Expert Insights: Biologic Decision-Making for Moderate-to-Severe Atopic Dermatitis
Prior to the 2026 Fall Clinical Dermatology Conference, Lisa Swanson, MD, emphasized that decisions to escalate treatment for moderate-to-severe atopic dermatitis (AD) should consider both clinical disease severity and the patient’s experience. Clinicians should assess body surface area, lichenification, scratching, and other visible signs while also asking about itch, sleep, concentration, activities, and social participation. She noted that an office visit captures only one moment and may not reflect disease burden over time.
When selecting systemic therapy, Dr Swanson highlighted the expanding range of biologics and oral JAK inhibitors and identified undertreatment as a major concern. Clinicians should educate patients and families about available options and consider comorbidities, treatment preferences, itch severity, affected areas, and disease morphology. When possible, selecting a therapy that addresses AD and a comorbid condition may offer additional benefits.
Dr Swanson also stressed that patients, particularly adolescents, may say they are “fine” despite having inadequately controlled disease. Further discussion and examination can reveal the true impact of AD, while education about available treatments can help patients understand that improved disease control is possible.
Shared decision-making is central to Dr Swanson’s approach. Rather than choosing a treatment for the patient, she explains the available options and allows patients and families to determine which best fits their needs and preferences.
Setting realistic expectations is also critical for adherence and long-term disease control. Patients should understand when they can expect improvements in itch and skin symptoms and how long a therapy may take to reach peak efficacy. Providing this information before treatment begins may prevent premature discontinuation when improvement is not immediate.
Overall, Dr Swanson advocated for individualized AD management centered on comprehensive disease assessment, patient education, shared decision-making, and clear treatment expectations.
Full video coming soon.
Reference
Swanson L. Better biologic decision-making for moderate-to-severe atopic dermatitis: an interactive expert exchange. Presented at: Fall Clinical Dermatology Conference; October 8–11, 2026; Las Vegas, NV.
