In 2023 and early 2024, the American Academy of Dermatology (AAD) published guidelines on the management of atopic dermatitis (AD) in adults with topical and systemic therapies. Recently published evidence and the US Food and Drug Administration (FDA) approval of novel topical small-molecule and biologic therapies necessitated an update of the previous guidance.

Topical therapies

• Tapinarof cream 1% is a nonsteroidal, topical aryl hydrocarbon receptor agonist FDA-approved for the treatment of AD in individuals aged 2 years and older in December 2024.
• Roflumilast cream 0.15% is a phosphodiesterase-4 inhibitor approved by the FDA in July 2024 for the treatment of mild-to-moderate AD in individuals aged 6 years and older.

Monoclonal antibodies (biologics)

• Lebrikizumab, a monoclonal antibody targeting interleukin-13, was FDA-approved for the management of moderate-to-severe AD in individuals aged 12 years and older in 2024.
• Nemolizumab, a monoclonal antibody targeting the interleukin-31 receptor, was FDA-approved in December 2024 for the management of moderate-to-severe AD that is inadequately controlled with topical therapies in individuals aged 12 years and older in combination with TCS and/or topical calcineurin inhibitors (TCIs).

Recommendations
The workgroup recommends the use of tapinarof cream, roflumilast cream, lebrikizumab, and nemolizumab with concomitant topical therapy for the management of AD in adults.

The focused update recommends:

• Tapinarof cream for adults with moderate-to-severe AD
• Roflumilast 0.15% cream for adults with mild-to-moderate AD
• Lebrikizumab for adults with moderate-to-severe AD
• Nemolizumab with concomitant topical therapy for adults with moderate-to-severe AD

 

The complete treatment algorithm for the management of atopic dermatitis is described in Figure 1.

Figure 1. Treatment algorithm for adults with atopic dermatitis

Reference: Davis DMR, Frazer-Green L, Alikhan A, et al. Focused update: Guidelines of care for the management of atopic dermatitis in adults. J Am Acad Dermatol. 2025;S0190-9622(25)02125-5.