International Eczema Council Definitions of Low Disease Activity and Remission in Atopic Dermatitis

Importance: Advances in targeted therapeutics have made substantial response states in atopic dermatitis (AD) increasingly attainable. However, the field lacks standardized, internationally endorsed definitions of low disease activity (LDA), very low disease activity (vLDA), and remission to benchmark treatment response, support regulatory clarity, and enable consistent cross-trial comparisons. Objective: To develop consensus-based definitions of LDA, vLDA, and remission in AD that accommodate regional regulatory frameworks and to refine associated terminology for clinical and research use. Evidence Review: A steering committee from the International Eczema Council (IEC) conducted a targeted systematic literature review. PubMed was searched in July 2024 for studies from January 1, 2004, through December 31, 2024, using combinations of terms related to atopic dermatitis, clinician-reported outcomes, patient-reported outcomes, disease control states, pruritus measures, and disease activity constructs. Evidence was appraised using the Oxford Centre for Evidence-Based Medicine criteria. Key conceptual domains were identified to inform a 3-round sequential modified Delphi process conducted from January to July 2025. Panelists (current IEC members with recognized AD expertise) iteratively reviewed feedback, refined thresholds, and provided qualitative rationale. Predefined criteria distinguished consensus (≥70% agreement), near consensus (60%-69%), and nonconsensus (