Topicals Demonstrate Targeted Control Across 3 Distinct Atopic Dermatitis Cases

“As a doctor, your only job is to give hope. Whether they have cancer or they have a chronic disease, you touch them, and you say, ‘I'm going to stick with you and we're going to get through this together,” said Aaron Farberg, MD, at a recent Dermatology Times Case-Based Roundtable event.

Farberg, a double board-certified dermatologist and Mohs surgeon, chief medical officer of Bare Dermatology in Dallas, Texas, and a Dermatology Times editorial advisory board member, moderated a discussion of 3 complex patient cases of atopic dermatitis (AD) with dermatology clinicians.

Case 1

A 46-year-old man with long-standing AD, diagnosed in childhood, presented with worsening disease activity characterized by eczematous lesions involving approximately 10% body surface area, predominantly affecting the neck and upper extremities. His disease had historically been managed with intermittent topical corticosteroids, including triamcinolone acetonide 0.1%, with partial control during flares. Over the past year, coinciding with increased occupational stress, flare frequency and persistence increased, accompanied by significant pruritus disrupting sleep and work performance.

“I see some patients using triamcinolone as an emollient. Sometimes, they are so scared and traumatized from their eczema for so long that they think they have to keep using it even when they're not itchy, and I tell them to stop,” said one attendee.

Transition to topical tacrolimus failed to achieve disease control, with continued progression of symptoms. Given inadequate response to prior topical therapies, treatment was escalated to ruxolitinib 1.5% cream (Opzelura; Incyte) applied twice daily. The patient reported rapid improvement in pruritus shortly after initiation, followed by marked clearance of eczematous lesions with continued use.

During the discussion, Farberg reviewed ruxolitinib’s rapid itch clearance data, highlighting results from the phase 3 TRuE-AD1 (NCT03745638) and TRuE-AD2 (NCT03745651) trials showing a greater percentage of patients who applied ruxolitinib cream achieved an itch-free state vs vehicle. The difference vs vehicle in itch numerical rating scale (NRS) 0/1 was statistically significant on day 2 (approximately 36 hours after first application) and remained significant through week 8.¹

“For me, I have seen Opzelura work the best in my patients. And then Zoryve and Vtama are hit or miss,” said an attendee.

“The reason I like Zoryve is because it is formulated to the pH of the skin and feels cosmetically elegant,” said another attendee.

Case 2

A 16-year-old boy with AD diagnosed in early childhood presented with persistent disease involving the neck and hands, characterized by frequent flares. Symptoms worsened during the school football season, and prior topical therapies were no longer providing adequate control. His treatment history included multiple topical corticosteroids, which offered variable flare control with rebound upon discontinuation, and topical tacrolimus, which provided only transient improvement. Despite these interventions, he continued to experience frequent flares and ongoing disease activity. Given the extent and persistence of involvement, systemic therapy with dupilumab (Dupixent; Sanofi and Regeneron) was discussed; however, the patient expressed reluctance to initiate injectable treatment. As an alternative step prior to systemic escalation, topical tapinarof cream (Vtama; Organon) was initiated once daily to address ongoing inflammation and improve disease control.

“If I had to choose one topical, I would pick Vtama. For my patients, it’s the only one that didn’t sting and burn,” said an attendee.

Farberg reviewed data from the ADORING 3 open-label extension trial (NCT05142774), where patients entered the ADORING 3 study (48 weeks) from previous tapinarof trials or as direct enrollees. Patients entering with a Validated Investigator Global Assessment scale for Atopic Dermatitis (vIGA-AD) greater than or equal to 1 received tapinarof until a vIGA-AD of 0 was achieved. Patients entering with vIGA-AD of 0 discontinued tapinarof and were assessed for maintenance of clear/almost clear skin off-treatment. Overall, 51.9% of patients using tapinarof cream achieved vIGA-AD 0 (complete clearance) and 81.6% of patients achieved vIGA-AD 0 or 1 (clear or almost clear).²

Case 3

A 9-year-old girl with AD diagnosed at age 3 presented with progressive disease activity involving the flexural surfaces of the elbows and knees. Her parents reported severe, persistent pruritus with frequent scratching that significantly disrupted sleep. Prior treatments included intermittent topical corticosteroids initiated at diagnosis with minimal sustained efficacy, topical calcineurin inhibitors with partial response, and oral antihistamines, which provided little relief of pruritus. Despite multiple therapeutic attempts, the patient continued to experience active disease and poor symptom control, highlighting the burden of uncontrolled itch in pediatric atopic dermatitis.

Based on the patient’s age, Farberg discussed data from the TRuE-AD3 trial (NCT04921969), where patients aged 2 to 11 years were randomly assigned 2:2:1 to receive 8 weeks of continuous treatment with 0.75% ruxolitinib cream twice daily, 1.5% ruxolitinib cream twice daily, or vehicle. Among patients aged 2 to 6 years, 60.6% of patients using 1.5% ruxolitinib cream achieved IGA-TS compared with 15.2% using vehicle. In patients aged 7 to 11 years, 52.3% of patients using 1.5% ruxolitinib cream achieved IGA-TS compared with 6.3% of patients using vehicle.³

One attendee described managing a four-month-old infant with severe AD, noting that the visit highlighted the challenges of current topical regimens in very young patients. Counseling the mother required extensive discussion of multiple therapies, application timing, and bathing practices, which left the mother feeling overwhelmed. The attendee also noted whether if in severe cases, it is easier to go a systemic route vs multiple topicals.

“I always worry patients go home and they sit in the bathroom and they read everything about the drug that they're about to put on and they'll think, ‘Oh my God, this is going to kill me. Look, it causes blood clots.’ And I say, ‘Yes, it says that there could be blood clots. The reality is, you have a greater chance of getting a blood clot from Advil. There's a greater chance of getting a blood clot from Advil than from any of these JAK inhibitors,” Farberg said.

Practice Takeaways

The roundtable event highlighted how dermatology clinicians are redefining AD management as a chronic, quality‑of‑life disease that demands empathetic counseling and evidence-based, long‑term strategies. Attendees emphasized moving beyond reliance on topical steroids toward earlier use of newer non-steroidal and JAK‑inhibitor therapies, while navigating insurance barriers, addressing lifestyle triggers, and tailoring treatment to age, skin type, and patient or caregiver engagement.

"Individualizing treatment for each patient with AD came up over and over again—balancing efficacy, safety, access, and patient preferences. A big focus of our roundtable was moving beyond a one-size-fits-all approach and meeting patients where they are in their disease journey," Farberg said. "Case-Based Roundtables create a comfortable, real-world setting where we can walk through challenging cases together and compare how different clinicians think. That back-and-forth on practical decision making is what really helps translate new data into day-to-day patient care."

References

1. Blauvelt A, Szepietowski JC, Papp K, et al. Itch-free state in patients with atopic dermatitis treated with ruxolitinib cream: a pooled analysis from two randomized phase 3 studies. J Am Acad Dermatol. 2023;88(3):651-653. doi:10.1016/j.jaad.2022.09.010
2. Bissonnette R, Stein Gold L, Kircik L, et al. Skin clearance, duration of treatment-free interval, and safety of tapinarof cream 1% once daily: results from ADORING 3, a 48-week phase 3 open-label extension trial in adults and children down to 2 years of age with atopic dermatitis. J Am Acad Dermatol. 2025;93(3):707-714. doi:10.1016/j.jaad.2025.05.1391
3. Soong W, Zaenglein A, Tollefson M, et al. Long-term safety and disease control of ruxolitinib cream in children aged 2 to 6 and 7 to 11 years: results from the TRuE-AD3 study. J Allergy Clin Immunol. doi:10.1016/j.jaci.2024.12.599