Study Highlights Atopic Dermatitis Practices in Different Regions of the World

New findings address clinical practices used to manage mild-to-moderate atopic dermatitis among dermatologists in different regions of the world, highlighting the use of topical corticosteroids (TCSs) and other widespread practices.1

Lawrence Eichenfield, MD, chief of pediatric and adolescent dermatology at Rady Children’s Hospital-San Diego, led a team of investigators to assess how dermatologists treat atopic dermatitis in various regions of the world. They highlighted that clinical guidelines are generalized and that regimens often depend on patient-specific elements as well as costs, regional drug access, patient education, and healthcare provider training.2

“To assess the management of mild-to-moderate [atopic dermatitis] with topical therapies across various geographic regions, an expert panel of dermatologists was selected to provide insight into their clinical practice,” Eichenfield and his team wrote.1

Surveying Dermatologists on Their Practices

Eichenfield and colleagues invited a set of dermatologists from various global regions to take part in their analysis, providing an electronic questionnaire to those who agreed to participate involving 43 questions. The assessment collected insights into respondents’ knowledge and experience in managing mild-to-moderate atopic dermatitis based on patient age groups (<2 years, 2–12 years, and >12 years) as well as the severity of disease (mild versus moderate).

There were 21 open-ended questions and 22 closed-ended ones. All of the necessary responses were collected by November 2022, with survey participants selected who were board-certified dermatologists known for expertise in the management of atopic dermatitis as well as professional recognition within their respective countries.

A total of 17 dermatologists in total took part, with respondents from the Middle East (n=4), North America (n=5), South America (n=2), Asia (n=5), and the UK (n=1). Sixteen individuals reported that topical calcineurin inhibitors (TCIs) were approved for implementation for patients older than 2 years in their region, whereas nearly half of the participants highlighted that TCIs were not approved for children under 2 years in their region.

In other findings highlighted in this survey, it was uncovered that most respondents had crisaborole available in their region, although 4 participants reported that it was not approved for children under 2 years. Additionally, 2 participants noted that it was not approved for patients older than 2 years.

When differentiating between mild and moderate atopic dermatitis, 14 of 16 individuals considered multiple factors. Several commented that moderate disease, compared to mild disease, typically involves more intense levels of itch, a greater level of impacted body surface area, and more extensive disease-associated lesions, including lichenification and excoriations, which often necessitate stronger topical drugs for disease control.

Only 2 out of 16 participants made a habit of utilizing scoring systems in their daily practices to evaluate atopic dermatitis severity. In terms of first-line therapies, almost all dermatologists involved in the survey suggested that they would use TCS as a first-line treatment across all age brackets.

For children under 2 years, 9 out of 17 preferred a low-to-medium–potency TCS, while for patients aged 2–12 years and older than 12 years, higher-potency TCSs were favored. Additionally, participants noted that they would prescribe a more potent TCS for moderate AD compared to mild AD.

A regular skin care regimen was advised to patients among 15 of 16 survey respondents. These regimens would commonly involve the utilization of a mild soap or gentle non-soap cleanser (9 of 16), a moisturizer (12 of 16), and either short baths or showers each day (9 of 16).

All participants emphasized that their determination of a topical medication would depend on the specific body area being treated. The survey revealed that many used lower-potency TCSs or non-TCS for sensitive bodily regions, such as the skin folds, groin, and face, reserving higher-potency TCSs for other areas.

Among patients under the age of 2 years, 8 of 16 participants reported that they would prescribe low-potency TCSs, though some preferred a non-TCS monotherapy as a treatment alternative. Most dermatologists in the questionnaire suggested that for all ages and disease severity levels, they would prescribe drugs for less than 2 or up to 4 weeks to achieve initial disease control. It was noted that treatment duration was not specific to any particular topical option.

“The management of mild-to-moderate [atopic dermatitis] in clinical practice is influenced by several patient-specific factors, access to treatment and practical experience with the available treatment options,” the team wrote. “A care plan tailored to patient needs and preferences with adequate patient education and cognizance of patient-specific factors is needed to achieve optimized patient outcomes.”1

Interested in dermatology? Learn more about the annual Revolutionizing Atopic Dermatitis (RAD) Conference, hosted by HCPLive Dermatology Times, and our CE/CME partner Physicians’ Education Resource.

References

1. Eichenfield, L.F., Stein Gold, L.F., Hebert, A.A., Guenther, L., Valdman-Grinshpoun, Y., Ben-Amitai, D., Dodiuk-Gad, R.P., Cork, M.J., Aoki, V., Chu, C.-Y., Zhang, J., Ma, L., Saeki, H., Luna, P.C. and Koh, M.J.-A. (2025), Management of Mild-to-Moderate Atopic Dermatitis With Topical Treatments by Dermatologists: A Questionnaire-Based Study. JEADV Clinical Practice. https://doi.org/10.1002/jvc2.611.

2. V. C. Correa, L. H. Lugo-Agudelo, D. C. Aguirre-Acevedo, et al., “Individual, Health System, and Contextual Barriers and Facilitators for the Implementation of Clinical Practice Guidelines: A Systematic Metareview,” Health Research Policy and Systems 18 (2020): 74.