New Consensus Defines Remission, Disease Activity in Atopic Dermatitis

The International Eczema Council (IEC) has published the first international consensus definitions for low disease activity (LDA), very low disease activity (vLDA), on-drug complete control, and off-drug remission in atopic dermatitis (AD), providing standardized treatment targets for clinical trials and routine practice.¹ The consensus statement, published online April 15, 2026, in JAMA Dermatology, was developed through a targeted systematic literature review spanning 2004 through 2024 and a 3-round modified Delphi process among global AD experts.¹² Among 151 invited participants, 103 completed the final round, representing diverse geographic regions and professional roles.¹

Although treat-to-target strategies have become increasingly common with the expansion of biologic and systemic therapies, clinical trials, regulators, and clinicians have used inconsistent definitions of disease control and remission. The resulting variability has complicated comparisons across studies and interpretation of treatment outcomes. The IEC developed these consensus definitions to establish standardized, measurable thresholds using validated clinician- and patient-reported outcome measures.

Delphi process established consensus definitions

The recommendations were developed through a systematic review of clinician- and patient-reported outcome literature followed by a 3-round modified Delphi process among international experts.¹ Both clinician-assessed disease severity and patient-reported symptoms were incorporated into the final definitions.¹³

• The panel defined LDA as a validated Investigator Global Assessment for Atopic Dermatitis (vIGA-AD) score of 2, or an Eczema Area and Severity Index (EASI) score of 7 or lower, combined with a Peak Pruritus Numerical Rating Scale (PP-NRS) score of 4 or lower.¹
• Very low disease activity (vLDA) requires a vIGA-AD score of 0 or 1, or an EASI score of 3 or lower, paired with a PP-NRS score of 0 or 1.¹

The consensus also distinguishes complete disease control from remission. On-drug complete control was defined as a vIGA-AD score of 0 or an EASI score of 0 with minimal pruritus sustained for at least 6 months while receiving therapy.¹² Off-drug remission requires similar thresholds maintained for at least 12 months after treatment discontinuation.¹²

Consensus support and limitations of the AD remission framework

Most panelists (74%) endorsed a modular framework that separates clinician-assessed signs from patient-reported symptoms rather than relying on a single composite score.¹ This approach allows clinicians and trial investigators to evaluate disease activity and itch as related but distinct measures of disease control.

The authors acknowledged variable participation across the 3 Delphi rounds, along with reliance on expert consensus rather than prospective clinical validation.¹ They called for future longitudinal studies to evaluate how the proposed definitions correlate with treatment response and long-term outcomes before widespread adoption in regulatory guidance and clinical trial design.

Potential impact on clinical trials and patient care

Lead author Joseph F. Merola, MD, MMSc, of UT Southwestern Medical Center in Dallas, told Medscape Medical News the definitions provide the field with "a common language for meaningful disease control."²

By replacing variable definitions with standardized thresholds based on vIGA-AD, EASI, and PP-NRS scores, the framework could improve consistency across clinical trials, facilitate regulatory evaluation, and help clinicians communicate realistic treatment goals with patients.¹³ The distinction between on-drug complete control and off-drug remission may also inform decisions about maintenance therapy and treatment discontinuation as additional validation studies emerge.

REFERENCES

1. Merola JF, Childs BA, Bartley BR, et al. International Eczema Council definitions of low disease activity and remission in atopic dermatitis: a consensus statement. JAMA Dermatol. Published online April 15, 2026. doi:10.1001/jamadermatol.2026.0662.
2. IEC panel issues standardized definitions for AD remission. Medscape Medical News. https://www.medscape.com/viewarticle/iec-panel-issues-standardized-definitions-ad-remission-2026a1000eop
3. IEC establishes global definitions for AD disease control and remission. Practical Dermatology. April 17, 2026. https://practicaldermatology.com/news/iec-establishes-global-definitions-for-ad-disease-control-and-remission/2486652/