Aligning Measurement with Patient Experience
At the ISAD–WHO closed workshop held in Melbourne in October 2025, international experts and patient representatives explored how a Treat-to-Target (T2T) strategy could be meaningfully adapted to atopic dermatitis (AD). The meeting brought together dermatologists, pediatric dermatologists, allergists, rheumatologists, pulmonologists, pharmacists, global health experts, and patient advocates from Europe, Asia, Australia, Africa, and North America, including representatives from ISAD, WHO, and national and international eczema organizations.
A central conclusion was that AD cannot benefit from T2T unless disease control is redefined beyond clinician-centric scores. Participants agreed that meaningful targets must better reflect patients’ lived experience of the disease. Drawing on lessons from rheumatology and asthma, the group emphasized that successful T2T strategies rely on composite measures combining physician assessment with patient-reported outcomes (PROs). In AD, however, current tools often fragment disease into visible signs versus symptoms, whereas patients experience AD holistically through itch, sleep disruption, pain, fatigue, and daily life impairment.
Patient and parent contributions were pivotal. Disease control was described not as achieving a numerical threshold, but as regaining sleep, school attendance, social participation, and relief from the burden of constant care. These perspectives reinforced the need to prioritize simple, sensitive, and feasible PROs, such as itch intensity, sleep disturbance, and patient global assessment. Participants stressed that PROs should complement—rather than replace—clinical evaluation within pragmatic composite indices adaptable to diverse health-care settings.
The discussion also challenged a binary concept of remission. While complete clearance may be attainable for some patients, minimal disease activity and stability were viewed as more realistic and motivating targets for many. This approach acknowledges the fluctuating nature of AD, where localized disease can rapidly generalize, and where instability itself is clinically meaningful.
The workshop concluded that T2T in AD should be seen not as a rigid algorithm, but as a patient-centered framework integrating composite measures, PROs, and regular reassessment. Aligning therapeutic targets with what matters most to patients is essential if T2T is to translate into improved outcomes and quality of life in atopic dermatitis.