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Personalized care for AD diagnosis
Personalized Care for Mild to Moderate Atopic Dermatitis: The Importance of Timely Diagnosis 

Released: May 20, 2025

Expiration: May 19, 2026

Benjamin Ungar
Benjamin Ungar, MD
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Key Takeaways
  • A key step in developing initial treatment plans for patients with atopic dermatitis is determining an accurate diagnosis of disease severity, which can present differently across the range of skin tones.
  • Although topical corticosteroids are the traditional first-line treatment option for mild to moderate atopic dermatitis, nonsteroidal options are available to use in combination with or replacement of these.
  • Regardless of atopic dermatitis severity, treatment should prioritize disease control and symptom improvement that is sustainable for patients to achieve a normal quality of life.

A key component that can make a big outcomes difference for patients with mild to moderate atopic dermatitis (AD) is an appropriate and timely diagnosis. This is because AD, even in milder forms or presentations, can have a significant and negative impact on quality of life. As a general rule, the earlier healthcare professionals (HCPs) can intervene, the sooner patients with AD can achieve a normalized quality of life without their disease affecting them negatively.

The Many Burdens of AD
When diagnosing and treating AD, HCPs must keep in mind that there is a large disease burden for patients who are dealing with this condition. This extends into multiple facets of their lives. One familiar aspect is the burden of itch, which can have an incredibly negative impact. In addition to the direct burden of having this very unpleasant symptom, itch can also interfere with patients’ sleep, which has numerous downstream negative consequences, including impaired social functioning and impaired functioning at school or work.

Also, AD is a chronic condition, where patients often face a financial burden regarding treatment. Many of the emollients and over-the-counter products for sensitive skin are costly. The financial burden truly adds up when considering this over the course of the months and years that patients will be treating their disease. Then applying these and other topical therapies, if ineffective, can add to the burden of the AD itself. The goal for HCPs is to find the most effective treatments that control the disease in a way that is sustainable for the patients and minimizes their symptoms (ie, reducing itch and improved sleep).

Correctly Diagnosing Disease Severity is Critical
Identifying disease severity requires careful and accurate characterization of patients’ AD presentation. Further, addressing disease severity comprises crucial points to achieve favorable outcomes. If patients are on the milder end of the spectrum, they may be amenable to treatment with short courses of topical therapies. If they are at the moderate end, topical therapies are appropriate but may require a slightly different approach.

Identifying disease severity is crucial and ensuring that it is diagnosed correctly is key to devising treatment plans. Although AD can have heterogeneous clinical presentation, it can vary depending on the affected area of the body and based on skin types, so HCPs should make sure to keep these factors in mind when examining patients. Darker skin tones may present with less visible erythema (often darker brown, purple, or gray) and more warmth, swelling, and dryness/scaling. There also can be more of a papular- or follicular-based presentation. Completing a close physical exam will allow HCPs to successfully diagnose AD in patients, including those with skin of color, and identify their disease severity.

Treatment Landscape for Mild to Moderate AD
For patients with mild to moderate AD, typically the first step is to treat with topical therapies. Commonly, one of the first steps prior to prescription topical therapies is using over-the-counter emollients and gentle skin-care practices. However, this is often unsuccessful in fully controlling patients’ disease, at which point HCPs should think about prescription topical therapies.

A core component of this is topical corticosteroids, which are very effective for many cases. But there are some significant drawbacks. Topical corticosteroids are associated with a substantial risk for toxicities related to consistent and chronic use. In addition, there are different corticosteroid potencies required for varying affected areas of the body, which can be confusing and burdensome for patients. Daily continued topical corticosteroid use is not necessarily safe, so this may be less of a treatment option for some patients with chronic or refractory AD requiring more frequent medication use.

Patients may also have steroid phobia or concerns about steroid withdrawal syndrome. In these cases, we are fortunate to be in a position where there are nonsteroidal topical therapy options (ie, topical calcineurin inhibitors, phosphodiesterase 4 inhibitors, JAK inhibitors, and aryl hydrocarbon receptor agonists) that have proven efficacy and safety. These treatments can be used in combination with topical corticosteroids or replace them. Approved nonsteroidal topical therapies include tacrolimus 0.03% or 0.1% ointment, pimecrolimus 1% cream, and crisaborole ointment, which have different mechanisms of action. Further, more recent approvals for nonsteroidal topical therapies (that are not included in current guidelines) include ruxolitinib 1.5% cream, roflumilast 0.15% cream, and tapinarof 1% cream. Of note, some of these do not require specific considerations for sensitive areas of the body. These all provide treatment potential and opportunities with advantages over traditional topical corticosteroids.

I will go into details of the current data, usage in terms of providing guideline-concordant care, and safety considerations for all of these topical therapies in the upcoming Medical Minutes dedicated to this education program.

Your Thoughts
How often do you see patients with mild to moderate AD in your practice? You can get involved in the discussion by answering the polling question and posting a comment below.

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