Study: Itch and Rash Severity Linked to Biologic Use in Eczema
Key Takeaways
Lesion and itch severity were independent predictors of biologic initiation in moderate-to-severe AD, according to a new paper.
Patients with severe itch were more likely to begin biologic treatment.
Itch documentation was also significantly associated with biologic prescribing.
Data from a recent pre-proof in the Journal of the American Academy of Dermatology highlights that both itch and lesion severity independently predict biologic treatment initiation in patients with moderate-to-severe atopic dermatitis (AD).
Using data from the OMNY Health platform collected between 2022 and 2024, the authors studied 8,589 biologic-naïve patients aged 12 years and older with documented IGA) and Itch Numeric Rating Scale (NRS) scores. Patients were stratified by itch severity into four clinical phenotypes based on lesion and itch severity: mild–moderate itch and lesions (MI-ML), severe itch/mild–moderate lesions (SI-ML), mild–moderate itch/severe lesions (MI-SL), and severe itch and lesions (SI-SL).
At index encounter, biologics were prescribed to 2% of MI-ML patients vs 25% of SI-SL patients. According to the results, cumulative biologic initiation reached 56% in the SI-SL group vs 9.3% in MI-ML at 12 months. Regression analyses showed patients with SI-ML, MI-SL, and SI-SL phenotypes were 4-, 5-, and 10-fold more likely, respectively, to receive biologics at baseline vs MI-ML. They also were more likely to initiate biologics during follow-up.
Documentation of itch was associated with increased likelihood of biologic initiation. The researchers noted that IGA scores were documented more consistently than itch NRS scores.
“Overall, both lesion severity and itch severity are independent predictors of biologic initiation in AD,” the authors wrote. “ Our findings highlight the importance 75 of a patient-centric approach that integrates both visual and symptomatic assessments when 76 determining treatment need, advocating for a broader adoption of routine itch assessment in routine 77 clinical practice to support more timely treatment decisions and equitable access to advanced therapies.”
Source: Yosipovitch G, et al. JAAD. 2025. Doi:10.1016/j.jaad.2025.11.021