The Topical Shift: Transforming Atopic Dermatitis Treatment in Primary Care

Panelist discusses how the atopic dermatitis treatment landscape has evolved with new non-steroidal topical therapies that can match the effectiveness of corticosteroids without their associated side effects and long-term risks.

Panelist discusses how atopic dermatitis presentation varies by age and skin tone, emphasizing that it's a systemic condition with multiple comorbidities that can be prevented through early aggressive treatment.

Panelist discusses how to assess atopic dermatitis severity using practical measures like body surface area, itch scores, and quality of life impact rather than complex clinical trial scoring systems.

Panelist discusses how proper skin care forms the foundation of atopic dermatitis treatment and emphasizes the importance of proactive rather than reactive treatment approaches using maintenance therapy.

Panelist discusses how the current treatment guidelines include four classes of topical therapies, with newer non-steroidal options like JAK inhibitors and PDE4 inhibitors providing effective alternatives to long-term corticosteroid use.

Panelist discusses how polling results show varied approaches to second-line atopic dermatitis treatment, emphasizing that topical corticosteroids remain the workforce but require proper usage limits of 1-2 weeks to avoid serious side effects, while highlighting growing patient concerns about steroid phobia and topical steroid withdrawal syndrome.

Panelist discusses how newer non-steroidal topicals including roflumilast (next-generation PDE4 inhibitor), ruxolitinib (JAK1,2 inhibitor), and tapinarof (aryl hydrocarbon receptor agonist) offer significant improvements in efficacy and tolerability compared to older agents like crisaborole, with clinical trial data showing 30-50% of patients achieving complete or near-complete clearance.

Panelist discusses how topical treatment selection should be based on affected body areas, patient preferences for vehicle type, and disease extent, noting that patients prefer topical over systemic therapies and emphasizing the importance of using specialty pharmacies with manufacturer contracts to ensure affordable access through proper prior authorization processes.

Panelist discusses how referral to dermatology should occur when patients fail to reach treatment goals despite proper skincare, appropriate topical steroid and non-steroid use, and proactive treatment, emphasizing the importance of maintaining open dialogue about systemic therapy options rather than dismissing them as "last resort" treatments.

Panelist discusses how patient cases demonstrate the importance of considering non-steroidal agents in patients of color (due to hypopigmentation risks) and elderly patients (due to skin thinning), concluding that effective atopic dermatitis management requires proper moisturizing, appropriate corticosteroid cycling, and proactive twice-weekly maintenance with newer non-steroidal topicals to prevent long-term complications.