Deciphering atopic dermatitis heterogeneity: a short review on the translational revolution from endotypes to immunotypes

Atopic dermatitis is the most prevalent chronic inflammatory skin disease, classically defined by its eczematous lesions and relapsing course. However, growing evidence over the past decade has revealed that this disease is in fact far more heterogeneous than previously thought - both in its clinical manifestations and in the underlying molecular and immunological mechanisms. This short review explores the evolving conceptual framework used to analyze atopic dermatitis, encompassing clinical presentations (phenotypes), immune polarization profiles (immunotypes), and the background disease-related and context-related factors that shape them. The aim of this review is to highlight how such heterogeneity influences disease severity, progression, and therapeutic response, particularly in the context of increasingly personalized treatment strategies. By synthesizing accumulated scientific and clinical insights, this short review provides clinicians with a practical guide to navigating the complex spectrum of AD and its underlying therapeutic targets. Recognizing and interpreting this multidimensional variability is essential for understanding disease course and optimizing treatment selection.