BIOLOGIC AND TARGETED THERAPIES IN ATOPIC DERMATITIS: A BIOMARKER-INFORMED FRAMEWORK FOR PERSONALIZED TREATMENT SELECTION

Background: Atopic dermatitis is a chronic inflammatory skin disease characterized by pruritus, eczematous lesions, and impaired quality of life. Advances in understanding type 2 immune dysregulation have led to the development of biologic and targeted systemic therapies; however, treatment response remains heterogeneous, highlighting the need for personalized therapeutic strategies. Objective: To review current biologic and targeted systemic therapies for moderate-to-severe atopic dermatitis, examine the role of clinical and molecular biomarkers in predicting treatment response, and propose a biomarker-informed framework for personalized treatment selection. Methods: A narrative review was conducted of literature published between January 2020 and July 2024 using major scientific databases. Included publications comprised randomized controlled trials, cohort studies, systematic reviews, and expert consensus documents addressing systemic therapies, biomarker associations, and stratified treatment approaches in atopic dermatitis. Results: Biologic agents, including dupilumab, tralokinumab, lebrikizumab, and nemolizumab, are associated with substantial improvements in skin inflammation and pruritus and demonstrate favorable safety profiles across diverse patient populations. Janus kinase inhibitors provide rapid symptom control but require careful patient selection due to safety considerations. Biomarkers such as thymus and activation-regulated chemokine, eotaxin-3, periostin, eosinophil count, and interleukin-13 gene expression contribute to the characterization of disease endotypes and may support biologically informed treatment decisions. Conclusions: Biologic and targeted systemic therapies have transformed the management of atopic dermatitis; however, optimal outcomes depend on individualized treatment selection. Biomarker-informed approaches offer a rational framework to reduce empirical treatment cycling and advance precision medicine in atopic dermatitis, although further validation in real-world clinical settings is required.