The Essential Role of Topical Targeted Therapy in Atopic Dermatitis
October 2026 | Volume 25 | Issue 10 | 898 | Copyright © October 2026
Published online September 29, 2026
Peter Lio MD FAADa, Latanya Benjamin MD FAADb, Mercedes E. Gonzalez MD FAADc, Sophie Guénin MD MSc,d, Adelaide A. Hebert MD FAADe, Pearl C Kwong MD FAADf, Nanette Silverberg MD FAAD FAAPg, Lawrence A. Schachner MD FAAD FAAPh
aDermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
bYoung Skin MD, Coral Springs, FL
cPediatric Skin Research, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery,
University of Miami Miller School of Medicine, Miami, FL
dDepartment of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
eDepartment of Dermatology and Pediatrics, McGovern Medical School, and Children's Memorial Hermann Hospital, Houston, TX
fSuncoast Skin Solutions Inc., Apex Clinical Trials, Jacksonville, FL
gDepartment of Pediatric and Adolescent Dermatology, Icahn School of Medicine at Mount Sinai, NY, NY
hDermatology and Pediatrics, Pediatric Dermatology, University of Miami School of Medicine, Miami, FL
Abstract
Background: Atopic dermatitis (AD) is a chronic inflammatory skin disorder marked by immune dysregulation, epidermal barrier dysfunction, microbiome imbalance, pruritus, and xerosis. Despite therapeutic advances, topical treatments remain the foundation of AD management across all severities. However, most existing topicals address only limited aspects of the disease such as itch or inflammation, resulting in frequent relapse and patient dissatisfaction.
Methods: A focused literature review of topical AD therapies published between January 2015 and July 2025 was conducted, emphasizing efficacy and safety. Recent findings were synthesized in this narrative review to highlight the ongoing role of topical treatments in AD management.
Results: AD is a multifactorial condition influenced by Staphylococcus aureus colonization, immune dysregulation, genetic susceptibility, and environmental factors. These contribute to disease pathogenesis, the itch-scratch cycle, and barrier disruption. While systemic therapies are important, AD treatment continues to rely heavily on topical agents. Optimal management should target inflammation, restore barrier function, and address microbiome dysbiosis. Most current treatments focus on individual disease components, with few addressing the full pathogenic spectrum. Emerging evidence on zabalafin (9.5%) hydrogel, a novel botanical topical therapy, suggests potential multi-target benefits, including anti-inflammatory, antipruritic, antimicrobial, and anti-xerotic effects.
Conclusion: There remains a significant unmet need for topical therapies that comprehensively address the AD continuum, including inflammation, itch, barrier dysfunction, and microbial imbalance. Novel agents such as zabalafin may help bridge this gap.
INTRODUCTION
Atopic dermatitis (AD) is a common inflammatory skin disease with a relapsing and remitting course over a patient's lifetime.1,2 This chronic skin condition is estimated to affect up to 20% of children and 1% to 6% of adults worldwide.3 AD is a heavily heterogeneous spectrum of disease affecting all age groups and skin types with varied clinical presentation and severity. The disease exists on a continuum with 4 significant skin findings: inflammation, dysbiosis/colonization/infection, pruritus, and xerosis, termed the "4 demons".4
Clinically, AD presents with recurrent, erythematous, pruritic eczematous plaques accompanied by dry, sensitive skin. AD frequently begins in infancy or early childhood and affects over 30 million people in the United States. The prevalence of this widespread disease is associated with an estimated global economic cost of $5 billion annually.5 In addition, AD is associated with increased stress, low self-esteem, poor sleep, and overall decreased quality of life.6
