Atopic Dermatitis: Disease Features, Therapeutic Options, and a Multidisciplinary Approach

**Background:** Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease characterized by eczema, dry skin, and severe itching. Its prevalence has doubled or tripled over the last 30 years in industrialized countries, affecting 15%–30% of children and 2%–10% of adults. The pathogenesis involves a complex interplay of genetic and environmental factors leading to epidermal barrier dysfunction (e.g., filaggrin gene mutations), immune dysregulation (predominantly Th2 cytokines IL-4, IL-5, IL-13, IL-31), and skin microbiome alterations (e.g., increased Staphylococcus aureus colonization). AD significantly impacts quality of life, psychological well-being, and social functioning, often requiring a multidisciplinary management approach.

**Methods:** This is a narrative review that synthesizes current literature on AD pathogenesis, clinical manifestations, diagnostic criteria, and therapeutic options. It discusses preventive measures, topical therapies (corticosteroids, calcineurin inhibitors, PDE4 inhibitors), phototherapy, conventional systemic treatments (cyclosporine, methotrexate, azathioprine), and newer agents including biologics (dupilumab, tralokinumab) and JAK inhibitors (baricitinib, abrocitinib, upadacitinib). The review also examines the psychological impact of AD and the rationale for a multidisciplinary care model involving dermatologists, psychologists, allergologists, nutritionists, and other specialists.

**Key Results:** The paper reports that AD is associated with a chronic Th2-dominant inflammatory response, with IL-4 and IL-13 playing crucial roles in IgE production, eosinophil recruitment, and itch. Filaggrin gene mutations on chromosome 1q21 are common, leading to increased transepidermal water loss and decreased natural moisturizing factors. Staphylococcus aureus colonizes 70% of AD lesions and 39% of nonlesional skin, with higher colonization rates in severe AD (83%) versus mild AD (43%). Diagnostic criteria (Hanifin and Rajka) have sensitivity of 87.9%–96.0% and specificity of 77.6%–93.8%. For treatment, dupilumab (600 mg loading dose, then 300 mg every 2 weeks) is approved for moderate-to-severe AD in adults and children ≥6 years. JAK inhibitors (baricitinib 4 mg daily, upadacitinib 30 mg daily, abrocitinib 100–200 mg daily) provide rapid itch reduction. Common adverse effects include conjunctivitis with dupilumab, and respiratory infections, herpes zoster, and laboratory abnormalities (e.g., increased CPK, hypercholesterolemia) with JAK inhibitors. Psychological comorbidities are prevalent: AD patients show higher levels of anxiety, depression, and suicidal thoughts, and perceived stress correlates with disease severity and quality-of-life impairment.

**Clinical Implications:** The review emphasizes that AD management should extend beyond topical and systemic therapies to include patient education, psychological support, and nutritional counseling. A multidisciplinary approach improves disease control, adherence, and quality of life while reducing healthcare resource utilization. The high cost of newer biologics and JAK inhibitors remains a barrier to access in some countries. The authors recommend integrating multidisciplinary care into universal AD guidelines, as it provides the best outcomes for patients with this complex, chronic condition.