At the ODAC Dermatology Conference, Peter Lio, MD, FAAD, shared an updated, patient-centered overview of atopic dermatitis (AD) and regional eczemas, integrating emerging science with real-world clinical strategies.
As noted in an article by The Dermatology Digest, Dr. Lio emphasized AD and regional eczemas are self-perpetuating disorders involving the skin barrier, immune system, microbiome, and sensory nerves. He outlined the epithelial barrier hypothesis and the concept of epicutaneous sensitization. Early, proactive intervention was framed as essential to preventing chronic inflammation, infections, and subsequent disease.
On therapy, Dr. Lio reviewed the expanding role of non-steroidal topical agents, noting their usefulness in sensitive areas and for patients who want a non-steroidal option. He also reinforced the value of adjunctive strategies such as wet wrap therapy. For systemic treatment, he discussed biologics and oral JAK inhibitors, highlighting evidence that dupilumab can uniquely improve the skin microbiome in moderate-to-severe AD. Shared decision-making was a central theme, with Dr. Lio presenting his ESTAR framework to help align treatment choices with patient priorities, and sharing the importance of written action plans.
Finally, Dr. Lio addressed topical steroid withdrawal as a legitimate and evolving diagnosis. He noted that formal diagnostic criteria are forthcoming, signaling progress toward clearer guidance for clinicians.
