Peter Lio, MD, Discusses Atopic Dermatitis Treatment Strategy and Microbiome-Targeted Therapies

“What's really exciting is that we're in this set of ideas I like to call the ‘virtuous cycle of drug development.’ We have new medicines that help us treat [atopic dermatitis], but that also have allowed us to understand it better, which has in turn led to better treatments,” said Peter Lio, MD, in an interview at the 2026 Revolutionizing Atopic Dermatitis (RAD) Conference in Nashville, Tennessee.

Lio, clinical assistant professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine in Chicago, Illinois, reviewed shared decision-making in atopic dermatitis (AD), the expanding systemic treatment landscape, and emerging microbiome-targeted therapies.

Building a Stepwise Shared Decision-Making Approach

Lio said the shared decision-making algorithm for AD continues to evolve as new medicines reshape what clinicians can offer patients.

"The shared decision making algorithm is tricky, and it keeps changing," Lio said.

He starts with education and gentle skin care, and he is specific about product selection rather than defaulting to mild or unscented options.

"I'm very prescriptive in this. I feel like finding a great cleanser, not just a mild cleanser, one that is hopefully going to do more, a great moisturizer, not just something that's non-scented," Lio said.

He encourages patients to sample topical options side by side and report which one performs better on their skin, a practice he frames as complementary to the existing evidence base rather than a replacement for it.

Weighing Systemic Options by Age and Experience

When the conversation moves to systemic therapy, Lio described an abundance of choices shaped by age-based indications and individual physician experience.

"There are certain medicines that I feel very comfortable with, and I say this one, I've used a lot, and I have a lot of patients who are doing great with this one," he said

He factors in family feedback throughout the decision-making process to determine where to start treatment.

A Virtuous Cycle of Drug Development

Lio described the current pace of atopic dermatitis research as a virtuous cycle, where new medicines improve disease understanding, which in turn drives further treatment advances. He pointed to the volume of publications and conferences as evidence of how quickly the field is moving.

"We are going to get patients, we already are getting patients better than they've ever been before, longer and more safely than ever before," Lio said.

Looking Ahead to Microbiome-Targeted Therapies

Lio said his current focus is the microbiome, which he considers an incompletely understood piece of the atopic dermatitis puzzle. He cited topical sprays designed to selectively target Staphylococcus aureus along with topical probiotics and prebiotics as tools capable of working alongside biologics and systemic medicines.

"For many of my patients who are already on a biologic or on a powerful systemic medicine, but need something more, I love the idea that these could be adjunctive," Lio said.

He described microbiome-directed approaches as supportive additions to existing treatment rather than standalone therapies.

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