• Vol. 50 No. 2, 171–173
  • 01 February 2021

A clinico-pathological approach to management of atopic dermatitis

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ABSTRACT

Recent research in atopic dermatitis (AD) has identified it to be a heterogeneous inflammatory skin disorder of different endotypes (immune polarisation of T-cell subsets and genetic mutations) underlying various phenotypes (age of onset, ethnicity, disease severity, etc.). The corresponding heterogeneity in underlying patho-mechanisms of the disease has resulted in an impetus towards an endotype-driven management of AD. We propose a practical approach that is based on classifying AD patients into intrinsic and extrinsic phenotypes and their corresponding underlying endotypes. This approach aims to provide a practical method that integrates recent understanding of AD pathogenesis for a targeted endotype-driven management of AD.


Recent research in atopic dermatitis (AD) has identified it to be a heterogeneous inflammatory skin disorder of different endotypes (immune polarisation of T-cell subsets and genetic mutations) underlying various phenotypes (age of onset, ethnicity, disease severity, etc.). The corresponding heterogeneity in underlying patho-mechanisms of the disease may explain the failure of effective control of AD through inhibition of one specific inflammatory pathway in a subset of patients in the recent dupilumab trials, whereby a reduction of Investigator’s Global Assessment score to 0–1 was seen in only 36–38% of participants.

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