New Therapies Address Infectious Complications in Atopic Dermatitis
Emerging treatments may reduce infection risk in atopic dermatitis through targeted immune modulation, according to a recent review published in Annals of Allergy, Asthma & Immunology.
Infectious complications are a significant comorbidity in patients with atopic dermatitis (AD). A new review from the University of Colorado and collaborating institutions highlights advances in understanding the pathophysiology and management of infection in AD, with a focus on novel therapies such as dupilumab and Janus kinase (JAK) inhibitors. The review synthesizes current data to provide clinical guidance on prevention and treatment strategies for infections in AD.
Study Findings
The authors reviewed published literature obtained through PubMed searches addressing the mechanisms of infection, clinical implications, and evolving treatments in AD. Their analysis emphasizes the role of skin barrier lipid abnormalities and immune dysfunction in driving infection risk.
A key factor is the decrease in long-chain fatty acids and omega-esterified ceramides, which renders the skin barrier more hydrophobic and susceptible to Staphylococcus aureus colonization. In addition, self-DNA and RNase inhibitors may impair host antimicrobial peptide activity against S aureus, while CD1a-restricted T cells recognizing S aureus lipid antigens may contribute to inflammation.
Therapeutically, meta-analyses cited in the review indicate that dupilumab—an interleukin (IL)-4 and IL-13 inhibitor—significantly reduces infection frequency in AD. Conversely, oral JAK inhibitors, despite their efficacy in inflammation control, are associated with higher rates of herpes zoster and herpes-related infections due to broader immunosuppressive effects.
Clinical Implications
Infectious complications remain a major challenge in uncontrolled AD, often exacerbating disease severity and complicating management. The findings underscore the need for personalized therapy selection based on immune modulation profiles and infection risk.
Integrating biologics may not only improve skin inflammation but also lower infection rates, thereby reducing hospitalization and antibiotic use. However, careful patient monitoring is essential when using systemic immunosuppressants like JAK inhibitors, particularly in populations at risk for viral reactivation.
Preventive strategies—such as maintaining barrier repair, minimizing antimicrobial resistance, and optimizing vaccination status—should accompany pharmacologic treatment to mitigate infection-related morbidity.
As atopic dermatitis management evolves, addressing infectious complications remains essential for achieving disease control. Ongoing research into immune-targeted therapies and barrier repair continues to shape the future of infection prevention in AD.
Reference:
Wang V, van Rensburg PJJ, Boguniewicz J, Ong PY. Infectious complications of atopic dermatitis. Ann Allergy Asthma Immunol. 2025;135(5):487–497.
