AAD Updates Systemic Therapy Guidelines for Adult AD

Key Takeaways

• Updated AAD guidance incorporates new evidence on biologics and JAK inhibitors for moderate to severe atopic dermatitis in adults, according to a poster presented at AAD 2026.
• Four new trials provided data that underpinned revisions to evidence certainty, with upgrades for dupilumab and upadacitinib.
• All evaluated targeted systemic therapies maintained strong recommendations, supporting their role in current treatment paradigms.

The American Academy of Dermatology (AAD) has issued an interim update to its clinical practice guidelines for systemic treatment of moderate to severe atopic dermatitis (AD) in adults, reflecting the rapid expansion of evidence supporting targeted therapies. The update evaluates biologics and Janus kinase (JAK) inhibitors using an evidence-based framework to refine treatment recommendations.

The guideline focuses on adults with moderate to severe AD and assesses therapies including dupilumab, lebrikizumab, tralokinumab, nemolizumab in combination with topical corticosteroids or calcineurin inhibitors, and the JAK inhibitors abrocitinib, baricitinib, and upadacitinib. Outcomes of interest included clinician-assessed disease severity, flare prevention, adverse events, patient-reported outcomes, quality of life, and itch reduction, according to the poster. 

The updated literature search identified four new clinical trials not included in prior 2023 or 2025 guideline iterations. These data were incorporated using pairwise meta-analyses and evaluated under the GRADE framework to determine certainty of evidence ratings.

Certainty ratings were revised for several therapies:

• Evidence supporting dupilumab and upadacitinib was upgraded from moderate to high certainty.
• Nemolizumab used with concomitant topical therapy was downgraded from high to moderate certainty. 
• Certainty ratings for lebrikizumab remained high, while tralokinumab, abrocitinib, and baricitinib remained at moderate certainty.
• A dosing-specific note was added for abrocitinib, with high certainty assigned to the 200-mg dose and moderate certainty to the 100-mg dose.

All evaluated biologics and JAK inhibitors retained strong recommendations in favor of use, according to the study researchers.

“This updated guideline provides clinicians with seven evidence-based recommendations to optimize systemic treatment selection for adults with moderate to severe AD, reflecting the current therapeutic landscape and supporting shared decision-making,” the authors wrote in the poster. 

Source:  Hawryluk E, et al. Updating the American Academy of Dermatology Clinical Practice Guidelines for Systemic Treatment of Moderate to Severe Atopic Dermatitis in Adults. Poster 71499. Presented at: American Academy of Dermatology Annual Meeting; March 27-31, 2026; Denver.