Treatment Satisfaction with Topical Therapies in Adolescent and Adult Patients with Moderate-to-Severe Atopic Dermatitis: A Real-World Study in the United States

Abstract

INTRODUCTION Atopic dermatitis (AD) is an increasingly prevalent chronic heterogeneous inflammatory skin disorder characterised by pruritus and eczematous lesions. Recent guidelines recommend using topical therapies for AD management. We describe the treatment satisfaction and disease activity in adolescent and adult patients with moderate-to-severe AD using topical therapies in the US.

Methods Data were drawn from the 2025 Adelphi Real World Topical Experience AD Disease Specific Programme, a cross-sectional survey with elements of retrospective data collection in the US. Health care practitioners (HCPs, dermatologists/allergists/immunologists/nurse practitioners/physician assistants) provided information on clinical characteristics, including physician-determined current disease severity (moderate/severe AD), treatment satisfaction, disease control, and reasons for dissatisfaction with current treatment. Patients (≥13 years) were required to be currently on topical therapy (corticosteroids/calcineurin inhibitors) for their AD, either as monotherapy or in combination with another treatment. Patients were stratified by type of treatment: topical monotherapy (no concomitant systemic treatment, TM) vs topical + advanced systemic (oral JAK-i or biologic, TAS). All analyses were descriptive.

Results Sample (mean age=32.2 years, 55% female) included TM: n=115 (84% moderate, 16% severe) and TAS: n=46 (87% moderate, 13% severe) patients with AD. Current head and neck involvement was reported in 61% TM and 67% TAS; current upper limb involvement in 77% TM and 83% TAS; current trunk involvement in 52% TM and 52% TAS; and current lower limb involvement in 69% TM and 65% TAS. Current mean (SD) BSA was reported as 17.2% (16.5) TM and 18.6% (18.7) TAS. Physician-determined success of treatment was reported in 58% TM and 61% TAS. HCPs reported they were “satisfied, and I believe this is the best control that can be realistically achieved for this patient” in 31% TM and 46% TAS; “satisfied, but I believe better control can be achieved for this patient” in 51% TM and 33% TAS; “not satisfied, and I believe this is the best control that can be realistically achieved for this patient” in 1% TM and 7% TAS; and “not satisfied, but I believe better control can be achieved for this patient” in 17% TM and 15% TAS. The main reason for dissatisfaction was “AD is still impacting the patient's quality of life” among TM and TAS, followed by “Lack of skin clearance” in TM and “Patient not satisfied” and “Persistent skin changes” in TAS. At data collection, flaring was observed in 33% TM (flare severity: 61% moderate, 34% severe) and 30% TAS (flare severity: 64% moderate, 36% severe). Mean (SD) number of patient-reported flares in the past 12 months was 3.2 (2.2) TM and 4.1 (3.9) TAS; however, only 25% TM and 27% TAS patients indicated reporting every flare to their HCP.

Conclusions While most HCPs were satisfied with the current treatment, over one-third still believed that better control can be achieved. Additionally, patients on topicals with or without systemic medication were actively flaring, and most patients did not report every flare to their HCP. Results indicate unmet treatment needs and a need for better awareness in patients with AD.