At EADV 2025, dermatologist Peter Lio, MD, a clinical assistant professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine and founding director of the Chicago Integrative Eczema Center, delivered a forward-looking perspective on managing atopic dermatitis, emphasizing the patient journey from daily moisturization to advanced therapies. In this exclusive Q&A, he unpacks practical strategies for pediatric care, the role of patient and caregiver preferences, and how new biologics, JAK inhibitors, and non-steroidal topicals are reshaping treatment. Lio also addresses gaps that remain, from rapid itch relief to access and affordability, while underscoring why foundational skin care still matters in an era of expanding systemic options.
Q&A
Optimizing patient journey: from daily moisturization to hydrotherapy
DT: How do you prioritize different hydration strategies—daily moisturizers, emollients, and bath practices—in pediatric AD care?
Lio: Daily moisturization is the foundation for almost everyone. It is a safe, low-cost, and very effective way to strengthen and protect the skin barrier. I like folks to apply moisturizer liberally at least once on dry skin and after bathing (‘soak-and-seal’). Wet-wrap therapy is really important for tougher flares. As for bathing, I like daily bathing for most and I really do prefer a gentle, oil-based cleanser.
DT: How do you integrate patient or caregiver preferences into a daily skin care routine without compromising efficacy?
Lio: I feel strongly that we need to work together to find the products and a routine they can actually do: cosmetically elegant is very subjective, so they have to like it and want to use it. I am a huge fan of eczema action plans because I find that when families help design the regimen, adherence and outcomes improve.
Navigating remaining gaps and new goals in AD management
DT: What are the most significant unmet needs in current pediatric AD management?
Lio: We have a lot! Rapid itch relief for sleep, long-term remittive control with fewer flares, options that don’t sting on sensitive areas, safe data down to the youngest ages, and—crucially—access and affordability are all key issues. With all of the great systemics, there can be this unfortunate (and incorrect) conclusion that we don’t need topical agents any more, but nothing could be further from the truth.
DT: How do you incorporate new therapies, like JAK inhibitors or biologics, into the treatment paradigm?
Lio: I’m an early adopter, in part because I have so many patients with unmet needs. I try to base care on severity and impact. For mild to moderate disease not controlled with moisturizers and low- to mid-potency steroids/TCIs, I lean on non-steroidal topicals like JAK or PDE-4 inhibitors for flare control and maintenance. For moderate to severe or quality-of-life-limiting disease, I escalate to targeted biologics (e.g., IL-13 or IL-31 pathway agents) while keeping a strong skin care routine at the core. I also am open to integrative approaches and try to incorporate them when patients and families are amenable.
Food allergies, nutrition, and atopic dermatitis
DT: When do you recommend formal allergy testing for children with AD?
Lio: This is always very tough, and many of my patients–most of them even–have already had testing. But, personally, I try to only test when the history suggests an immediate-type reaction (hives/vomiting within minutes to hours) or when severe, persistent AD isn’t improving despite optimal skin care and there’s a clear dietary link. Broad screening panels tend to have a lot of false positives and can cause all sorts of confusion and unnecessary food avoidance.
DT: Are there patient subgroups who may benefit most from dietary interventions, and how do you identify them?
Lio: Those with proven IgE-mediated food allergy need allergist-guided plans. That part is clear. Otherwise, elimination diets offer at best modest benefit and potential nutritional risk as well as the more recent understanding that avoiding some foods can actually make food allergy happen. Dr. Ruchi Gupta puts it beautifully: “Through the skin allergies begin, through the diet they stay quiet.” In the meantime, I try to focus on general healthy patterns, vitamin D supplement, and probiotics.
DT: With so many recent approvals spanning a variety of MoAs, to what degree are additional new therapeutics options needed in the AD landscape?
Lio: Even with IL-13 and IL-31 pathway biologics and new non-steroidal topicals, there’s room for therapies that act more quickly, are better tolerated, and deliver durable remission with fewer visits and lower out-of-pocket costs. Choice matters in a heterogeneous disease like AD and I’d say we still have a long way to go to meet the needs of all my patients.
DT: In June we saw a focused update on AD guidelines in JAAD, how important is this proactivity in terms of encouraging uptake of emerging therapies?
Lio: I think this is actually important. Clear, frequently updated guidance accelerates appropriate adoption and gives clinicians confidence to individualize care. This is all the more important because of the rapid rate of change right now in AD.
DT: What newer therapies would you say have the most potential but are currently being underutilized?
Lio: I think that while the systemic agents get lots of attention (and reasonably so), I want to call out the newer non-steroidal topicals for maintenance on sensitive areas and for steroid-sparing strategies. I honestly think that well formulated topicals have the potential to touch–literally and figuratively–far more patients than the biologics and systemic agents in general, so they warrant more attention than they are currently receiving.