Atopic Dermatitis: Updated Insights Into Pathophysiology and Emerging Therapies

Atopic dermatitis (AD) is a chronic, relapsing skin ailment characterized by intense itching and diverse clinical manifestations. Its pathogenesis is complex, involving genetic, microbial, and immunological factors. Recently, significant therapeutic advancements have been made in AD, including topical phosphodiesterase-4 (PDE-4) inhibitors, Janus kinase (JAK) inhibitors, and biologics targeting cytokines and signaling molecules such as Interleukin-13 (IL-13), Interleukin-31(IL-31), thymic stromal lymphopoietin (TSLP), and OX40/OX40L. This review comprehensively demonstrates the genetic, microbial, and immunological factors underlying AD, with a particular emphasis on the gut-skin axis. Furthermore, it summarizes recently approved drugs and potential therapeutic agents currently under clinical trials. Besides, the review highlights the emerging role of the gut-skin axis in AD pathogenesis and the breakthroughs in novel targeted therapies. These include inhibitors of IL-13 and IL-31, which have shown remarkable efficacy in reducing disease severity and improving quality of life in patients with moderate-to-severe AD. Additionally, the review contains the potential of targeting the OX40/OX40L pathway, which holds promise for future therapeutic development. Based on these advancements, the review provides an outlook on the potential for individualized treatment strategies or precision medicine approaches in AD, aiming to optimize therapeutic outcomes and patient management.