Precision Medicine in Atopic Dermatitis: Current Challenges and Future Directions

Christopher Bunick, MD, PhD, associate professor of dermatology at Yale School of Medicine and editor in chief of Dermatology Times, discussed where precision medicine currently stands in atopic dermatitis. While gene expression profiling and immune characterization continue to advance, Bunick said additional work is needed before clinicians can reliably predict which therapies will produce the best outcomes for individual patients.

Gene Profiling Is Only the Beginning

Gene expression profiling has helped distinguish molecular patterns associated with different therapeutic responses, including Th2-driven disease and JAK inhibitor-responsive profiles. However, Bunick emphasized that current approaches have not yet reached the point of precise pharmacogenomic prediction.

It's a step in the right direction. I think there's a lot more that needs to be done to get to precise pharmacogenomic prediction. We're not quite there, - Christopher Bunick MD, PhD,

As additional therapies, including investigational STAT6-targeted agents, continue to enter development, researchers will need a deeper understanding of the biologic mechanisms driving atopic dermatitis to determine which patients are most likely to benefit from each treatment.

Understanding Disease Biology

Achieving precision medicine will require more than transcriptomic data alone. Bunick highlighted the importance of understanding how therapies affect memory T cells, T-regulatory cells, antigen-presenting cells, and immune feedback loops over both short- and long-term treatment.

“It’s going to take a combination of gene expression profiling, further understanding of proteomics, and further understanding of the immunologic cells that are driving disease,” Bunick said. “That full map may give us some more insight into what therapies are best.”

Integrating these biologic pathways may ultimately provide a more complete framework for individualized therapy selection.

Current Benchmarks and Future Therapeutic Targets

Oral JAK inhibitors continue to serve as an important benchmark in lymphocyte activation assays because of their broad cytokine suppression. Many emerging therapies are being evaluated against that benchmark while investigators continue exploring whether broader immune modulation translates into improved clinical outcomes.

Looking ahead, Bunick highlighted therapies that act further upstream in the immune response, including agents targeting IL-2 signaling and T-regulatory cells. These approaches may provide additional insight into disease modification and durable disease control.

“Modulating the immune system upstream of the cytokines can be incredibly important to this concept of disease modification and long-term disease control,” Bunick said.

Integrating Research Approaches

Future advances in precision medicine will likely depend on integrating transcriptomics, proteomics, cytokine biology, and immunology into a more complete understanding of atopic dermatitis.

“It’s integrating teams together, integrating approaches together for the betterment of patients,” Bunick said.