Advancements in Patch Testing and JAK Inhibitor Use for Atopic Dermatitis

At the 2025 Elevate-Derm Summer Conference held in Park City, Utah, Dr. Walter Liszewski, a board-certified dermatologist and associate professor of dermatology at the Northwestern Feinberg School of Medicine, underscored the critical role of patch testing in managing chronic dermatitis, particularly atopic dermatitis (AD). During his presentation, Liszewski advocated for comprehensive patch testing and shared insights on the effective integration of Janus kinase (JAK) inhibitors in treatment regimens.

Patch testing has emerged as a transformative tool in dermatology, offering a detailed analysis of allergens that may exacerbate chronic dermatitis. According to Liszewski, many clinicians often rely on limited commercial patch testing kits, which may overlook significant allergens. "Comprehensive patch testing is extremely beneficial for patients with chronic dermatitis," Liszewski stated. He recommended that patients who continue to experience flare-ups despite initial patch testing should be referred to specialists equipped to conduct expanded allergen panels.

The importance of thorough patient product reviews was emphasized, as many patients may fail to identify hidden allergens in their personal care products. Liszewski noted that clinicians should guide patients in recognizing potential allergens that are often not clearly labeled, such as fragrance molecules. He warned that without proper avoidance counseling, even accurate patch test results may not lead to tangible clinical improvement.

In a separate session titled "JAK Inhibitors: Practical Tips for Integration Into Practice," Liszewski discussed the nuances of using JAK inhibitors in treating atopic dermatitis. Despite existing black box warnings associated with these medications, he argued against withholding them based solely on demographic risk factors, such as a patient's age or concurrent medication use. "With appropriate monitoring, JAK inhibitors offer rapid and dramatic improvements, especially in patients who are refractory to biologics," he asserted.

Liszewski encouraged clinicians to consider escalating JAK doses, as recent trial data indicate minimal safety concerns with increased dosages and substantial benefits in terms of itch reduction, sleep quality, and overall skin clearance. He cited that none of his patients transitioning from biologic therapies to JAK inhibitors regretted their decision, reinforcing the importance of individualized treatment plans.

"We know, based on large-scale extension trial data, that when you increase the dose of things like Rinvoq or Cibinqo, the rates of side effect increase are very minimal, but the improvement in quality of life and itch management is tremendous," concluded Liszewski, highlighting the favorable risk-benefit ratio of JAK inhibitors in clinical practice.

The insights shared during the conference reflect a broader trend within dermatology to adopt more nuanced and patient-centered approaches to treatment, which may significantly impact the management of atopic dermatitis and enhance patient outcomes.