Ep 7. Atopic Dermatitis Management with Peter Lio, MD Part 1

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Atopic Dermatitis Treatment Ladder: Moisturizers, Topical Steroids, Nonsteroidals, Biologics, and JAK Inhibitors (with Dr. Peter Lio) | The Derm Resident

Contact: thedermresident.pod@gmail.com.

Host dermatology resident Jonny Hatch interviews Dr. Peter Lio about atopic dermatitis treatment, emphasizing moisturizers (prescriptive product guidance, National Eczema Association Seal of Acceptance, ointments/petrolatum for stinging) and topical corticosteroid selection by potency, vehicle, and body site, with counseling on rare but important adverse effects and steroid stewardship. They distinguish tachyphylaxis from topical steroid withdrawal, noting evolving recognition and potential mechanistic clues. The episode reviews nonsteroidal topicals (tacrolimus/pimecrolimus counseling, black box warning context, stinging mitigation, crisaborole limitations, roflumilast benefits/rare diarrhea, topical ruxolitinib efficacy and boxed warning counseling), then escalates to systemic therapy with phototherapy, biologics (dupilumab, tralokinumab, lebrikizumab, nemolizumab), and oral JAK inhibitors (upadacitinib, abrocitinib) including risks and lab monitoring. They also discuss limited roles for antihistamines, the Dr. Aron regimen compound, and phage-lysin anti-staph products, and preview part two. 

00:00 Welcome and Guest Intro
00:51 Moisturizers as Foundation
02:45 Choosing Eczema Safe Products
05:27 Ointments for Sensitive Skin
07:07 Topical Steroid Ladder Basics
08:43 Potency Picks and Stewardship
11:18 Monitoring Steroid Side Effects
12:45 Eyelids and Steroid Sparing
14:19 Tachyphylaxis vs TSW
17:23 Steroid Mechanism of Action
18:51 Calcineurin Inhibitors Counseling
22:42 Eucrisa and PDE4 Reality Check
24:07 Roflumilast Practical Use
25:59 Topical JAK Inhibitor Opzelura
28:43 Placebo and Adherence
29:14 When to Escalate Care
29:41 Biologics Treatment Targets
31:57 ADCT Control Scoring
32:45 Insurance Documentation Tips
33:24 Dupilumab Side Effects
34:15 Managing Eye Symptoms
36:13 Head and Neck Flares
37:37 Switching Biologics Strategy
39:32 Nemolizumab Itch Control
40:00 Oral JAK Inhibitors Overview
41:45 Black Box Risk Counseling
44:36 Lab Monitoring Schedule
46:13 Antihistamines Reality Check
47:51 Aaron Regimen Compound
51:53 Bacteriophage Spray Future
53:42 Closing and Next Steps

This episode is sponsored by Mind the Skin, a patent-pending, steroid-free, patch system. Learn more at mindtheskinlabs.com. Use code TDRP26 at checkout for 20% off.