The ‘High-Functioning’ Flare: Why Settling for ‘Good Enough’ Atopic Dermatitis Care Is Costing You

"Quality of life is a major consideration with atopic dermatitis because the condition can be highly disruptive, especially if symptoms return quickly once treatment stops or surface-level treatments alone are no longer enough," says Alexandra Bowles, DO, a dermatologist at MONA Dermatology in Cincinnati.

One of the first steps in navigating beyond "good enough" AD treatment is recognizing when it may be time for a treatment switch. Dr. Bowles says signs can include:

• Flares become more frequent, last longer, or both.
• Symptoms are increasingly difficult to control despite consistent use of topical therapies and good skin-care habits.
• Sleep is disrupted by itching and discomfort.
• Itching is intense enough to cause cracked or scratched skin that becomes prone to infection.
• Medications seem to cause more side effects than relief.

Another indication that your treatment needs to change is a negative impact on daily activities and emotional well-being, says Kellie Reed, MD, a dermatologist at Westlake Dermatology in Austin, Texas. This might take the form of reduced confidence, lack of focus, and self-consciousness about trying to hide or minimize symptoms, particularly in a work setting.

It can be helpful to keep a treatment diary, says Dr. Reed. Log your skin-related symptoms and note how long a topical treatment brings your relief. But also record issues like professional difficulties and sleep quality problems. Specific, comprehensive insights into all the many effects of AD can help drive more productive conversations with your dermatologist and healthcare team, she says.

Systemic therapy is generally considered if you have moderate to severe disease with frequent or severe flares, says Tanya Evans, MD, a dermatologist and the medical director of the skin cancer program at the Melanoma Clinic at MemorialCare Saddleback Medical Center in Laguna Hills, California.

"New systemic therapies, especially JAK inhibitors, are transforming treatment for moderate to severe atopic dermatitis by offering rapid symptom relief and high efficacy," explains Evans. "However, they require an understanding of whether you're a good candidate, and ongoing monitoring to balance benefits with potential side effects." She says these may include:

• Nausea
• High blood pressure
• Headache
• Diarrhea
• Increased risk of infections

It's important to keep in mind that systemic therapies don’t replace good skin care, they work alongside it, says Bowles.

"Even when someone starts an oral medication, maintaining a gentle, consistent skin care routine remains essential to support the skin barrier and reduce irritation," she says. "That includes regular moisturizing, avoiding harsh cleansers, and minimizing known triggers. The most effective approach is a layered one that addresses both internal inflammation and external barrier support."

You don’t have to settle for incomplete symptom control and pushing through flares. If you’re considering switching treatment for atopic dermatitis, it helps to create a list of questions around your treatment goals you can take to your next dermatology appointment.

• With "high-functioning flares," your AD symptom management is less than ideal, which can take a toll on your mental health and productivity.
• Oral therapies such as JAK inhibitors offer new ways to stop the itch-scratch cycle and manage chronic inflammation.
• Keep track of your symptoms and plan questions in advance to make discussions with your dermatologist more productive.