Biologic Therapy Decision-Making and Monitoring in AD

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Biologic therapy initiation requires comprehensive evaluation beyond traditional BSA measurements, incorporating patient-reported outcomes and disease burden assessment. Andrew M. Mastro, MS, PA-C, explains that patients with low BSA but high symptom burden, particularly those with disease affecting special anatomical sites such as the hands, feet, face, or genitals, may be appropriate candidates for biologic therapy despite not meeting traditional BSA criteria. The decision-making process must consider patient quality-of-life impacts, treatment history, and individual circumstances rather than relying solely on objective measurements.

Patient characteristics influencing biologic selection include comorbidities suggesting type 2 immune profile, potential for preventing atopic march progression, and practical considerations like insurance coverage and access to patient assistance programs. Clinicians must navigate complex prior authorization processes, co-pay assistance programs, and sample availability to ensure patients can access prescribed therapies. The heterogeneous nature of atopic dermatitis (AD) requires individualized treatment approaches that consider both clinical efficacy and practical implementation factors.

Monitoring strategies must adapt to diverse patient populations, particularly patients with darker skin tones who may experience persistent postinflammatory pigmentation changes. Photography becomes essential for documenting progress in patients with skin of color, as improvements may not be visually apparent during routine visits due to residual pigmentation changes. Patient-reported outcomes like the Patient-Oriented Eczema Measure score and Atopic Dermatitis Control Tool provide valuable insights into treatment effectiveness beyond clinical assessments. The ultimate monitoring goal involves assessing how many days patients can forget about their chronic condition, representing true disease control.