Redefining Remission and Low Disease Activity in Dermatology

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The language of remission and low disease activity (LDA) is evolving rapidly across chronic inflammatory diseases, and dermatology is finally catching up. Borrowing from rheumatology, gastroenterology, and oncology, our field is beginning to align around meaningful, patient-centered outcomes that go far beyond the traditional metrics of response.

At Masterclasses in Dermatology, one of our ongoing goals has been to shine a light on emerging definitions that are poised to reshape clinical care and trial design. This year, we had the opportunity to reflect on our work in psoriasis, atopic dermatitis (AD), connective tissue disease, and cutaneous lupus, and where we are heading next.

On-Drug and Off-Drug Remission: Lessons from Psoriasis

In psoriasis, the National Psoriasis Foundation (NPF) consensus project helped establish a critical distinction between on-drug remission—sustained clearance on therapy—and off-drug remission, the maintenance of control after stopping therapy. This framework has already begun to change how we think about clinical trial design, drug development, and, importantly, what we can promise patients in the clinic.

The implications of these concepts are profound. On-drug remission reflects the durability of a treatment in real-world practice, whereas off-drug remission moves us toward the aspirational goal of disease modification or even cure. Publications from the NPF group and others have begun to operationalize these definitions, laying the groundwork for new ways of approaching both research and patient care.

Borrowing From Other Fields: Treat-to-Target as a Driver of Progress

Other specialties have shown us the power of precise, ambitious targets. In rheumatoid arthritis, treat-to-target strategies anchored on remission and LDA transformed patient outcomes, reshaping not only trial design but also the daily practice of medicine. In inflammatory bowel disease, the concept of deep remission— extending beyond symptoms to include mucosal healing—helped redefine what success looks like and spurred the development of therapies that could achieve these higher benchmarks.

Dermatology is now adopting similar ambitions. By clearly articulating remission and LDA, we are creating clinically relevant goals that push innovation and accelerate the development of new mechanisms. These targets encourage strategies such as combination approaches, induction-maintenance models, and biomarker-driven pathways—all designed to reach levels of disease control that once seemed unattainable.

Biomarkers and the Next Generation of Definitions

Perhaps the most exciting frontier is the development of biomarker-defined remission. Work exploring immune signatures, molecular predictors, and other biologic markers opens the possibility of tailoring therapy to those most likely to achieve and sustain remission. Biomarker strategies may eventually allow us to predict which patients can taper or discontinue therapy while maintaining control or, conversely, identify those at higher risk for relapse who require ongoing treatment.

The ability to define remission not only by what we see clinically but also by what we measure biologically will be an essential step if remission is to become a durable, reproducible, and universally accepted goal.

Expanding to AD and Beyond

The recent International Eczema Council consensus project that we are now finalizing offers definitions of LDA, vLDA (very low disease activity), on-treatment complete control, and off-drug remission for AD. This work has underscored several important innovations. First, there is a growing recognition that terms like on-drug remission may not resonate equally well with patients or providers, and alternative terminology was explored to more accurately and comfortably capture states of disease control. Second, the group has arrived at a set of working definitions along the LDA-remission spectrum—pragmatic approaches that reflect what is possible in 2025 given the current and emerging therapeutic pipeline and are consistent with regulatory guidance, while also leaving space for future refinement as drugs with novel mechanisms become available. Third, there is increasing consideration of whether we should at times uncouple signs from symptoms, recognizing that patients may experience discordant trajectories where visible skin improvements do not fully align with symptom relief, particularly in diseases where itch may dominate.

Parallel efforts are also underway in cutaneous lupus and connective tissue diseases, where LDA concepts could finally allow us to better capture the heterogeneity of disease activity and treatment response. Just as in psoriasis and AD, the articulation of these definitions will enable more meaningful trial endpoints and, ultimately, provide a roadmap for clinical decision-making.

The Road Ahead

The progress across our field makes one thing increasingly clear: remission and LDA are no longer aspirational concepts. They are achievable, measurable, and essential to the future of dermatology. What lies ahead is the work of refining our language and frameworks so they are practical for today’s clinic while being ambitious enough to inspire the therapies of tomorrow.

Key directions include advancing beyond the current terminology of on-drug remission to terms that resonate more effectively with both patients and providers, developing working definitions that reflect the therapeutic realities of 2025, and exploring frameworks that may distinguish disease activity in signs from that in symptoms. Together, these innovations will help us set clearer targets, improve trial design, and provide patients with a more transparent understanding of what they can expect from their treatment journey.

At Masterclasses in Dermatology, we remain committed to advancing these conversations and equipping dermatologists with the tools to lead this next chapter.

Disclosure: Dr Gottlieb has received research/educational grants from Bristol Myers Squibb, Janssen Pharmaceuticals, Moonlake, and UCB and honoraria as an advisory board member and consultant for Bristol Myers Squibb, Eli Lilly and Company, Janssen Pharmaceuticals, Novartis, Oruka Therapeutics, Sanofi, Sun Pharma, Takeda, Teva, and UCB. At UT Southwestern, she is sub I on studies from Janssen Pharmaceuticals, Bristol Myers Squibb, and UCB.

References of Note

Armstrong AW, Gondo GC, Merola JF, et al. Defining on-treatment remission in plaque psoriasis: a consensus statement from the National Psoriasis Foundation. JAMA Dermatol. 2025;161(8):863-869. doi:10.1001/jamadermatol.2025.1625

Armstrong AW, Siegel MP, Bagel J, et al. From the medical board of the National Psoriasis Foundation: treatment targets for plaque psoriasis. J Am Acad Dermatol. 2017;76(2):290-298. doi:10.1016/j.jaad.2016.10.017

Renert-Yuval Y, Thyssen JP, Bissonnette R, et al. Biomarkers in atopic dermatitis— a review on behalf of the International Eczema Council. J Allergy Clin Immunol. 2021;147(4):1174-1190.e1. doi:10.1016/j.jaci.2021.01.013

Smolen JS, Aletaha D, Bijlsma JWJ, et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010;69(4):631-637. doi:10.1136/ard.2009.123919