’ lives, mainly in its severe forms. It has different clinical presentations throughout the disease course, different age groups and across ethnicities. It is characterized by a spectrum of clinical phenotypes as well as endotypes. Hence, the therapeutic approach should be personalized for every patient and should rely on endotype. 

Treatment personalization should consider an integrated approach including characteristics of the patient and the disease; including age, ethnicity, gender, morphology and localization of skin lesions, the severity of disease considering body area covered and symptoms intensity, duration of disease, frequency of AD relapses, response to prior AD treatments, comorbidities, probable accompanying therapies and impact on patient’s quality of life. 

The prospect of personalized therapeutic options in AD will include the real-life use of validated AD-specific biomarkers in the selection/stratification as well as monitoring of AD patients. Recent years have witnessed a rapid and promising expansion of biological therapies and JAK-inhibitors as a toll against AD.

Current available (till September 2021) topical and systemic treatments for AD:

Topical treatments

• Emollients for daily use
• Topical corticosteroids for short-term use in the acute phase/proactive therapy
• Topical calcineurin inhibitors to be used in skin sensitive areas/proactive therapy
• Crisaborole to be used in mild-moderate AD
• Topical JAK-inhibitors as delgocitinib, approved in Japan.

Systemic treatments

• Corticosteroids for short-term use in severe AD
• Cyclosporine A for chronic severe AD
• Azathioprine, mycophenolate mofetil to be used if cyclosporine A is not effective or not indicated
• Methotrexate for long-term maintenance
• Dupilumab in moderate-severe AD (>12 years) or severe AD (>6 years)
• Oral JAK-inhibitors like baricitinib in moderate-severe AD.

Source: Salvati L, Cosmi L, Annunziato F. From emollients to biologicals: targeting atopic dermatitis. Int J Mol Sci. 2021;22(19):10381.