Atopic Dermatitis: A Better Understanding for Better Management

Atopic dermatitis is a chronic inflammatory skin condition that affects 10 to 15% of children and 3 to 4% of adults in France. It most often begins during childhood and is characterized by dry skin, inflammation, and itching that can sometimes be very severe.

This condition has long been subject to numerous misconceptions that have hindered patient care: in fact, although it may be accompanied by other conditions in the same group, such as asthma, allergic rhinitis, or certain food allergies, atopic dermatitis is not itself a skin allergy, but rather a hypersensitivity of the skin. 

Moderate to severe forms, which account for about 50% of cases, have a major impact on quality of life: itching can disrupt sleep, concentration, and daily activities and may be accompanied by significant psychological effects, particularly when the lesions are visible. In children, school performance and social life may also be affected.

For several decades, treatment for mild to moderate forms of the disease relied primarily on skin hydration and topical anti-inflammatory treatments, particularly topical corticosteroids, to relieve flare-ups. 

Since these options were not sufficiently effective for patients with severe forms of the disease, treatment alternatives have expanded considerably since 2018. Management now relies primarily on two major classes of treatments: biologics and JAK inhibitors, with seven treatment options (four biologics and three JAK inhibitors) that offer physicians and patients a broader range of treatment choices. Today, more than 80% of patients with these forms of the disease can be treated with these new therapies.

However, treatment selection is still largely based on the patient’s clinical characteristics and any risk factors or comorbidities. Research must now enable more personalized treatment strategies in order to identify the treatments best suited to each individual.

The guidelines published in 2025 by the Evidence Center of the French Society of Dermatology, with the participation of the GREAT-FRADEN network, emphasize that the management of atopic dermatitis goes beyond drug treatments. Topical care, skin hygiene, and the management of irritants constitute the first step in care. 

Therapeutic education also plays an important role in this care pathway, offering patients comprehensive support in managing their condition. It may sometimes be accompanied by psychological support, in order to better address the patient’s feelings and experience of the condition and thus prevent a situation of treatment failure from leading to an escalation of treatments or a loss of trust.

Clinical research on atopic dermatitis has expanded significantly with the emergence of new treatment options. However, clinical trials conducted before a treatment becomes available cannot answer all the questions that subsequently arise in daily practice.

Real-world data has therefore become essential for evaluating the efficacy and tolerability of treatments in patients followed in routine clinical practice, over longer periods and in more diverse situations than those found in clinical trials. 

This is notably one of the roles of the GREAT-FRADEN network: to bring together French expert centers in order to conduct multicenter studies and build cohorts of patients followed over time. These data help to better document the use of treatments in routine practice, but also to answer questions that cannot always be addressed within the framework of industry-sponsored research.

Since 2018, the network has been regularly conducting research on the disease and its treatments. To name just a few: the DUPISWITCH trial examined strategies to adopt in the event of adverse effects leading to a change in treatment; the TRALO-OEIL study examined ophthalmological adverse effects associated with biologic therapies; and the PREGRALL study focused on the prevention of atopic dermatitis in at-risk children through prebiotic supplementation for the mother during pregnancy. Although the results did not demonstrate a preventive effect at one year of age, follow-up of the children continues until they reach age 5.

Scheduled to begin in the first quarter of 2027, a new national study coordinated by GREAT-FRADEN will, among other things, evaluate various treatment strategies and provide a better understanding of their role in patient care. Those wishing to obtain information about upcoming studies or how to participate can contact the network at bp-reseau-fraden@chu-nantes.fr