World Atopic Eczema Day and National Atopic Eczema Week shine a light on both the burden of atopic dermatitis (AD) and the progress being made in how we understand and manage it. Affecting millions worldwide, AD is a chronic, immune-mediated disease with a profound impact on quality of life, mental health, and comorbid conditions. In recent years, new insights into its underlying biology have transformed clinical care, paving the way for more targeted therapies that go beyond symptom control.
The Immunopathogenesis of Atopic Dermatitis
Traditionally, AD has been characterized as a Type 2 inflammatory disease, driven by cytokines such as IL-4, IL-13, and IL-31, which disrupt the skin barrier, fuel itching, and worsen inflammation. This knowledge led to the first biologic therapies, setting the stage for disease-modifying treatment options.
More recently, however, research and clinical trial data have revealed that additional pathways, such as OX40–OX40L co-stimulatory signaling, JAK-STAT activity, and cytokines like IL-22 and IL-17, also play a role in sustaining chronic disease. Building on these discoveries, researchers are expanding the therapeutic horizon beyond traditional Type 2 pathways. For example, a study in the British Journal of Dermatology highlighted the OX40L/OX40 pathway as a potential driver of persistent inflammation, opening the door to therapies that may provide longer-lasting control.
These insights reinforce that AD isn’t the same in every patient and that personalized, pathway-based care will be key moving forward.
Translating Pathways Into Therapies
In the past decade, AD treatment has grown dramatically. Dupilumab, the first biologic approved for moderate-to-severe AD, targets IL-4 and IL-13 signaling, achieving durable control for many patients. Newer agents, including tralokinumab and lebrikizumab, have since joined the class, giving clinicians more flexibility.
Oral JAK inhibitors, including baricitinib, upadacitinib, and abrocitinib, take a broader approach, blocking multiple cytokine signals upstream and offering rapid relief of itch and inflammation. Topical ruxolitinib provides another option, offering localized disease control in a targeted way.
With more tools available, the challenge becomes matching the right therapy to the right patient—taking into account disease severity, comorbidities, patient preferences, lifestyle, and long-term safety.
As experts note: “Despite these advances, there remains a need for therapies that are safe and efficacious across the heterogeneous population of patients with AD. Therapies that target other pathways, such as IL-17, IL-22 and IL-31, are in development for the treatment of AD.”
What’s Next in Atopic Dermatitis Care
The therapeutic pipeline for AD continues to expand rapidly.
Nemolizumab, an IL-31 receptor blocker, has shown strong efficacy in alleviating itch and improving sleep quality, addressing two of the most debilitating symptoms of AD.
OX40 pathway therapies are especially promising. By disrupting T-cell activation and cytokine release, they aim to deliver longer-term control. Currently, three investigational drugs are in development:
- Amlitelimab (OX40L blocker) – demonstrated up to 80% improvement in severity in early trials.
- Rocatinlimab (anti-OX40 antibody) – achieved 61% improvement, with benefits sustained even after treatment stopped.
- Telazorlimab (OX40 blocker) – produced 54-59% improvement and may also affect immune pathways beyond Type 2 inflammation.
While these agents are still under investigation, they represent the next wave of therapies that could reshape AD management.
Clinical Implications
For dermatologists, this wave of innovation brings both opportunities and responsibilities. More options mean greater ability to personalize care, improve patient quality of life, and adapt management strategies. At the same time, careful decisions must be made around when to use biologics versus JAK inhibitors, how to monitor for safety—especially in vulnerable patients—and how to address persistent barriers like cost and access.
Equally important, patient education remains central. Helping individuals understand their choices, set realistic expectations, and engage in shared decision-making will be critical for long-term treatment success.
Concluding Thoughts
AD research is moving at an unprecedented pace, and with it, the standard of care continues to evolve. By moving away from a one-size-fits-all approach and toward targeted, pathway-specific therapies, clinicians are better equipped to transform patient outcomes.
World Atopic Eczema Day and National Atopic Eczema Week serve as important reminders—not only of the disease burden but also of the remarkable progress being made and the innovations still on the horizon.
Sources:
- Emma Guttman-Yassky, Michael Croft, Bob Geng, Natalie Rynkiewicz, Davide Lucchesi, Mark Peakman, Cassandra van Krinks, Wendell Valdecantos, Heming Xing, Stephan Weidinger, The role of OX40 ligand/OX40 axis signalling in atopic dermatitis, British Journal of Dermatology, Volume 191, Issue 4, October 2024, Pages 488–496, https://doi.org/10.1093/bjd/ljae230
- Galderma Receives U.S. FDA Approval for Nemluvio® (Nemolizumab) for Patients with Moderate-to-Severe Atopic Dermatitis
- Nemolizumab in patients with moderate-to-severe atopic dermatitis: Randomized, phase II, long-term extension study. Journal of Allergy and Clinical Immunology, Volume 142, Issue 4, 1121 – 1130.e7
