Scoping Review of Prognostic Markers Involved in the Response to Topical Treatment in Patients with Atopic Dermatitis

Abstract Purpose of Review Atopic dermatitis (AD) is a chronic inflammatory skin disease that significantly affects quality of life. Early identification of clinical or biomarkers capable of predicting response to topical therapies including topical corticosteroids, topical calcineurin inhibitors, and phosphodiesterase-4 inhibitors could reduce the time required to achieve disease control. The aim of this study was to explore the emerging literature on clinical or molecular biomarkers associated with the response to first-line topical treatment in AD. The review followed the PRISMA-ScR statement. Recent Findings Nine studies involving 345 patients were included. Different biomarkers have been explored as potential biomarkers of clinical responses to topical treatments in AD. TARC/CCL17 levels significantly decreased in both skin and blood, correlating with reduced SCORAD and pruritus. CCL27 and CXCL8 also showed reductions. While blood IL-31 was unrelated to treatment response, baseline skin levels of IFN-γ and IL-21 predicted improvements in SCORAD. Blood CCL22 strongly predicted clinical response to therapies. Elevated serum total IgE (≥ 10,000 IU/ml), high LDH levels, and contact allergies, were associated with poor clinical control with topical therapy. Summary Although several biomarkers exhibit statistical associations with treatment response, none have yet been validated for predictive accuracy. Current evidence is exploratory, limited by small sample sizes, inconsistent methodologies, and lack of diagnostic performance metrics. More rigorous prognostic studies are needed to determine their clinical utility.