Study: Adherence Declines With Complex Atopic Dermatitis Regimens

Key Takeaways:

• New guidelines recommend a range of topical treatments, but complexity is a challenge for adherence.
• Financial burdens and insurance issues complicate long-term AD management.
• Adherence to topical corticosteroids declines by 60% within three days of treatment.

New American Academy of Dermatology (AAD) guidelines emphasize complex topical regimens for atopic dermatitis (AD), but adherence issues may limit their effectiveness, according to new research.

According to a recent article in the Journal of Drugs in Dermatology, the AAD released new guidelines for managing atopic dermatitis (AD), focusing on topical treatments such as corticosteroids, calcineurin inhibitors, PDE-4 inhibitors, and JAK inhibitors. While these treatments target both the immune response and skin dysfunction, the complexity of the recommended regimens presents challenges for patient adherence. Concerns about regimen complexity, patient education, and non-adherence—exacerbated by cost and practicality—are key obstacles. According to the paper, adherence to topical corticosteroids drops by 60% within three days of initiation. The guidelines, according the study authors, also highlight the financial burden of emollients, which are not typically covered by insurance, and suggest lifestyle interventions like wet wrap therapy and bleach baths. 

"In a real-life practice setting, a proactive approach may not be pragmatic, as patients often do not use topical treatments even when acutely suffering from skin disease," the authors wrote. "Encouraging complex, multi-modal treatment regimens when the condition is inactive may be unrealistic at best and counterproductive at worst. Implementing a simple reactive approach to treat flaring AD with a single topical followed by cessation of therapy once symptomatic improvement occurs and then initiating therapy again for subsequent flares is more realistic and likely more effective."

Source: Oscherwitz M, et al. Journal of Drugs in Dermatology. 2024;23(10):8006.