Addressing existing gaps in the management of young adults with atopic dermatitis

The research by Carmanius et al.¹ analyse drug utilization among young adults with atopic dermatitis (AD) providing valuable insights into important gaps.

The study revealed that nearly half of young adults with AD were undertreated or completely untreated.¹ It is particularly concerning that none of them received the recommended emollient amounts, and only less than five were dispensed sufficient topical corticosteroids (TCS).¹ Patients were dispensed an average per month of only 40 grams of emollients and 5.65 grams of TCS¹ – much below recommended monthly amounts of 60–90 grams for TCS and 1000 grams for emollients.² The fact that none of these patients received the recommended amount of emollients indicates a critical gap in primary care, as emollients are the foundation of every step of AD treatment.² Moreover, more patients with moderate-to-severe AD received emollients than those with mild AD¹ suggesting patients only use emollients during flares rather than daily, diverging from guidelines.² The underuse of TCS reveals a broader issue, as sufficient dosage, together with appropriate potency, and correct application is key to effective topical anti-inflammatory therapy.² Inadequate topical treatment could lead to disease progression and more harder-to-treat cases of AD. Since the study focused only on dispensed medications, patients may have received a prescription but did not have it dispensed, what the authors emphasized.¹ Hence, the underutilization of treatments may result from either the patient's side—such as a lack of understanding of the medication's importance and low treatment adherence—or the physician's side, such as a lack of patient education or failure to adhere to treatment guidelines.

Interestingly, men were more likely to be dispensed TCS than women.¹ Perhaps gender plays a role, or there are differences in disease severity. Men more often experience severe forms of AD than women.³ However, the current study did not find any gender differences in disease severity,¹ suggesting other involved factors. Topical corticosteroid phobia is common among AD patients,⁴ which could make women more hesitant to use TCS. This indicates an unmet need for personalized care that addresses patients' medication concerns to improve adherence. Conversely, the study showed that women more often than men were dispensed systemic corticosteroids (SCS).¹ This raises questions about whether women seek treatment more actively or if treatment patterns differ by gender due to healthcare providers' or patient preferences. To understand this phenomenon, further investigation is needed.

Moreover, a very low proportion of patients received systemic therapy (15.7% for systemic corticosteroids, despite they are recommended only in short courses and less than 2% for other systemic immunosuppressants) despite the high prevalence of moderate-to-severe AD (47.9%).¹ Undertreatment of AD patients with systemic therapy has been observed before, where patients seen by general practitioners and private practice dermatologists were less likely to receive systemic treatment than those referred to hospital-based dermatologists.⁵ This may be due to among others limited resources or less experience in managing severe AD. Undertreatment is also common in children. One study found that 9.8% of children with severe AD had not used any topical or systemic treatments.⁶

In light of the findings,¹ we can close existing gaps by emphasizing the role of education, increasing awareness of the using emollients, and ensuring that all patients with AD, regardless of the place of treatment, have access to therapies consistent with guidelines. Moreover, in the era of modern treatment, proper topical therapy is extremely important, which will allow us to dedicate the appropriate group of patients to modern treatment. Delaying the decision on systemic treatment, when it is necessary, can lead to irreversible health and mental consequences for both patients and their families. A personalized approach to patients combined with shared decision-making guarantees treatment success.

MT has been a speaker and/or consultant and/or investigator and/or participant of the Advisory Board for Abbvie, Bausch Health, Bioderma, Eli Lilly, La Roche-Posay, Leo pharma, Mead Johnson, Novartis, Pfizer, Pierre Fabre, Pfizer, Sanofi Genzyme.