Harrison Nguyen, MD, MBA, MPH, is a double board-certified dermatologist/Mohs micrographic surgeon and clinical researcher in Houston, Texas.

Harrison Nguyen, MD, MBA, MPH

 has evolved in recent years, providing clinicians in the field with an expanding range of topical, biologic, and oral treatment options.

While these advances have created new opportunities to improve patient outcomes, they have also introduced greater complexity into the selection of drugs, requiring dermatologists to weigh disease severity, comorbidities, patient preferences, and quality-of-life considerations when determining the most appropriate medication.

 Conference in Nashville, Harrison Nguyen, MD, MBA, MPH, founder of Harrison Dermatology & Research Group, speaks on the key themes from his session, ‘Medical Crossfire.'

 He shared his views on tailoring treatment decisions to individual patients, identifying when to escalate from topical to systemic therapy, and the importance of shared decision-making:

You gave a talk at RAD titled ‘The Medical Crossfire.’ In light of this session, what are some of the most common areas of debate when choosing between topical therapies, oral agents, and biologics for atopic dermatitis?

 Well, I often say we're in a golden revolution of atopic dermatitis. We have, fortunately, several options for treating our patients, both from a topical standpoint and also systemic. As we're understanding more and more about these therapies, both ones that are established and emerging, we're trying to understand which patient will benefit from which therapy. For each therapy, we're understanding more and more about their biologic behavior, how they behave in certain manifestations of atopic dermatitis, and, of course, which patient would benefit the most based on those characteristics.

So, I presented a case of a teenage patient with atopic dermatitis with a significant history of atopic disease in that patient's family. The mom has a history of asthma. Dad has a history of food allergies and allergic rhinitis. Actually, a younger sibling has developed new-onset chronic spontaneous urticaria. All type 2 inflammatory diseases. In my presentation, I argued that the best treatment for this patient, once we made the decision to escalate from a topical treatment to a systemic treatment, is dupilumab. Why is that? Dupilumab blocks not just IL-13 but IL-4 as well. IL-4 is critical in so many mechanisms of type 2 inflammation.

It's critical in class switching for antibodies is critical. Critical in Th2-mediated disease. So if we can interfere and block IL4 in addition to IL13, our patients will really benefit from it. Not only are we able to control their symptoms of atopic dermatitis, but we're also seeing emerging data that we're able to prevent the development of other type two inflammatory diseases, things like asthma, things like allergic rhinitis. Then also [we may be] able to address other comorbidities that may emerge, such as chronic spontaneous urticaria.

When you're evaluating a patient with moderate to severe disease, what factors most strongly impact your decision to then escalate from topicals to a systemic?

 It's quality of life. The impact on quality of life is the single most important driver of escalation of therapy. It's the impact on the itch. So, is a patient so itchy that it's interfering with his or her ability to sleep, his or her ability to function, his or her ability to work or to study? Is the topical burden so overwhelming that it’s also interfering with quality of life? Sometimes for parents who are caregivers for patients or adolescents with atopic dermatitis, the burden of having to apply topicals can be really challenging for caregivers.

We really want to understand the patient's journey, the patient's impact on quality of life, and then from there, we also go into things like preferences, comorbidities, and of course, manifestations of disease. We stratify based on specialty site involvement, such as head and neck atopic dermatitis, atopic dermatitis affecting the hands and the feet, because these types of involvement in specific areas will also determine our selection as well.

There's a growing number of available therapies. How has your approach to treatment sequencing evolved? Are there situations where you're moving quickly towards oral or biological therapies that maybe more quickly than you would have several years ago?

 I believe that we should always meet the patient where they are. So it doesn't matter if they walk into my clinic for the first time and they've never tried a topical treatment, but they're covered from head to toe with atopic dermatitis…I'm not going to delay treatment and say, ‘Okay, we're going to try topicals first.’ We know that a patient is a systemic or biologic patient, right? So I try to meet the patient where they are in their atopic dermatitis journey. You know, for some patients, we do start with topicals, but when the burden of disease is impactful, no matter what time they're meeting me, I try to meet them where they are.

Typically, in my practice, I will usually start with a biologic. We have four biologics available: dupilumab, lebrikizumab, tralokinimab, and nemolizumab. But we also have 2 systemic JAK inhibitors: abrocitinib and upadacitinib. And for my patients who I think will benefit from the get-go from JAK inhibition right away, I have no hesitation to put them on a JAK inhibitor and not step through a biologic. But that being said, the majority of the time I do start with a biologic. It's not necessarily escalating faster. It's just meeting the patient where they are.

For clinicians who are attending this session, what practical takeaways do you hope they take away regarding how to individualize treatment selection and engage patients in shared decision-making?

 I hope the audience took away key principles about understanding each atopic dermatitis patient's presentation preferences and journey. Not every atopic dermatitis patient is the same, and we want to choose the best treatment for the patient in front of us. Take into account the patient's presentation. What anatomical sites are affected, the patient's comorbidities, and patient preferences, so that we can really cater our treatment to our patient. Sometimes, I think it feels like we have good treatment for atopic dermatitis, and we can just do 1 treatment for every patient in front of us. We would probably get good results, ranging from good to excellent for all our patients, or at least for the vast majority of them. But I think if we take a customized, catered approach, we can get excellent results for each and every 1 of our patients based on their characteristics, disease course, and their patient preferences.

Editor’s note: Nguyen had no relevant financial disclosures of note.

Nguyen H, Bunick C, Cotter D, Shahriari M. Medical Crossfire and Clinical Case Challenge. Session presented at: 2026 Revolutionizing Atopic Dermatitis Conference; June 17-19, 2026; Nashville, TN.

Nguyen H. Emerging Evidence in Atopic Dermatitis Management, With Harrison Nguyen, MD, MBA, MPH. HCPLive. June 19, 2026. Accessed July 29, 2026. 

https://www.hcplive.com/view/emerging-evidence-atopic-dermatitis-management-harrison-nguyen-md-mba-mph

Articles

Therapeutic options for atopic dermatitis now span multiple topicals, biologics, and oral systemic agents, increasing both opportunity and decision complexity. Treatment escalation is primarily driven by quality-of-life impairment, especially pruritus, sleep disruption, functional limitation, and topical-treatment burden for patients and caregivers. Systemic selection should incorporate disease phenotype and anatomic distribution, comorbid type 2 inflammatory conditions, and patient preferences. Dupilumab may be favored when broader type 2 blockade is desired. Sequencing should “meet patients where they are,” including direct initiation of biologics or JAK inhibitors when appropriate.

How should clinicians choose atopic dermatitis treatments? Harrison Nguyen, MD, discusses personalized therapy and when to escalate care.

Q&A: Which Factors Guide the Choice Between JAKi, Biologics, or Other AD Drugs?

Individualizing Treatment Selection in Atopic Dermatitis, With Harrison Nguyen, MD, MBA, MPH

2026 Revolutionizing Atopic Dermatitis (RAD) Conference

 in Nashville, Harrison Nguyen, MD, MBA, MPH, spoke in an interview on the importance of individualized treatment selection in atopic dermatitis following his portion of a session at the meeting, highlighting ways in which clinicians should tailor therapy decisions to the unique needs of each patient.

 interview, Nguyen identified quality of life as the single most important factor influencing his decision to escalate treatment from topical therapies to systemic options. While disease severity remains an important consideration, he noted that the impact of atopic dermatitis on sleep, daily functioning, work, and school often provides the clearest indication that additional intervention may be necessary. He also pointed to the burden of topical therapy itself, particularly among caregivers of pediatric patients, as an important but sometimes overlooked factor when evaluating treatment needs.

“The burden of having to apply topicals can be really challenging for caregivers,” Nguyen said. “We really want to understand the patient's journey [and] impacts on quality of life. Then from there, we also go into things like preferences, comorbidities, and of course, manifestations of disease.”

Beyond quality-of-life considerations, Nguyen described selection of treatments as being increasingly guided by different patient-specific factors. The factors include comorbid conditions, the preferences of individuals, and the anatomic distribution of one’s atopic dermatitis. For example, involvement of regions such as the head and neck, hands, or feet may impact the therapeutic choices clinicians make and help them to determine which available options are most appropriate for a given individual.

Nguyen also pointed to the rapidly expanding therapeutic landscape as having changed his approach to disease management. Rather than following a rigid treatment sequence, he highlighted the value of “meeting patients where they are” in their disease journey. In practice, he noted, this can mean recognizing when a patient’s disease burden warrants systemic therapy from the outset rather than requiring them to progress through multiple topical treatments first.

While Nguyen noted biologics often function as his preferred first-line systemic agent, he also noted the growing role of Janus kinase (JAK) inhibitors for select patients who may see benefit from that mechanism of action. The expanding number of available therapies, he explained, has created new opportunities to personalize care rather than rely on a one-size-fits-all treatment approach.

Nguyen had no relevant financial disclosures of note.

Nguyen H. Emerging Evidence in Atopic Dermatitis Management, With Harrison Nguyen, MD, MBA, MPH. HCPLive. June 19, 2026. 

Videos

Nguyen urges clinicians to consider patient's disease presentation, comorbidities, treatment goals, and preferences when making therapeutic decisions.

Emerging Evidence in Atopic Dermatitis Management, With Harrison Nguyen, MD, MBA, MPH

Harrison Nguyen, MD, MBA, MPH, founder of Harrison Dermatology & Research Group in Houston, Texas, spoke with HCPLive about the inccreasing complexity, and level of opportunity, within the atopic dermatitis treatment space, following his session titled “Medical Crossfire” at the 

Revolutionizing Atopic Dermatitis (RAD) Conference 2026

Speaking with the editorial team, Nguyen described the modern era of treatment as a “golden revolution” in atopic dermatitis care. He hoted clinicians can now access an increasing array of topical and systemic medications, though 1 of the central questions facing providers is finding out which treatment is best for which patient. Increasingly, decisions related to medications are being guided not only by disease severity but also by underlying immunologic mechanisms, comorbidities, and individual patient characteristics, he noted.

“[For] each therapy, we're understanding more and more about their biologic behavior, how they behave in certain manifestations of atopic dermatitis, and of course, which patient would benefit the most based on those characteristics,” Nguyen expressed.

In his session, he presented the case of an adolescent patient with atopic dermatitis and a strong family history of atopic disease. The patient’s family history included asthma, food allergies, allergic rhinitis, and chronic spontaneous urticaria—conditions linked through shared type 2 inflammatory pathways. According to Nguyen, such cases underscore the importance of evaluating atopic dermatitis within the broader context of systemic inflammatory disease rather than viewing it solely as a cutaneous condition.

During the debate-style session, Nguyen argued in favor of dupilumab as the preferred systemic therapy for this particular patient. He explained that the biologic’s dual inhibition of interleukin (IL)-4 and IL-13 may offer advantages for patients with significant type 2 inflammatory burden. While IL-13 plays an important role in atopic dermatitis pathogenesis, Nguyen pointed to IL-4 as being involved in many immune processes, including antibody class switching and Th2-mediated inflammation, making it a critical therapeutic target.

Outside of disease control, Nguyen noted emerging data suggesting potential implications of the targeted treatment of atopic dermatitis for the broader atopic disease spectrum. He noted growing interest in whether treatments such as dupilumab could impact the development or progression of related conditions, including asthma and allergic rhinitis, particularly among patients at elevated risk.

Nguyen’s session reflected the growing level of personalization of atopic dermatitis management, with drug selection becoming more closely tied to a patient’s immunologic profile, family history, and risk for associated type 2 inflammatory conditions.

At RAD 2026, Nguyen speaks on key highlights from his “Medical Crossfire” session, touching on the atopic dermatitis treatment landscape.

The Cost of Delay: How Prior Authorization Is Impacting Dermatology

 today, clinicians have access to an unprecedented array of biologics and targeted treatments designed to dramatically improving outcomes for individuals living with chronic inflammatory skin diseases such as atopic dermatitis, psoriasis, and hidradenitis suppurativa (HS).

However, according to 3 dermatologists interviewed by 

, gaining patients access to these drugs has evolved into a more and more complicated procedure. This, they and others in the field have noted, is due to prior authorization requirements, ‘step therapy’ protocols, and formulary restrictions caused by insurers and pharmacy benefit managers, also known as PBMs.

Prior authorization, the process by which health insurance plans go over and approve or deny various types of covered health services or medications, has evolved from an occasional administrative task into a routine part of practice management in dermatology.

 In this feature, the issues many clinicians have with the prior authorization process is explored, along with the potential need for future reforms.

Harrison Nguyen, MD, MBA, MPH, managing director of Harrison Dermatology & Research Group, was 1 such clinician who spoke with 

 about this complicated process as a substantial burden on both physicians and staff. While physicians may identify the most appropriate medication for a patient early in the visit, Nguyen highlighted the securing of a treatment’s approval as often requiring extensive paperwork, repeated communication with insurers, and dedicated personnel focused solely on navigating the authorization process.

Shannon Trotter, DO, known for her work with DOCS Dermatology Group, spoke with 

 about prior authorization, describing it as having long been a challenge in dermatology, though she highlighted the growing role of artificial intelligence (AI) in the process as both positive and negative. While AI tools can allow practices to better streamline submissions and diminish their own administrative workload, Trotter described insurers as also beginning to use similar technologies, creating what she described as an ongoing back-and-forth between providers and payers.

Outside of administrative burdens, all 3 of these clinicians emphasized the impact these barriers can have on patient care. Trotter pointed to step therapy requirements as a frequent source of delays, noting that patients may be required to try and fail therapies for months prior to gaining access to the medication their clinician originally recommended. During such time, a patient may continue experiencing symptoms that interfere with work, sleep, overall quality of life, or even becoming more debilitating.

Nguyen described formulary changes as also potentially forcing patients to switch from therapies that may already be working well. While some transitions occur without issue, he noted patients with conditions such as atopic dermatitis and HS can sometimes report disease worsening or loss of treatment response when required to shift between treatments for non-clinical reasons. In certain cases, Nguyen noted, interruptions in therapy can make future treatment far more challenging.

Matthew Zirwas, MD, a board-certified dermatologist at Dermatologists of Greater Columbus, spoke even more adamantly against prior authorization as a practice. Zirwas pointed to the growing number of available therapies as having intensified prior authorization challenges. He pointed to PBM rebate structures and limited transparency surrounding formulary decisions as key drivers of the issue, suggesting that treatment preferences often do not align with what clinicians believe is best for patients. Additionally, he noted his own view of the need for reforms that allow for incentives among PBMs to shift, as well as the need for more transparency.

Despite differences in emphasis, all 3 clinicians agreed that reform is needed. Proposed solutions included greater transparency around formulary and rebate decisions, streamlined authorization processes, improved peer-to-peer review systems, and reforms to step therapy requirements.

Overall, each of these 3 leaders in the field spoke in favor of a reduction of unnecessary barriers as helpful to ensure patients are given the right treatment at the right time, while nevertheless expressing the need to preserve access to the therapeutic advances known to have shaped the modern dermatologic landscape.

Disclosures: Trotter, Nguyen, and Zirwas had no relevant disclosures of note.

Amann ST, Shah ED, Wilson LJ. An Overview of the Challenging Process of Prior Authorization: Medical Necessity for a Better Way. Clin Gastroenterol Hepatol. 2024 Dec;22(12):2362-2366. doi: 10.1016/j.cgh.2024.09.001. Epub 2024 Sep 18. PMID: 39303798; PMCID: PMC11604005.

Sharma SP, Russo A, Deering T, Fisher J, Lakkireddy D. Prior Authorization: Problems and Solutions. JACC Clin Electrophysiol. 2020 Jun;6(6):747-750. doi: 10.1016/j.jacep.2020.04.022. PMID: 32553230.

Sampathkumar G. Rethinking prior authorization: bridging clinical needs and administrative burdens. Am J Manag Care. 2026 Feb 1;32(2):e31-e33. doi: 10.37765/ajmc.2026.89883. PMID: 41759204.

Kyle MA, Song Z. The Consequences and Future of Prior-Authorization Reform. N Engl J Med. 2023 Jul 27;389(4):291-293. doi: 10.1056/NEJMp2304447. Epub 2023 Jul 22. PMID: 37486761; PMCID: PMC10676707.

Wang Y, Levy JF, Mattingly TJ 2nd, Anderson G. Prior Authorization and Associated Delays and Denials of Branded Medication Dispensation. JAMA Health Forum. 2026 Apr 3;7(4):e260760. doi: 10.1001/jamahealthforum.2026.0760. PMID: 41996105; PMCID: PMC13090851.


This video feature highlights the views of dermatologists on prior authorization, step therapy, and issues related to these processes.