Immunological Insights and Therapeutic Innovations in Atopic Dermatitis: A Contemporary Review

Abstract

Atopic Dermatitis (AD) is a recurrent, chronic inflammatory skin condition that has a substantial negative impact on patients' quality of life and is becoming a major global health concern. This review offers a thorough summary of the developments in AD treatment and immunological knowledge between 2003 and 2025. The pathophysiology of AD is now understood to be multifactorial, involving Th1, Th17, and Th22 pathways, genetic predispositions, microbiome changes, and environmental factors. Initially, the disease was characterized by T-helper 2 (Th2)-driven immune responses and skin barrier dysfunction. The treatment of moderate-to-severe AD has changed dramatically with the advent of biologics like dupilumab and small-molecule inhibitors like Janus kinase (JAK) inhibitors, which provide safer, more targeted, and more effective alternatives to traditional treatments. New treatments that target the gut-skin axis, probiotics, dietary changes, and new immunological targets like alarmins and microRNAs are also highlighted in recent studies. Even with great advancements, there are still difficulties in customizing treatments for pediatric patients, refractory disease patients, and diverse populations. In order to maximize patient outcomes in AD, this review highlights the significance of precision medicine, endotype-specific strategies, and ongoing translational research.