ABCs in Dermatology: Updates in Atopic Dermatitis Live at RAD 2026

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New analyses are adding momentum to early systemic intervention in moderate-to-severe atopic dermatitis (AD), with growth outcomes emerging as a previously underappreciated marker of disease control in children. The findings reinforce a broader shift across the AD biologic class toward measuring success beyond skin clearance alone.

In a live recording of ABCs in Dermatology, co-hosts Christopher Bunick, MD, PhD, and Lindsay Ackerman, MD, FAAD, discussed the maturing interleukin-4 (IL-4)/interleukin-13 (IL-13) biologic landscape in AD. The conversation, recorded live at the Revolutionizing Atopic Dermatitis (RAD) 2026 meeting in Nashville, Tennessee, spanned dupilumab (Dupixent), tralokinumab (Adbry), and lebrikizumab (Ebglyss).Because no head-to-head trials exist among the 3 agents, comparative efficacy data rely on indirect network meta-analyses.

Roughly 30% of patients reach Eczema Area and Severity Index (EASI) 90 or Investigator Global Assessment (IGA) 0/1 by week 16, with response rates continuing to climb well beyond this early window. In dupilumab's long-term extension trial, more than 90% of patients who had not reached EASI 75 by week 16 achieved it by week 100.

None of the 6 FDA-approved advanced AD therapies require routine laboratory monitoring, and tralokinumab and dupilumab have each published 5-year safety data showing predominantly mild to moderate adverse events without new safety signals.

By contrast, around 1 in 5 patients with moderate to severe AD still receive oral corticosteroids. Even a 6-day prednisone dose pack raises the risk of sepsis, bone fracture, and venous thromboembolism for 30 days afterward.Pediatric growth emerged as a focal point. Extension data from the Liberty AD PS trial showed children treated early with dupilumab had a 3.7- to 4.2-fold greater likelihood of meaningful growth improvement versus peers on no systemic therapy, independent of corticosteroid exposure. Bunick described the underlying mechanism as likely multifactorial, reflecting reduced inflammation, lower corticosteroid use, and improved sleep.

Itch tracks closely with quality of life: registry data show quality of life drops sharply unless itch reaches a 0 or 1 on a 10-point scale. This prompted both hosts to counsel patients toward this stricter target rather than partial relief. Collectively, the data point to a biologic class no longer competing only on skin clearance, but increasingly on durability, safety, and capacity to address the systemic burden of AD across the lifespan.

Relevant disclosures for Bunick include AbbVie, South Beach Symposium, Almirall, Apogee Therapeutics, Arcutis Biotherapeutics, Daiichi Sankyo, Eli Lilly, LEO Pharma, US, Novan, Novartis, Ortho Dermatologics, Palvella Therapeutics, Pfizer Inc., Sanofi, Sun Pharmaceutical Industries Ltd., Timber Pharmaceuticals, and UCB. Relevant disclosures for Ackerman include AbbVie, Alumis, Amgen, Arcutis, Beiersdorf, Boehringer Ingelheim, Bristol Myers Squibb, Dermavant, Galderma, L'Oréal, Novartis, Sun Pharmaceutical, and UCB.