4 New Recommendations for Atopic Dermatitis Management, with Robert Sidbury, MD, MPH

A new focused update has been issued by the American Academy of Dermatology (AAD) regarding guidelines on the utilization of topical and systemic drugs for adults with atopic dermatitis, given the recent emergence of several novel therapies.1

A multidisciplinary workgroup recently conducted a systematic review that led to this update, applying the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to available evidence. Robert Sidbury, MD, MPH, a professor in the Department of Pediatrics at the University of Washington School of Medicine and a chief of the Division of Dermatology at Seattle Children’s Hospital, spoke with HCPLive about the updates.

“The fact that this exists is an evolution,” Sidbury said. “I've been part of the AAD [atopic dermatitis] guidelines since 2004, then again in 2014, and the field has just changed so rapidly. We've had so many new medications, which is exciting, but it means that it’s a guideline out every 5 to 10 years that can quickly become out of date…The AAD had the foresight to plan for that this go round and have us review the evidence for medications which were not yet approved by the time we had planned to publish the manuscript with regard to topical therapies and systemic therapies.”

The 4 treatments highlighted in the focused update were tapinarof cream 1%, lebrikizumab, roflumilast cream 0.15%, and nemolizumab (with topical therapy). These treatments are recommended for clinicians to integrate into clinical practice.

Tapinarof cream 1% was approved by the US Food and Drug Administration (FDA) in 2024 for moderate to severe atopic dermatitis. The nonsteroidal aryl hydrocarbon receptor agonist demonstrated significant clinical improvements in Investigator’s Global Assessment (IGA), Eczema Area and Severity Index (EASI)-75, and itch scores following once-per-day use for 8–12 weeks in 4 trials. Lebrikizumab, an interleukin (IL)-13 monoclonal antibody, was approved in 2024 for moderate to severe disease, having shown improved clinical and patient-reported outcomes in over 1,700 individuals, with or without topical corticosteroids.

Roflumilast cream 0.15%, a topical PDE4 inhibitor approved in 2024 for mild to moderate disease, had shown significant gains in IGA and EASI-75 within trials featuring 1,427 patients and 4 weeks of treatment. Nemolizumab (plus topical therapy) was approved in 2024 for patients 12+ with inadequately controlled atopic dermatitis, and it led to notable itch reductions as well as improvements in Dermatology Life Quality Index (DLQI) and EASI-75 across 3 studies when paired with topical corticosteroids (± topical calcineurin inhibitor).

“Our work group used the same GRADE format, which is just a systematic way of evaluating evidence that we've used for all of the manuscripts this go-round,” Sidbury explained. “We reviewed the literature of these medications that we're going to talk about today and sort of put it aside and said, ‘Once they're FDA-approved, then we'll be able to publish a focused update with the recommendations for these medications.’”

For any additional information about the atopic dermatitis guideline recommendations, view the full interview segment posted above.

The quotes contained in this summary were edited for clarity.

Sidbury reports serving on Pfizer’s advisory board, for which he receives honoraria; acting as an investigator for Brickell Biotech and Galderma USA, with support through grants and research funding; serving as a principal investigator for Regeneron, also receiving grant and research support; and working as a consultant for Galderma Global and Microes, with compensation provided or, in some cases, not received.

References

1. Davis DMR, Frazer-Green L, Sidbury R, et al. Focused update: Guidelines of care for the management of atopic dermatitis in adults. J Am Acad Dermatol. 2025 Jun 17:S0190-9622(25)02125-5. doi: 10.1016/j.jaad.2025.05.1386. Epub ahead of print. PMID: 40531067.