Exploring Novel Topical Treatments for Atopic Dermatitis: Clinical Insights from Patient Cases

At a recent Dermatology Times Case-Based Roundtable event titled “Exploring Novel Topical Treatments for Atopic Dermatitis: Clinical Insights from Patient Cases,” John Browning, MD, led a discussion on evolving strategies for atopic dermatitis (AD) management. Through 3 distinct patient cases, clinician attendees examined the expanding role of innovative topical agents and the importance of individualized, empathetic care.

A Shifting Therapeutic Landscape

Browning, pediatric dermatologist at Texas Dermatology and Laser Specialists, adjunct associate professor at UT Health San Antonio, assistant professor at Baylor College of Medicine, and clinical faculty at UIW School of Medicine, opened by recognizing the progress achieved with targeted systemic therapies for moderate to severe AD. Yet, he emphasized that topical therapies remain the gold standard for most patients. The proliferation of both systemic and topical agents has introduced complexity in treatment selection, requiring consideration of factors such as mechanism of action, formulation, ease of use, and patient preference.

“These discussions really highlight how far we’ve come,” Browning noted. “But they also remind us that even with an abundance of options, getting the right treatment to the right patient—and ensuring adherence—remains a daily challenge.”

Case 1: Man With Persistent AD

The first case involved a 30-year-old man with childhood-onset AD that persisted into adulthood—a trajectory seen in roughly one-third of patients. The patient presented with 10% body surface area (BSA) involvement, sparking conversation on the challenges of maintaining adherence when large areas require topical application.

Attendees were struck by the patient’s response to topical ruxolitinib, with significant improvement and rapid itch reduction. “Almost everyone assumed this patient would need a systemic agent,” Browning said. “The strong response to topical ruxolitinib [Opzelura; Incyte] and its ability to reduce itch was impressive.”

Vehicle selection and patient lifestyle were also discussed as key considerations in maximizing adherence and satisfaction.

When discussing AD severity and topics, one attendee noted, “I almost never call atopic dermatitis mild because I feel like if the patient is presenting that that’s their chief complaint, to me, that already makes it in a category where I feel like a lot of patients who may consider it a mild problem, actually wouldn't take the time and commit to coming to see a dermatologist.”

Case 2: Teen With Low-BSA, High-Impact Disease

The second case highlighted a 15-year-old girl with low-BSA AD that primarily affected visible areas such as the face and neck. Though her disease was limited in extent, it caused substantial psychosocial distress.

“This was an interesting case,” Browning reflected. “Many of us see frustration in our adolescent patients who have recalcitrant facial dermatitis. Some even experience worsening facial AD when started on systemic agents.”

The group discussed how novel nonsteroidal topicals—such as roflumilast—can fill an important therapeutic gap for patients hesitant to use systemic treatments. Attendees noted the impressive clinical response and improved tolerability compared with traditional agents such as crisaborole.

“I have a lot more success with my patients if the treatment I give them is only once a day. I feel like the more topicals we prescribe, or the more times a day they have to apply them, the compliance sharply drops for the patient population that I see. So, I try to come up with a regimen that's as simple as possible,” said an attendee.

Browning also emphasized the value of patient-centered communication: dermatologists should clearly discuss expectations, onset of effect, and safety to improve comfort with newer agents.

Case 3: Pediatric Hand Involvement

The final case focused on a 7-year-old boy with chronic hand AD, an area prone to barrier disruption and environmental exposure. Traditional corticosteroids and calcineurin inhibitors had failed to provide lasting benefit.

“This case really reminded everyone of the frustration many families feel when cycling through traditional topicals and even antihistamines,” Browning said. He reiterated that histamine is not a key itch driver in AD, and sedating antihistamines can negatively affect school performance.

Participants agreed that the child would likely respond well to a newer nonsteroidal agent. “Our patients are very open to trying steroid-free topicals,” Browning noted. “There’s definitely interest in seeing ruxolitinib approved for younger ages.”

One attendee also shared her experience recommending tapinarof (Vtama; Organon) for families seeking a more natural-based topical option—an approach Browning said resonated with several participants.

“When you're treating kids, you're also treating their parents. So, listening to what the parents have to say and what they observe on a regular basis. If the child is scratching actively in the clinic, we want to try to reduce that the itch, which can be pretty severe for some people, compared to the actual rash,” said an attendee.

Access and Advocacy

Across all 3 cases, access to advanced therapies emerged as a key barrier. Browning encouraged dermatologists to prepare detailed documentation, including BSA, Investigator’s Global Assessment scores, and prior treatments, to streamline payer approval. He also recommended utilizing samples, patient assistance programs, and accurate coding to ensure equitable access.

Reflecting on the event, Browning said, “What makes these case-based discussions so valuable is that we’re not just listening to a lecture—we’re learning from each other’s real-world experiences. These conversations help us refine our approach and ultimately improve how we care for patients with atopic dermatitis.”