Topical vs Systemic Treatment for Atopic Dermatitis Evaluated in Real-World Study

Atopic dermatitis is treated with the use of topical steroids in most patients and approximately one-third use systemic treatment.

Study data published in the Journal of the American Academy of Dermatology outline trends in topical and systemic treatment use among patients with atopic dermatitis.

TARGET-DERM ( Identifier: NCT03661866) is a longitudinal observational study of patients with atopic dermatitis that was designed to assess the long-term, real-world efficacy of treatments for the condition. According to the study authors, “Evaluation of treatment patterns can ensure optimal care for patients in diverse settings.”

The first participants were enrolled between January 2019 and December 2020. Data were derived from up to 3 years of retrospective medical records in addition to prospective physician assessment and patient-reported outcomes. The present analysis examined the relationship between treatment type and patients’ baseline characteristics. Treatments for atopic dermatitis were categorized as either topical or systemic. Multivariate logistic regression analysis was used to identify predictors of treatment type. Models were adjusted for sex, race, insurance type, and study site.

The study cohort comprised 1263 patients, among whom 57% were adults. At enrollment, 82% of patients were undergoing treatment for atopic dermatitis with topical agents and 30% were undergoing treatment with systemic agents. The use of systemic treatments was more common in adults compared with adolescents and children (41% vs 33% and 9%, respectively; P <.001). In addition to older age, greater disease severity and impact of disease on quality of life were each independently associated with use of systemic treatments for atopic dermatitis. Specifically, patients with severe atopic dermatitis based on the Patient Oriented Eczema Measure were more than twice as likely to initiate systemic treatment compared with patients with atopic dermatitis classified as being nonsevere (odds ratio [OR], 2.59; 95% CI, 1.12-5.96). Further, patients who reported that atopic dermatitis had an “extremely” or “very large” impact on their quality of life were significantly more likely to undergo treatment with systemic agents compared with patients with lower self-reported impact of atopic dermatitis on their quality of life (OR, 3.48; 95% CI, 1.29-9.38). This relationship was particularly pronounced in non-Hispanic White patients, a finding that was not seen in other racial/ethnic groups.

Evaluation of treatment patterns can ensure optimal care for patients in diverse settings.

Results from this large diverse cohort of patients with atopic dermatitis outline real-world trends in treatment use and outcomes. The majority of study participants underwent treatment with topical steroids, and nearly one-third used systemic treatment. The rate of systemic treatment use increased with age, severity of disease, and impact on quality of life. Replication in clinical trials is necessary to better understand these findings, particularly the differential effects of the severity of atopic dermatitis on treatment type by race. 

Disclosure: This research was supported by Target RWE. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Abuabara K, Eichenfield LF, Bissonnette R, et al. Real-world evidence on atopic dermatitis: baseline characteristics and predictors of treatment choice in the TARGET cohort. J Am Acad Dermatol. Published online December 12, 2022. doi:10.1016/j.jaad.2022.08.065