Persistent Underutilization of Systemic Therapy for Atopic Dermatitis Highlights Gap Between Need and Care

A real-world analysis of nearly 2,000 patients with atopic dermatitis reveals a significant treatment gap, with only 8.61% of patients with moderate-to-severe disease using systemic therapies despite clinical guidelines recommending these medications for more severe cases.

Isabelle Thibau, MPH

Courtesy of National Eczema Association

The study, conducted by researchers at the National Eczema Association and presented at Revolutionizing Atopic Dermatitis 2025, June 6-7, in Nashville, TN, found that systemic treatment usage has actually declined compared to previous years, dropping from 22.4% to 8.61% among individuals with moderate-to-severe disease.

The research team, led by Isabelle J. Thibau, MPH, examined data from EczemaWise, a mobile health app, to understand how people with atopic dermatitis use systemic treatments in real-world settings. The investigators analyzed information from 1,950 US residents between May 2024 and April 2025, comparing their findings with data from 734 individuals in a previous period from August 2022 to July 2023. The study population consisted primarily of patients themselves (97.95%) vs caregivers, with women representing 79.69% of participants; the majority of the population )65.7%) was White.

Thibau and colleagues measured disease severity using the Patient-Oriented Scoring Atopic Dermatitis (PO-SCORAD) scale and itch intensity through numerical rating scales tracked within the mobile application. They defined systemic treatment usage as patients who documented tracking a systemic medication within the app during the study period. The research team also examined demographic variables including age, gender, race, ethnicity, urbanicity, and relationship to the patient to identify potential disparities in treatment access.

FINDINGS

The findings revealed concerning patterns in treatment utilization. Among participants with mild disease, 91.39% used non-systemic treatments while 8.61% used systemic therapies. Surprisingly, those with moderate-to-severe disease showed nearly identical patterns, with 92.13% using non-systemic treatments and only 7.87% using systemic options. Thibau et al observed similar trends when examining itch intensity, with participants with high pruritis scores showing systemic treatment usage rates of just 7.87%.

Investigators also reported geographic disparities in use of systemic AD therapies. Individuals in micropolitan, small town, or rural areas showed lower systemic treatment usage (7.64%) compared to those in metropolitan areas (8.86%), a difference that reached statistical significance (P =.027). This geographic gap suggests that access barriers may disproportionately affect patients in less populated areas.

When Thibau and colleagues compared the current data with that from 2 years earlier, a downward trend emerged. The current study population showed a higher average age (34.85 years versus 26.13 years in the previous period) but dramatically lower rates of systemic treatment use among the adults with moderate-to-severe disease. The decline from 22.4% to 8.61% for individuals with moderate-to-severe PO-SCORAD scores and from 21.1% to 7.87% for patients with higher itch levels represents a substantial reduction in systemic therapy utilization.

The investigators conclude that despite moderate-to-severe disease severity or high itch levels, many individuals report limited systemic treatment use, indicating a significant gap between clinical need and actual care received. They identify multiple potential barriers contributing to this treatment gap, including access limitations, clinical hesitancy among healthcare providers, and patient reluctance to use systemic medications. Thibau et al noted that the barriers are particularly pronounced in rural areas, where people face additional challenges in accessing specialized dermatologic care.

The research, supported solely by the National Eczema Association, highlights the need for improved strategies to ensure that patients with more severe atopic dermatitis receive appropriate systemic treatments that could significantly improve their quality of life and disease control.

Source: Thibau IJ, Mantell B, Smith Begolka W. Real-world assessment of systemic treatment usage for atopic dermatitis. Poster presented at: Revolutionizing Atopic Dermatitis 2025; June 6-7, 2025; Nashvhille, TN.