Tailoring Atopic Dermatitis Treatment and the Safety of Topical Therapies, Ruxolitinib

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Lawrence F. Eichenfield, MD, FAAD, chief of pediatric and adolescent dermatology at Rady Children's Hospital and professor of dermatology and pediatrics and vice chair of the department of dermatology at the University of California San Diego School of Medicine, emphasized that shared decision-making is paramount in atopic dermatitis management.

Eichenfield explained how to tailor treatment plans based on patient history, prior treatment experiences, and disease severity, with options ranging from intermittent topical corticosteroids to newer non-steroidal agents like ruxolitinib. He highlighted key findings from data presented at the American Academy of Dermatology 2025 annual conference on the long-term safety of ruxolitinib for patients with atopic dermatitis.

This transcript was lightly edited for clarity; captions were auto-generated.

Transcript

How do you incorporate shared decision-making into the selection of topical therapies for atopic dermatitis, ensuring that patient and family preferences are considered alongside clinical evidence?

Shared patient decision making is something we try to do all the time in our clinics, and atopic dermatitis is still pretty complex. In talking to patients and families, and especially in the case of pediatrics, you're really sort of wrestling with a set of issues to get the family to understand partially the pathogenesis, the inherent skin barrier, the associated changes in microbiome, what happens with clinical rashes and itch as well, and coming up with regimens of care that we think are going to get the skin under control.

We're very much into skin-directed therapy and deciding whether a regimen of topical agents is going to be sufficient to minimize rash, minimize itch, and minimize sleep disturbance—[the] core outcomes that I'm going for.

Depending upon severity, that may be what we're going for, and expect that's all we're going to need to do. Then we'll discuss which agents we are going to use for that, which depends upon their history of experience, use of those products, or whether it's a fresh patient who's never used any prescriptive agent and was only using moisturizers.

For some patients, they may do very well with only intermittent topical corticosteroids, and we might just do that because it's cost-effective. In other patients, they may be avoiding topical corticosteroids because they've had problems where they find that whenever they stop a topical steroid, their disease comes back. Then, we'll be discussing the options of our nonsteroid agents with variable potency and various histories of use and come up with a regimen that might put them only on that therapy or a mix and match between different topical agents, and they will be part of that decision making process. As the decision is made, we may be abandoning topicals as the core therapy and moving to systemic therapy, though topicals are usually still part of that. That shared decision making is really depending upon the history of the patient, what their prior uses of agents are, and where we think we need to go to get the outcomes that we need.

It's also influenced by things like the ability to access the drugs and what the cost might be for the drugs, and also how disabling the atopic dermatitis might be and have been to the patient, as well as to the family. We have a dermatology family impact score. We don't necessarily take that score in clinical practice, but when you're talking to patients and families about the impact of atopic dermatitis on the life of the family, it moves along that decision making process.

What are the biggest takeaways from ”Long-Term Safety of Ruxolitinib Cream in Adults and Adolescents With Mild-to-Moderate Atopic Dermatitis: Adverse Events of Interest From the TRuE-AD1 and TRuE-AD2 Phase 3 Studies”?

A long title of a study that's really looking at the sort of cumulative experience of topical ruxolitinib in patients with atopic dermatitis. This poster was looking at the present labeled use, which is patients 12 and older with atopic dermatitis. It was really looking at a longer extension time period.

We initially had an 8-week trial with topical ruxolitinib and then flipping over to the long-term extension, up to a year on an as-needed basis. One of the questions we have when you go from a 2-month trial to an extended trial is, do you start to see things more with extended use? Is it that cumulative exposure creates more issues? This study is really looking at some of the major events that might have been of concern if they had occurred, and looking at it in the population studied, looking at it also at a rate of adverse events over time, as compared with what might be seen in the atopic dermatitis population not treated.

Generally, this was a very positive paper for topical ruxolitinib, showing that, for instance, cutaneous infections were actually lower in the group with topical ruxolitinib than would be expected in the atopic dermatitis group. Instead of having a problem, like, this is a potent anti-inflammatory that's increasing infections, there's decreased infections. Many of the adverse events that are of interest or of concern with a systemic [Janus kinase] inhibitor, we don't really see signs of them being bigger issues. We're looking at this in a sort of rigorous way of adverse events over time. This was a very positive study about supporting the use of topical ruxolitinib as needed in this population with atopic derm.