Which patient is most likely to require systemic treatment for atopic dermatitis?

The patient most likely to require systemic treatment for atopic dermatitis is the 25-year-old woman with a SCORAD of 47, who cannot tolerate topical corticosteroids (TCSs).

Atopic dermatitis (AD) severity is often assessed using the SCORAD index, with higher scores indicating more severe disease. A score of 47 suggests that her condition is not only significant but may also be resistant to standard topical treatments. In cases where patients have severe forms of atopic dermatitis and are unable to use topical treatments due to side effects or inefficacy, systemic therapies become necessary to manage the condition effectively.

Systemic treatment options, such as oral immunosuppressants or biologics, can provide broader and more effective control of inflammation and symptoms compared to topical medications alone, especially in cases where the patient's quality of life is severely impacted and local treatments fail to yield adequate results.

The other scenarios presented indicate different levels of severity or management strategies. For instance, the 35-year-old man with a SCORAD of 33, although demonstrating significant disease, experiences flares only once annually and responds well to TCS, indicating that his condition can be managed with those medications. The 4-month-old infant likely has a common