Atopic Dermatitis Insights from SDPA: Innovations and Barriers in Care

At the SDPA’s 22nd Annual Fall Dermatology Conference, Matthew Zirwas, MD, delivered an engaging lecture titled “Managing Atopic Dermatitis: Innovations, Challenges, and Care Strategies.” Dr. Zirwas shared critical insights into the evolving understanding of atopic dermatitis (AD), with a focus on itch pathophysiology, misdiagnosis, and the need for updated diagnostic criteria. His lecture also explored barriers to effective treatment and the implications for clinical practice.

Scratching the Surface: What We Now Know About Itch

Dr. Zirwas began by discussing the unique nature of itch, describing it as a distinct neurological sensation. “[Itch] is a specific thing with specific neurons. It is not some type of pain,” he explained. Highlighting the powerful physiological response to scratching, Dr. Zirwas shared findings from functional MRI studies, which show that scratching activates the brain’s reward centers in a manner similar to cocaine.

Despite the critical role of itch in AD, effective treatments targeting this symptom alone remain limited. Dr. Zirwas emphasized that the sensation of itch and the behaviors it provokes are central to the patient experience of AD, underscoring the importance of addressing this unmet need in dermatology care.

The Diagnostic Dilemma in Atopic Dermatitis

A striking gap in care lies in the underutilization of advanced systemic therapies for moderate-to-severe AD, even though they have been available for nearly seven years. According to Dr. Zirwas, 2 million of the estimated 2.5 million individuals with moderate-to-severe AD in the U.S. are not receiving these therapies. He attributed this treatment gap in part to widespread misdiagnosis.

“In fact, the data now confirms we are misdiagnosing two-out-of-three people with atopic dermatitis,” Dr. Zirwas noted. He pointed to outdated diagnostic tools, such as the Hanifin and Rajka criteria, which are poorly suited for identifying adult AD. Unlike pediatric AD, adult forms often lack hallmark features such as flexural involvement or atopic comorbidities.

The Path Forward: Improving AD Diagnosis and Care

Dr. Zirwas’ lecture highlighted critical challenges that dermatology providers must address to improve care for patients with AD. With millions of patients misdiagnosed or undertreated, there is a pressing need to refine diagnostic methods and increase the use of systemic therapies for eligible patients. These updates would not only align clinical practice with current data but also enhance outcomes for patients living with this chronic and often debilitating condition.

By reevaluating diagnostic frameworks and addressing barriers to treatment, providers can better meet the needs of the growing population of adults with AD. As new research continues to reshape understanding of this condition, these adjustments will remain key to advancing dermatology practice.