International Eczema Council Releases Definitions of Remission, Low Disease Activity

A new consensus statement published in JAMA addresses a longstanding gap in atopic dermatitis research and care: the lack of universally accepted definitions for several key treatment outcomes, such as low disease activity (LDA), very low disease activity (vLDA), and disease remission.1

Atopic dermatitis, often referred to as atopic eczema, is a relapsing inflammatory skin disease with clinical manifestations known to be both variable and dependent on patient’s age.2 It is also 1 of the most common skin disorders around the world.

This new statement regarding disease definitions for key outcomes in atopic dermatitis was authored by such investigators as Joseph Merola, MD, MMSc, of the Department of Dermatology and Department of Medicine at UT Southwestern Medical Center and O’Donnell School of Public Health in Dallas. Merola et al noted that, although recent advances in targeted medications have led to higher levels of disease control being more attainable, variability in the ways outcomes are defined has complicated clinical trial comparisons.

It has also made regulatory decision-making and treatment goal-setting difficult. In order to address this concern, the team of investigators with the International Eczema Council set out to determine what will become the standardized, consensus-driven definitions to be applied across both research and clinical practice around the world.

“This modified Delphi initiative establishes a globally endorsed, expert-derived framework defining LDA, vLDA, on-drug complete control, and off-drug remission in [atopic dermatitis],” Merola and coauthors wrote.1

The initiative was led by a steering committee from the International Eczema Council, which began by conducting a focused systematic literature review. Using PubMed, the group identified relevant studies published between 2004 and 2024 that examined clinician-reported and patient-reported outcomes, disease activity measures, and pruritus severity in patients with atopic dermatitis.

The quality of evidence was evaluated using established criteria from the Oxford Centre for Evidence-Based Medicine. These findings informed the development of key conceptual domains that would guide a structured consensus-building process. In order to ensure agreement among the team’s set of experts, Merola et al employed a modified Delphi method consisting of 3 sequential survey rounds. They conducted their development of this statement in the period between January - July 2025.

Those who took part included a set of members currently involved with the International Eczema Council who also had recognized expertise in atopic dermatitis. Across the 3 rounds, those involved as panelists looked over the proposed definitions, providing various levels of feedback and refining the thresholds for disease activity measures. The process incorporated a set of predefined criteria to determine the levels of agreement, with 70% consensus at minimum being required for the adoption of a definition.

There were 151 experts in total who were invited to take part, with varying response rates across rounds. Those taking part represented a broad global distribution, including Europe, North America, Asia-Pacific, Latin America, and areas around Africa and the Middle East. The expert panel was made up primarily of clinician-researchers and practicing clinicians, in addition to a smaller proportion of researchers and individuals representing patient perspectives or advocacy groups.

One of the key outcomes of panel’s process was strong support for a modular framework that distinguishes between clinician-assessed signs and patient-reported symptoms as separate but complementary elements related to disease control. This approach allows for more nuanced categorization of remission, including distinctions between improvement in patients’ visible disease and relief of symptoms such as itch.

Overall, Merola and colleagues noted the final consensus definitions laid out specific thresholds using commonly utilized clinical tools. Low disease activity was defined by the panelists as moderate but controlled disease, based on validated global assessment scores or limited atopic dermatitis extent combined with manageable levels of itch. Very low disease activity reflected minimal or near-clear skin alongside little to no itch.

The team of experts also defined “on-drug complete control,” describing individuals who attain full disease clearance and resolution of symptoms while continuing medication use for a sustained timeframe. In contrast, “off-drug remission” was defined by the panelists as the maintenance of such outcomes for an extended time period following the discontinuation of a treatment.

Overall, the consensus statement was described by Merola and colleagues as representing 1 of the first globally coordinated attempts to standardize treatment outcome definitions in the atopic dermatitis space. Through the establishment of clinically meaningful and clear benchmarks, the team’s framework is designed to allow for improvement of consistency across clinical trials, support regulatory assessment of novel treatments, and facilitate long-term comparative research. Ultimately, the set of definitions may also allow for guidance in a more structured, treat-to-target approach in clinical practice.

References

1. Merola JF, Childs BA, Bartley BR, et al. International Eczema Council Definitions of Low Disease Activity and Remission in Atopic Dermatitis: A Consensus Statement. JAMA Dermatol. Published online April 15, 2026. doi:10.1001/jamadermatol.2026.0662.

2. Jeskey J, Kurien C, Hostoffer R, et al. Atopic Dermatitis: A Review of Diagnosis and Treatment. J Pediatr Pharmacol Ther. 2024 Dec;29(6):587-603. doi: 10.5863/1551-6776-29.6.587. Epub 2024 Dec 9. PMID: 39659858; PMCID: PMC11627575.