Allie McAllister, FNP-C, DCNP, interviews Marc Serota, MD, on his lecture, Emerging Topical and Systemic Agents in Atopic Dermatitis, on Thursday, November 3, 2022, at the PA/NP Elevate-Derm Conference in Tucson, Arizona.

In this video

Dr. Serota does not consider atopic dermatitis a skin disease at all — he describes it as "a systemic disease with cutaneous manifestations," TH2-driven and comparable to how the field now thinks about psoriasis. He points to the high rate of atopic comorbidities, noting that roughly 50% of patients have comorbid asthma, as evidence that the inflammation is systemic rather than tissue-specific.

Looking ahead, he is excited both about the medications already at hand — which he expects to be studied further and gain expanded and pediatric indications — and about newer agents not yet approved, including another IL-13 inhibitor and a novel IL-31 inhibitor. On prevention, he draws on the allergy world's experience with immunotherapy inducing tolerance, and raises the hope that starting newer atopic therapies earlier could similarly interrupt the atopic march, while cautioning that more years of data are needed. In the meantime, his practical advice for at-risk children is to avoid the "bubble" and expose kids early to many allergens — including, as he and McAllister agree, giving them peanuts.

  • Think of atopic dermatitis as a systemic, TH2-mediated inflammatory disease with cutaneous manifestations, not simply a skin disease.
  • Roughly half of atopic dermatitis patients have comorbid asthma, underscoring the shared atopic, TH2-driven mechanism.
  • Emerging agents to watch include another IL-13 inhibitor and a novel IL-31 inhibitor, alongside expanding indications for current therapies.
  • The hope is that initiating newer atopic therapies earlier could interrupt the atopic march and induce tolerance, similar to allergen immunotherapy — but this claim awaits more years of data.
  • For at-risk children, early and broad allergen exposure — rather than a protective "bubble" — supports immune tolerance and fewer allergies.