Walter J. Liszewski, MD, is an associate professor of dermatology and cancer epidemiology at Northwestern University Feinberg School of Medicine.

Walter J. Liszewski, MD

Treatment selection in atopic dermatitis is becoming increasingly personalized as therapeutic options expand.

Biologics, JAK inhibitors, and advanced topicals each play distinct roles in long-term disease management.

Biomarkers and real-world evidence may help guide more individualized treatment decisions in the future.

 has created new opportunities for personalized care, but it has also made treatment selection increasingly complex, according to Walter Liszewski, MD.

Revolutionizing Atopic Dermatitis (RAD) Conference

 in Nashville, Liszewski discussed how clinicians are navigating a growing number of oral, biologic, and topical drugs while tailoring treatment plans to individual patient needs.

What Factors Should Guide Atopic Dermatitis Treatment Selection? With Walter Liszewski, MD

Liszewski explained that the increase in available therapies has shifted the conversation toward shared decision-making. Rather than focusing solely on efficacy, clinicians can now consider patient preferences regarding route of administration, treatment speed, potential adverse effects, and long-term disease management. He added that having multiple therapeutic options is especially valuable for patients who do not respond adequately to an initial therapy, providing clinicians with additional strategies when treatment failure occurs.

Addressing Treatment Gaps in Atopic Dermatitis

When discussing advanced systemic therapies, Liszewski noted that Janus kinase (JAK) inhibitors remain highly effective options, although current US Food and Drug Administration labeling generally reserves them for patients who have already received another systemic therapy. He suggested that as additional long-term safety data continue to emerge, dermatologist confidence in prescribing JAK inhibitors is likely to grow. Meanwhile, advanced topical therapies continue to fill an important role for patients with persistent disease who may not require biologic treatment, while also serving as adjunctive therapy to address localized areas of residual disease in patients receiving systemic agents.

Liszewski acknowledged that sequencing therapy after treatment failure remains one of the least defined areas in eczema management. Current evidence is limited, with clinicians often relying on case reports and real-world experience when considering combination therapy, phototherapy, or dose adjustments. He noted that emerging therapies with new mechanisms of action may help expand these options in the coming years.

Looking Ahead: The Future of Eczema Treatment

Looking to the future, Liszewski highlighted the growing importance of patient-reported outcomes, including measures of itch and sleep, alongside objective skin clearance. He also pointed to biomarkers and accumulating real-world evidence as promising tools that could help clinicians better identify which patients are most likely to benefit from specific therapies. While an expanding evidence base may increase the complexity of treatment decisions, he emphasized that it will ultimately support more individualized, patient-centered care.

Disclosures: Liszewski did not have any relevant disclosures of note.

Liszewski W, Rubin C, Cotter D, et al. Session 4: Medical Crossfire® and Clinical Case Challenge. Session presented at: 2026 Revolutionizing Atopic Dermatitis Conference; June 17-19, 2026; Nashville, TN.

Liszewski W. Q&A: How Is Treatment Selection Changing in Atopic Dermatitis? HCPLive. July 27, 2026. Accessed July 28, 2026. 

https://www.hcplive.com/view/q-a-how-treatment-selection-changing-atopic-dermatitis-

Videos

How is drug selection evolving in atopic dermatitis? Walter Liszewski, MD, discusses personalized therapy and long-term care.

The rapid expansion of treatment options for 

 has transformed clinical decision-making, giving dermatologists more tools than ever to individualize care while introducing new questions about treatment selection, sequencing, and long-term disease management.

As biologics, Janus kinase (JAK) inhibitors, and advanced topical medications continue to reshape dermatology’s therapeutic landscape, clinicians are increasingly balancing efficacy, safety, patient preferences, and quality-of-life considerations when developing personalized treatment plans.

 in Nashville, Walter Liszewski, MD, an associate professor of dermatology and cancer epidemiology at Northwestern University Feinberg School of Medicine, highlights the evolving approach he explored in his session to selecting treatments for patients with atopic dermatitis.

In this Q&A interview, Liszewski shares his perspective on choosing between oral and biologic agents, the growing role of advanced topical drugs, managing patients after treatment failure, and how emerging biomarkers and long-term real-world evidence may help clinicians deliver increasingly personalized care in the years ahead:

 In your session at RAD, you focused on treatment selection across oral, biological, and topical options in atopic dermatitis. With more approved options in atopic dermatitis than ever before, has treatment selection gotten easier or more complex for the practicing dermatologist?

 It's gotten a little bit more complicated, only in the sense that we have more options available. This is a great thing for patients, because we have the ability to let patients control the conversation. Do they want an oral option? Do they want an injectable? What side effects are tolerable to them? How important is it to control how quickly it works?

Having more options available allows us to provide better care and allows patients to be more empowered. The other thing is that it gives us more options where things fail. That was part of one of my talks. Although we have great medications and have great therapies, not everyone responds, so having a backup plan or multiple backup plans is really helpful.

How do you think about the oral versus biologic decision in a field where the safety conversation around JAK inhibitors is continuing to evolve?

It's complicated. I do think that oral options like JAK inhibitors can be incredibly effective. However, the way that they're currently positioned, due to FDA labeling, is that they need to be used when a patient is found to have a systemic agent. So, are there patients who would benefit from starting with a JAK inhibitor as their first advanced agent? Absolutely, but unfortunately, that's not something we can do. We do have more and more safety data about JAK inhibitors. I think there's really starting to be a turn within the dermatology practice. I think many providers are starting to feel more comfortable using JAK inhibitors. I think we're going to see more momentum, more utilization in the coming years.

The emergence of advanced topicals has expanded the toolkit. Should dermatologists be incorporating them rather than defaulting to what they already know?

Using advanced therapies can be very effective, and it's important to remember atopic dermatitis exists across the spectrum of mild, moderate, and severe, and sometimes those are fluid in patients. We do know that atopic dermatitis is a long-term chronic condition. For some patients, short-term use of topical steroids can be effective, particularly if their disease doesn't flare. That often tends to be very mild, but for some patients who have more chronic disease that don't necessarily qualify or need a biologic, that's where these advanced therapies are great.

But what's really exciting is we know even when we use advanced therapies, our oral agents or biologics, not everyone gets completely clear. We can still have hotspots that are active areas that are very bothersome, either cosmetically or in terms of itching patients. That's where we can leverage and utilize advanced therapies that have safer long-term utilization in combination with advanced therapies. It is really the next step in managing atopic dermatitis.

Sequencing after treatment failure is one of the murkier areas in atopic dermatitis management. How do you approach that decision, and what does the evidence actually support?

 Yeah, this is kind of the wild west. So, we have case reports, and we have individual experiences. For me, if someone's failed a biologic in a JAK, and this is what I talked about in my presentation, it's really challenging because we don't really have a backup option right now. We do have things in the pipeline that potentially, in the next 1 or 2 years, may give us a different mechanism of action. Things like the OX-40s. Currently, though, we have a variety of options. One is to utilize a biologic or JAK inhibitor in combination with phototherapy.

It's a little bit of an insurance nightmare, but using a biologic with a JAK inhibitor, and there is some evidence for escalating JAK inhibitors above the standard atopic doses, particularly for drugs like upadacitinib, which do have higher 45 milligram dosing. There is evidence for using those for long-term or short-term control in patients who fail current FDA-approved concentrations for atopic dermatitis.

 How much do patient preferences and quality of life priorities drive treatment selection, and is the field doing enough to focus on that in clinical decision making?

 I haven't been in practice that long. I've only been in practice now for about 8 years, but not that long ago, when I was in residency, we never really talked about itch in atopic dermatitis. Since then, there's really been a major change in conversation with our patients who are asking about itch and how they feel. I think we've really seen a major shift in terms of how we're incorporating patient symptoms and how we can control the RPs.

I think we're going to continue to see more utilization not only about asking but also sometimes for using patient-reported outcome measures. Things like a POM score or just routinely asking about NRS-Itch or NRS-Sleep can really help us better understand the symptoms our patients are going through and whether or not our patients are being fully controlled. Not only in terms of skin clearance, but also in terms of symptoms such as itch or pain or insomnia or anxiety.

Looking at where the evidence gaps still are, what would you say is most helping practicing dermatologists make more confident, individualized decisions for their atopic dermatitis patients?

I think that because we have more therapies, we're starting to see more data, and also just real-world use of trying different drugs, which patient populations do well with one but not another. I think we're still figuring that out. We are starting to see the beginnings of utilization of biomarkers commercially to identify and segment patients. I think there's going to continue to be refinement and improvement in that, and I think when that is at a very high level, highly successful, then hopefully we'll have an ability to routinely personalize medications based on a patient's genetic need. Excellent,

How do you think the treatment selection conversation will change as long-term real-world data continues to mature?

 I think it's going to, in many ways, maybe make it a little bit more difficult because as we have more data, there's more we need to review, and for patients, there's a lot they have to digest. So having more data is a good thing. It helps us know long-term what the safety maturity is. What is this long-term X? Is it durable? So having more data that shows that these drugs are effective long-term, that there's continued improvement over time, is helpful. It's also very reassuring.

The more extension trial safety data we have, because these medications are long-term medications. So knowing what the long-term side effects are. On the flip side, it's a lot more that we have to review with our patients. But ultimately, the more data we have, the more we can empower our patients to make the decision that's right for them.

Articles

The proliferating atopic dermatitis armamentarium is increasing decision complexity while enabling more patient-driven, individualized care. Selection now hinges on route of administration, speed of onset, tolerability, and contingency planning for nonresponse. Oral JAK inhibitors offer high efficacy, but FDA positioning and evolving safety perceptions influence sequencing and uptake. Advanced topical agents are increasingly used both for chronic moderate disease not warranting systemic therapy and as adjuncts for residual “hotspots” on systemic treatment. Evidence gaps persist post-failure; biomarkers and maturing real-world datasets may refine personalization.

Walter Liszewski, MD, discusses how dermatologists can personalize atopic dermatitis treatment using biologics, JAK inhibitors, and topicals.

Q&A: How Is Treatment Selection Changing in Atopic Dermatitis?

What’s Next in Dermatology? Dermatologists Weigh In On 2026

 are looking ahead to a year defined by expanding oral therapeutics, immunologic insights, next-generation biologics, and the increasing artificial intelligence (AI) integration into clinical settings. At the 

 team spoke on-site with several leaders in the field of skin health about new data and therapeutic advances they anticipate shaping the field in the year ahead.

Featured leaders included Linda Stein Gold, MD, director of dermatology clinical research at Henry Ford Health System; Lawrence Eichenfield, MD, chief of pediatric and adolescent dermatology at Rady Children’s Hospital and professor of dermatology and pediatrics at the University of California (UC), San Diego School of Medicine; Neal Bhatia, MD, director of clinical dermatology at Therapeutics Clinical Research in San Diego; Dawn Eichenfield, MD, PhD, associate professor of dermatology and pediatrics at UC San Diego School of Medicine and Rady Children’s Hospital-San Diego; Philip J. Mease, MD, director of rheumatology research at Providence Swedish Medical Center and clinical professor at the University of Washington (UW) School of Medicine; Paul Nghiem, MD, PhD, George F. Odland Endowed Chair in Dermatology at the UW School of Medicine; and Walter J. Liszewski, MD, dermatologist and clinical educator specializing in complex medical dermatology.

Stein Gold noted 2026 may mark “the year of the oral psoriasis therapy,” highlighting anticipation surrounding the potential approval of the oral interleukin (IL)-23 inhibitor icotrokinra and continued development of next-generation TYK2 inhibitors. She pointed to the expansion of oral options as potentially providing patients with efficacy comparable to biologics without compromising safety or tolerability, broadening flexibility in systemic psoriasis.

Lawrence Eichenfield focused on atopic dermatitis, noting several unanswered questions surrounding long-term immunologic modulation. He pointed to differences among biologics targeting IL-4/IL-13 pathways, IL-13 alone, IL-31, and upstream mediators such as OX40 and OX40 ligand. Although clinical endpoints such as Eczema Area and Severity Index (EASI) scores remain central, Eichenfield indicated understanding immunologic “rebooting” after prolonged therapy may shape treatment paradigms in the future, especially among pediatric and adult patients.

Bhatia pointed to excitement around a novel systemic acne therapy, denifanstat, a fatty acid synthase inhibitor targeting de novo lipogenesis to reduce sebum production. Unlike isotretinoin or antibiotics, Bhatia describes this mechanism as addressing a key driver of the pathogenesis of acne without retinoid-associated adverse effects, representing a potential paradigm shift in moderate-to-severe acne management. It is pending additional US-based research.

Dawn Eichenfield highlighted advances in the pediatric dermatology space, particularly highlighting genetic diagnostics and evolving biologic platforms. She suggested oral biologics and medications with extended dosing intervals could improve patient adherence as well as the quality of life of children and adolescents who prefer not to experience injections at an increased frequency.

In Mease’s segment of this interview, he described continued innovation across dermatology and rheumatology, noting small-molecule and biologic therapies aimed at IL-17A/F, IL-23, and TL1A pathways. Mease additionally referenced emerging long-acting biologic options potentially requiring administration only once or twice per year. This development of emerging options reflects efforts to refine molecular configurations for sustained treatment efficacy.

Nghiem spoke in his interview about AI’s growing role in dermatology, particularly in complex malignancies such as Merkel cell carcinoma. While he acknowledged potential overhype, Nghiem emphasized AI’s potential value in expanding patient access to multidisciplinary insights and surfacing considerations clinicians may not initially identify.

In his segment, Liszewski highlighted increasing awareness of chronic hand eczema (CHE) and renewed dermatology engagement in chronic spontaneous urticaria (CSU) management, especially with the emergence of newer agents such as remibrutinib and dupilumab. These drugs, Liszewski highlighted, are reshaping treatment algorithms.

Collectively, these leading experts at Maui Derm Hawaii 2026 signaled a year defined not only by new research and emerging treatment options, but by deeper immunologic understanding, improved personalization of medications, and expanded tools to enhance patient-centered care in the field of dermatology.

For more information on research covered at the 2026 Maui Derm conference, view the full video above or check out the 

Disclosures: Stein Gold has reported serving as an investigator, advisor, or speaker for Johnson & Johnson. Lawrence Eichenfield previously reported receiving personal fees from Pfizer; grant support from AbbVie, Arcutis Biotherapeutics, Castle Biosciences, Dermavant Sciences, Galderma, Pfizer, Regeneron, and Sanofi; consulting fees from multiple pharmaceutical companies; and serving on the board of directors of Forté Pharma. Bhatia has reported serving as an advisor, consultant, and investigator for AbbVie, Almirall, Arcutis Biotherapeutics, Beiersdorf, Biofrontera, Boehringer Ingelheim, Bristol Myers Squibb, Cara Therapeutics, Dermavant Sciences, EPI Health, Ferndale, Galderma, Incyte, ISDIN, Johnson & Johnson, La Roche-Posay, LEO Pharma, Lilly, Ortho Dermatologics, Pfizer, Regeneron Pharmaceuticals, Sanofi, Sun Pharma, and Verrica Pharmaceuticals. Dawn Eichenfield had no relevant disclosures of note for this interview. Mease has previously reported receiving research grants from AbbVie, Amgen, Bristol Myers Squibb, Janssen, Lilly, Novartis, Pfizer, Sun Pharma and UCB; and serving as a consultant and/or receiving speaker fees from AbbVie, Acelyrin, Aclaris, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Galápagos, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, Sun Pharma, UCB, Ventyx Biosciences, and XinThera. Liszewski has no disclosures of note.

Stein Gold L, Hawkes J. Best of the Best at Maui Derm. Presented at the 2026 Maui Derm Hawaii Conference, January 25-29.

Eichenfield L, Silverberg J, Chovatiya R. Atopic Dermatitis and Pruritus: Current Concepts and Therapeutics for 2026. Presented at: Maui Derm Hawaii 2026; January 25-29, 2026; Maui, Hawaii.

Rosen T, Bhatia N. New Drugs and Therapies in 2026. Presented at the 2026 Maui Derm Hawaii Conference, January 25-29.

Eichenfield D, Fallon Friedlander S, Treat J, et al. Pediatric Dermatology 2026. Presented at the 2026 Maui Derm Hawaii Conference, January 25-29.

Stein Gold L, Song E, Gordon K, et al. Psoriasis Update 2026. Presented at: Maui Derm Hawaii 2026; January 25-29, 2026; Maui, Hawaii.

Liszewski W. Contact Dermatitis Update 2026. Presented at: Maui Derm Hawaii 2026; January 25-29, 2026; Maui, Hawaii.

Dermatology leaders preview 2026 breakthroughs including oral psoriasis drugs, new biologics, novel acne drugs, and AI tools transforming patient care.

 at the Grand Wailea Hotel, a session titled ‘Contact Dermatitis Update 2026’ highlighted the evolving challenges of diagnosing and managing contact dermatitis.

 Presented by Walter Liszewski, MD, associate professor of dermatology and cancer epidemiology at Northwestern University’s Feinberg School of Medicine, this session emphasized several key points, including noting the limitations of existing patch-testing Core Series panels.

’s editorial team, Liszewski spoke about these key takeaways from the session, addressing common diagnostic pitfalls and stressing the importance of distinguishing allergic contact dermatitis from atopic dermatitis, given that targeted biologic therapies for atopic disease may not improve allergic etiologies. These points and others are highlighted in this Q&A transcript of his interview:

Dr. Liszewski, thanks so much for taking the time to speak with us today. Firstly, what are the most important changes or updates from the past year that you feel are important for clinicians to recognize?

 It's a couple of different things. First is that in patch testing, we have different ‘Core Series.’ These are allergens that we set nationally for the US and Canada that will catch the most common allergens. But they're not updated annually. What we start to see is that, in between the periodic updates, which occur every three to five years, there may be new allergens that are all of a sudden becoming very relevant. A couple of these that I emphasize, the big one is benzisothiazolinone.

It is not in the American contact dermatitis series, nor is it in the T.R.U.E. TEST. It's structurally similar to methylisothiazolinone and methylchloroisothiazolinone. Benzisothiazolinone is used predominantly in hand soaps, dish soaps, and laundry detergents. But it's less problematic. So many dermatologists may not have heard of benzisothiazolinone, let alone know how to counsel their patients about it. So, if you have a patient with recalcitrant hand dermatitis or weird rashes on their hands and arms, be sure to look at their hand soap, look at their dish soap, and make sure it does not contain benzisothiazolinone.

We know you discussed a range of dermatitis dilemmas. What were some of the most challenging or commonly mismanaged scenarios that you highlight?

There are two major ones. The first is chronic hand eczema. Chronic hand eczema is not atopic dermatitis. It can be in some circumstances, but for many patients with chronic hand eczema, they have a multifactorial cause of their dermatitis. There's allergic contact dermatitis, there's irritant contact dermatitis, and there can also be atopic dermatitis, but more often than not, it's multifactorial. The pearls I give [include one suggesting] that if you have a patient with chronic hand eczema, start with a prescription topical, but if that's still not working, then you should consider doing patch testing to make sure that there's not an allergenic cause.

The second thing I talk about is chronic lip dermatitis or colitis; more often than not, it's not an allergy. You can do patch testing, but you're probably not going to find anything. Most cases of chronic lip dermatitis are due to irritants. They're due to chronic lip licking. They're due to using too many skin care products. What patients in this group really benefit from is establishing a new treatment regimen. Simplify their products down, switch to thick barrier creams like Vaseline or Aquaphor, and try to pivot to using more hypoallergenic toothpaste in skincare products.

 Were there any allergens, exposures, or patient behaviors that you emphasized as increasingly relevant in 2026?

I think the big thing is [regarding] gel nails and acrylic nails, but predominantly gel nails. Gel nails have been very popular in the past couple of years, but there have been numerous new at-home kits. They're excellent, so consumers are doing them more at home. The issue is that, historically, the major allergen in gel nails was something called 2-Hydroxyethyl methacrylate or HEMA. It's part of a larger group of adhesives called methacrylates. The issue is that the industry is now starting to use all kinds of different methacrylates. If you have a patient who comes in with allergies, and you suspect that there's an allergy to their acrylic or gel nails, if you're only testing with a standard series, which would be the ACDS Core Allergen Series or the North American Core, you're only going to be testing for Hydroxyethyl methacrylate.

The T.R.U.E. TEST does not even test for Hydroxyethyl methacrylate. So, if you have a patient like this, and you have a very high suspicion for a gel nail allergy, and they didn't react to HEMA, there's a good chance they were reacting to a different methacrylate. As someone who does extended patch testing, I have an additional 20 methacrylates I can test. I routinely test on an extended tray to make sure I'm not missing any methacrylate allergies. But if you're someone who doesn't have that available, it's just important to remember that HEMA, although it catches many forms of gel nail allergies, given that there's so much heterogeneity currently in the market for the glues that companies are using, it may not catch all cases.

How did you recommend clinicians refine their diagnostic approach when contact dermatitis overlaps with atopic or other inflammatory diseases?

It's difficult. The challenging thing is that for atopic dermatitis, there is no diagnostic test, but for allergic contact dermatitis. So if you have a patient with moderate to severe eczema and it's not improving with topicals, those patients are candidates for patch testing. If you find an allergy and they get better, you know that there was either an exclusive allergic reaction or part of the dermatitis was due to allergies. However, if you do patch testing and there are no allergens, then you know that their allergen is either irritant dermatitis or exclusively atopic dermatitis in nature. The reason why that's important is that many of the drugs we use to treat atopic dermatitis, like lebrikizumab or dupilumab, will not be effective for most forms of allergic contact dermatitis. So identifying a precise cause is very important, because not all treatments will work for all forms of eczema.

If clinicians could take away only one or two practice-changing points from your session, what would you want them to remember?

The first thing is, we always need more people to do patch testing. And I'm someone who specializes in advanced patch testing. I have 500 allergens in my clinic. I routinely test patients for more than 100 allergens. Technically, yes, that is the ideal way it should be done. But that's not the only way that needs to be done. And if you're someone who can only do the American contact dermatitis 90 allergens, or even just the T.R.U.E. TEST, it can still be helpful. We need more dermatologists who are willing and capable of doing patch testing, because it can be transformative for many of our patients with chronic eczematous dermatitis.

The second thing that I would emphasize is that you need to read labels. One thing that I encourage all of you to do is next time you're at the grocery store, you're at a pharmacy, and you're looking at shampoos or lotions, look at a bunch of them. Look at the ingredients. Are there new chemicals you haven't seen before? Are there certain chemicals that you used to see all the time, like methylisothiazolinone, that just aren't there anymore, or methyldibromo glutaronitrile? Some chemicals become popular, and then they go away. I think it's very important for us to know what are the chemicals that our patients are coming in contact with, so that we can better identify potential causes and tailor our patch testing to their needs.

The quotes used in this summary were edited for the purposes of clarity.

Liszewski did not have any relevant disclosures of note.

Schalock PC, Dunnick CA, American Contact Dermatitis Society Core Allergen Series Committee, et al. American Contact Dermatitis Society Core Allergen Series: 2020 Update. Dermatitis. 2020 Sep-Oct;31(5):279-282. doi: 10.1097/DER.0000000000000621. PMID: 32947457.

This Q&A summarizes a recent 2026 Maui Derm Hawaii interview with Walter J. Liszewski, MD, regarding contact dermatitis updates.