Special Report: Reframing Skin Pain in Atopic Dermatitis

Skin pain has historically been underrecognized in atopic dermatitis, with clinical assessments focused primarily on pruritus, erythema, and extent of involvement.

In this video, host Mona Shahriari, MD, associate clinical professor of dermatology at Yale University, introduces a focused discussion on skin pain as an integral component of disease burden in moderate to severe atopic dermatitis. Expert guest Andrew Mastro, MS, PA-C, outlines how this symptom has emerged as a clinically meaningful target, distinct from itch and often inadequately captured by traditional outcome measures. Their conversation emphasizes skin pain can significantly impair quality of life, activity level, and treatment satisfaction, warranting intentional and routine evaluation in practice.

In this video, which is part of a 6-part Special Report series on switching therapeutic classes in atopic dermatitis, Shahriari and Mastro highlight how the advent of JAK inhibitors has driven more granular assessment of patient-reported symptoms, including pain. Mastro reviews data with upadacitinib demonstrating rapid and sustained improvements in skin pain, with clinically meaningful reductions evident as early as week 1 and increasing through weeks 4 and 16 at both the 15-mg and 30-mg doses. He notes by week 16, approximately half of patients receiving 15 mg and up to about two-thirds of those receiving 30 mg achieved minimal to no skin pain. He also references abrocitinib data demonstrating significant pain improvement from week 2 through weeks 12 to 16 across multiple studies and dosages, including monotherapy and combination regimens.

For clinicians, the key message is skin pain should be approached as a discrete and modifiable symptom rather than a secondary consequence of itch alone. JAK inhibitors such as upadacitinib and abrocitinib provide examples of advanced systemic therapies can achieve rapid relief from pain in addition to improving skin clearance and pruritus. Incorporating structured pain assessments into routine visits, particularly when initiating or switching systemic therapy, can help align treatment choices with patient priorities and reinforce shared decision-making. As Shahriari notes, recognizing the “need for speed” in symptom relief, including pain, can guide the selection of appropriate advanced therapies for patients with high symptomatic burden.

Relevant disclosures for Shahriari include AbbVie, Apogee, Arcutis, Bristol Myers Squibb, Dermavant, Galderma, Incyte, Johnson & Johnson, LEO, Lilly USA, Novartis, Regeneron, Sanofi-Genzyme, Takeda, UCB, Pfizer, and others. Mastro has no relevant disclosures to report.

References:

1. Silverberg JI, Gooderham M, Katoh N, et al. Combining treat-to-target principles and shared decision-making: International expert consensus-based recommendations with a novel concept for minimal disease activity criteria in atopic dermatitis. J Eur Acad Dermatol Venereol. 2024;38(11):2139-2148. doi: 10.1111/jdv.20229

2. Silverberg JI, Bunick CG, Hong HC, et al. Efficacy and safety of upadacitinib versus dupilumab in adults and adolescents with moderate-to-severe atopic dermatitis: week 16 results of an open-label randomized efficacy assessor-blinded head-to-head phase IIIb/IV study (Level Up). Br J Dermatol. 2024;192(1):36-45. doi: 10.1093/bjd/ljae404