Alexandra Golant, MD discusses pearls from her lecture My Approach to AD in 2025 at the 2nd Annual Elevate-Derm Alliance Summer Conference at the Grand Hyatt Deer Valley in Park City, Utah.

In this video

Dr. Golant calls the science behind AD comorbidities "the sweet spot right now," describing dupilumab's approval down to six months as the biggest window to follow young children and track markers like asthma, allergic rhinitis, and food allergy. The earliest data suggests that decreasing type 2 inflammation early may lower rates of these conditions later — potentially "halting of that atopic march" — though she notes we won't fully know until these kids become adolescents and young adults. That, she says, is where we begin to "fundamentally change that concept of cumulative life course impact."

On patch testing during systemic therapy, she explains her institution patches on biologics — since their mechanism isn't thought to prevent a positive result — but not on JAK inhibitors, whose "very fast on and very fast off" short half-life makes it easy to eliminate, test, and resume. For treatment selection, she admits more options have made her job feel harder, and shares how she thinks in buckets — topical patient versus systemic patient — anchored in shared decision-making, comorbidities, and each patient's "gestalt presentation."

  • The earliest data on treating young children suggests early targeted intervention may lower later rates of asthma, allergic rhinitis, and food allergy — a possible way to halt the atopic march.
  • Patch test on biologics without stopping them; avoid patch testing on JAK inhibitors, but use their short half-life to eliminate, test, and quickly resume therapy.
  • Think in buckets — topical patient versus systemic patient — rather than just mild, moderate, severe, and confirm the patient agrees through shared decision-making.
  • For topical patients, optimize control with advanced nonsteroidal topicals for both acute treatment and maintenance rather than defaulting to a generic topical steroid.
  • For systemics, let comorbidities (asthma, EoE, COPD), age, prior therapy weak spots, and speed of onset guide selection — a JAK inhibitor's fast pharmacokinetics fits a patient who needs rapid clearance.