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This letter to the editor discusses the case of a 52-year-old female patient with atopic dermatitis (AD) who experienced treatment failure with various medications. The patient initially tried dupilumab, which improved some symptoms but did not fully resolve the condition. She then switched to upadacitinib, which initially showed improvement but later led to worsening symptoms and side effects. Finally, the patient started tralokinumab, which resulted in some initial improvement but persistent facial involvement. The letter highlights the challenges of treating resistant AD and suggests that more research is needed to identify factors that contribute to treatment resistance. [Extracted from the article]