Shawn Kwatra, M.D. Highlights Challenges in Treating Complex Skin Conditions | Fall Clinical Derm 2025

Shawn Kwatra, M.D., Joseph W. Burnett endowed professor and chair of dermatology at the University of Maryland School of Medicine, discussed the challenges of treating complex skin conditions such as atopic dermatitis and prurigo nodularis recently with Managed Healthcare Executive.

Kwatra, who also serves as dermatology chief of service at the University of Maryland, explained that these diseases can present themselves differently in each patient, making caring for patients more challenging.

At the 2025 Fall Clinical Dermatology Conference in Las Vegas, Kwatra presented his insights, highlighting the complexity of these conditions.

“Prurigo nodularis, as well as atopic dermatitis, are very skin diseases that have different manifestations in different patients, and especially different patient skin types, skin tones, different races, ethnicities,” Kwatra said.

He stressed that providers need to recognize the various “morphologies” of these conditions to ensure accurate diagnosis and treatment. Many patients also have comorbidities and may come from disadvantaged backgrounds, which adds to the complexity of care.

Research suggests that undertreatment of conditions such as prurigo nodularis can contribute to organ damage, highlighting the importance of early intervention with targeted therapies that address specific immunologic pathways.

Kwatra also noted that treatment safety is a key concern. Traditional therapies, such as off-label methotrexate—which is sold under different brand names—may provide some benefit but can affect organs such as the liver or kidneys. This happens especially in patients with multiple health conditions.

These symptoms highlight the need for safer, breakthrough treatments that effectively manage disease while minimizing risk.

Kwatra added that improving patient outcomes requires not only access to advanced therapeutics but also increased awareness among clinicians and continued research into safe and effective treatment strategies.

His presentations at the conference also explore itch, skin conditions and the OX40 ligand signaling pathway for atopic dermatitis, highlighting the evolving landscape of dermatology care.