![](\"https:\/\/www.europesays.com\/ie\/wp-content\/uploads\/2025\/08\/1112a26736d2b636a55208863b8805ab2c2f552d-1920x1080.png\"\/)
<\/p>\n<\/p>\n
\u201cIn an age where we are rapidly filling a tool chest of advanced targeted therapies for moderate to severe atopic dermatitis, we now have the challenge of asking which to use, which is a great problem to have,\u201d Adam Friedman, MD, FAAD, said.<\/p>\n
In a recent Dermatology Times Case-Based Roundtable event titled “Exploring Novel Topical Treatments for Atopic Dermatitis: Clinical Insights from Patient Cases”, Friedman led an engaging discussion on the evolving landscape of atopic dermatitis (AD) treatment. The event provided a unique opportunity to explore real-world patient scenarios while emphasizing the growing range of topical therapies now available.<\/p>\n
A Shifting Therapeutic Landscape<\/strong><\/p>\n Friedman opened the event by highlighting the significant progress made in the treatment of moderate-to-severe AD, particularly with systemic targeted therapies. However, he emphasized that despite these advances, topical agents remain the cornerstone as \u201cfirst line workhorses\u201d for most patients, including corticosteroids and calcineurin inhibitors. Now, with an “embarrassment of riches” in both expanding systemic and topical options, the challenge becomes selecting the right agent for the right patient\u2014especially when considering factors such as mechanism of action, vehicle formulation, application feasibility, and patient preference.<\/p>\n Case 1: Classic Childhood-Onset AD<\/strong><\/p>\n The first case focused on a patient with AD beginning in childhood and persisting into adulthood, which, according to Friedman, is the trajectory for roughly one-third of patients. Importantly, he pointed out that about 20% of adult AD cases begin in adulthood, challenging the common notion that it\u2019s strictly a pediatric disease.<\/p>\n This patient had approximately 10% body surface area (BSA) involvement, prompting discussion on how disease extent complicates topical treatment adherence. Friedman stressed the importance of appreciating the burden of applying topical treatments over large areas, joking that it should be a requirement in medical school to apply a topical on 30% to 40% BSA.<\/p>\n \u201cIt’s easy to tell someone to put something on their skin. It’s another to actually do that…See how easy it is to go about your day, to really appreciate what it’s like to walk in your patient’s shoes and have some empathy,\u201d Friedman said.<\/p>\n The attendees also emphasized the significance of vehicle selection based on the area of involvement and patient lifestyle. Above all, itch management emerged as a central therapeutic goal, and novel agents are now offering rapid-onset itch relief, sometimes within minutes, which dramatically improves patient quality of life.<\/p>\n Case 2: Addressing Low-BSA Disease<\/strong><\/p>\n The second case featured a patient whose AD persisted from childhood but was inconsistently managed, often with a primary care-prescribed topical like triamcinolone. Though his BSA was low, the disease had progressed and impacted visible areas like the head and neck.\u00a0Friedman underscored how low-BSA cases can still have a significant quality-of-life impact. Despite qualifying for systemic therapy, this patient was reluctant to escalate.<\/p>\n In response, Friedman discussed the importance of patient-centered conversations. Clinicians should be ready with scripts that clearly outline safety, efficacy, and expectations. He also spoke about newer topical agents that overcome limitations of older therapies\u2014highlighting differences between agents like crisaborole and roflumilast, which share similar targets but differ in tolerability and formulation. For patients unwilling to pursue systemic treatment, these novel topicals provide meaningful alternatives.<\/p>\n Case 3: Pediatric AD on the Hands<\/strong><\/p>\n The third case involved an 8-year-old with hand involvement, which is a particularly challenging area due to constant exposure, trauma, and barrier disruption. Friedman emphasized that common treatment missteps, such as the inappropriate use of antihistamines, can complicate care. He reminded attendees that histamine is not a primary driver of itch in AD and that sedating antihistamines can negatively affect school performance and development.<\/p>\n Topical steroids and calcineurin inhibitors had been tried but were either ineffective or poorly tolerated. The discussion again returned to newer options such as ruxolitinib that offer safety for sensitive areas like the hands, while providing fast, sustained relief and improved patient adherence.<\/p>\n A Recurring Theme of Access and Advocacy<\/strong><\/p>\n Across all cases, the issue of access repeatedly emerged as a major barrier to implementing advanced therapies. Friedman urged providers in the room to anticipate payer requirements such as documentation of BSA, Investigator’s Global Assessment\u00a0scores,\u00a0and past treatment history, to streamline prior authorizations and avoid delays in care. He also discussed the importance of leveraging samples, support programs, and proper coding to increase the likelihood of access for underserved or Medicaid populations.<\/p>\n Final Thoughts<\/strong><\/p>\n Friedman praised the event for its blend of meaningful discussion and camaraderie, calling it \u201ca novel approach to small-group learning.\u201d He highlighted how the intimate and informal design\u00a0created flowing conversations, fresh perspectives, and countless learnings into managing AD with today\u2019s growing arsenal of treatments.<\/p>\n \u201cI was so pleasantly surprised by the incredible marriage of practical education with fun,\u201d Friedman shared with readers. \u201cMy advice is that if you get invited to one of these things, please go. I think it’s worth it and you will absolutely get something out of it.\u201d<\/p>\n Interested in attending a Case-Based Roundtable Event near you? Click here<\/a> to see our\u00a0current schedule and join our guest list<\/a> to be notified when Dermatology Times is coming to your city!<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"\u201cIn an age where we are rapidly filling a tool chest of advanced targeted therapies for moderate to…\n","protected":false},"author":2,"featured_media":10638,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[74],"tags":[10305,10307,10306,10309,10311,10310,18,10308,19,17,2668,82],"class_list":{"0":"post-10637","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-technology","8":"tag-ad","9":"tag-adam-friedman","10":"tag-atopic-dermatitis","11":"tag-case-based-roundtable","12":"tag-dermatology-roundtable-event","13":"tag-dermatology-times-case-based-roundtable","14":"tag-eire","15":"tag-faad","16":"tag-ie","17":"tag-ireland","18":"tag-md","19":"tag-technology"},"share_on_mastodon":{"url":"","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/posts\/10637","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/comments?post=10637"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/posts\/10637\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/media\/10638"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/media?parent=10637"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/categories?post=10637"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/tags?post=10637"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}