Integrative Approaches to Atopic Dermatitis: Exploring Biomarkers, Current Therapies, and the Potential Role of Osteopathic Manipulative Medicine

Abstract

Atopic dermatitis (AD) is a chronic, relapsing, and remitting condition that affects approximately 10% of the population. It is a multifactorial disease involving immune dysregulation, gene mutations, and environmental factors that ultimately disrupt skin barrier restoration, causing pruritic lesions. Given the marked heterogeneity of AD and the presence of multiple immune and clinical endotypes, no single therapeutic strategy is likely to be universally effective. Instead, a growing panel of distinct biomarkers offers an avenue for true precision medicine by enabling more accurate endotype classification, prediction of treatment response, and tailored treatments. In this context, ongoing research is increasingly focused on individualized, biomarker-informed strategies, as well as the evaluation of adjunctive approaches that can be integrated with standard therapies to optimize long-term disease control. Given the central role of systemic inflammation and barrier dysfunction in AD, the mechanistic focus of osteopathic manipulative medicine (OMM) on circulation, lymphatic drainage, and autonomic regulation offers another biological treatment to use alongside conventional therapies. This concise review examines the pathogenesis of AD, current treatments and their limitations, and the expanding role of biomarkers in refining diagnosis, prognosis, and therapeutic decision-making. It also explores the potential integration of OMM as a biologically plausible adjunct to support individualized, endotype-aware treatment strategies, while emphasizing the current lack of empirical evidence and the need for rigorous mechanistic and clinical studies.