Endotypes of atopic dermatitis

Fyhrquist N, Yang Y, Karisola P, Alenius H. J Allergy Clin Immunol. 2025 Jul;156(1):24-40.e4. doi: 10.1016/j.jaci.2025.02.029.

Abstract

 Pathogenetic pathways, immune endotypes,
and targeted treatments in AD.

Atopic dermatitis (AD) is a chronic, heterogeneous skin condition driven by a combination of genetic, immune, and environmental factors. The original classification into extrinsic and intrinsic endotypes has proven to be too simplistic. Recent research into the varied immune profiles and molecular signatures of AD has revealed distinct endotypes—that is, subtypes defined by specific biological processes rather than visible symptoms alone. These endotypes encompass classifications that are based on immune pathways, including TH2 dominant, TH1, TH17/TH22-driven responses, genetic factors, and microbial interactions.
Recognizing these endotypes has become essential for advancing personalized treatments because each subtype responds differently to immune-modulating therapies. Current treatment options, such as moisturizers, immunosuppressants, and biologics, show varied efficacy across AD endotypes, underscoring the need for more precise, endotype-specific approaches. Emerging molecular profiling technologies offer promising avenues to identify distinct biomarkers, refining AD classification and paving the way for more targeted treatments and improved patient outcomes.

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