Thinking Beyond the Cytokines: Optimizing Management of Atopic Dermatitis

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes E. James Song, MD, Chief Medical Officer at Frontier Dermatology, to explore the nuances of systemic therapy selection for atopic dermatitis (AD) and offer practical guidance on tailoring treatment plans to optimize outcomes for these patients. They begin by discussing the importance of considering patient-specific factors, such as contraindications, access, and age, when selecting among the 3 currently available biologics for AD: dupilumab, tralokinumab, and lebrikizumab. While these therapies share many similarities, nuanced differences—such as dupilumab’s approval for younger patients and asthma comorbidity, or lebrikizumab’s sustained efficacy after discontinuation—can guide treatment decisions. They also discuss adverse events, including conjunctivitis and dupilumab-associated facial erythema, highlighting strategies for managing these issues. Dr Song notes that switching within the IL-13 pathway can often resolve conjunctivitis and speculates on the possible mechanisms behind facial redness. They then explore one critical insight: the potential for patients to fail one biologic and still respond to another within the same class. While complete nonresponders may benefit from switching to a different class, such as JAK inhibitors, partial responders often do well with another IL-13 inhibitor. Tune in to the full episode to explore more insights on optimizing AD management, including how to navigate biologic options, manage adverse events, and approach challenging cases while embracing new therapies and tailoring care to each patient’s unique needs.