Fast Five Quiz: Atopic Dermatitis Management

William D. James, MD


February 22, 2021

Oral and topical JAK inhibition represents a potential new treatment strategy for atopic dermatitis. JAK inhibitors act on a common inflammatory pathway of many dermatoses. In support of the direct antipruritic effect of JAK inhibitors, a 2017 study identified that neuronal JAK1 signaling critically regulates atopic dermatitis–associated itch in mice, independently of any effect on the immune system. Currently, clinical studies are ongoing for topical and oral formulations. The topical formulations probably offer more opportunities to target milder forms of atopic dermatitis in contrast to the oral formulation, which, owing to its potency, is being investigated for moderate to severe atopic dermatitis.

IL-4, IL-5, and IL-13 play critical roles in the etiology of atopic dermatitis in response to activation by epidermal cell–derived cytokines. Anti–IL-4Ra therapy, subcutaneous dupilumab, was approved by the US Food and Drug Administration in 2017 for adults with moderate to severe atopic dermatitis not adequately controlled with topical prescription therapies or when those therapies are not advisable. In 2019, this indication was expanded to include adolescents aged 12 years or older, and in 2020 to include children as young as 6 years.

Immunomodulators are used for the treatment of patients with severe disease in whom conventional therapy is ineffective. Tacrolimus, an immunomodulator that acts as a calcineurin inhibitor, is available as an ointment in two strengths, 0.1% for adults and 0.03% for children, to treat moderate to severe atopic dermatitis. It is indicated for children older than 2 years.

A topical PDE-4 inhibitor is a nonsteroidal option for atopic dermatitis treatment. PDE-4 inhibitors allow cyclic adenosine monophosphate to remain intact in order to decrease the proinflammatory response (eg, cytokine release) associated with atopic dermatitis. Crisaborole is indicated for mild to moderate atopic dermatitis in adults and children aged 3 months or older.

Learn more about medication for atopic dermatitis.


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