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Atopic Dermatitis Provider Toolkit

Adult Immunization Provider Toolkit

Dermatology Hot Topics

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Authors

A 13-year-old girl with known eczema presents with a vesicular rash on her palms that appeared after swimming in the ocean. Skin is tender; vesicles ooze clear liquid. Treated with triamcinolone w/o effect. Watch real-time examination on video.

A. Acute palmoplantar eczema (dyshidrotic eczema)

VIDEO: The child's hands are chronically dry but the skin has recently begun to crack; vesicular rash appeared after an ocean swim. Dx?

Clinical Topics

A 13-year-old Girl with a Vesicular Rash on Palms 

A 64-year-old woman with a history of basal cell carcinoma presents to the dermatologist for skin cancer surveillance. She is incidentally noted to have bruising on her upper eyelids (above). On questioning, she reports experiencing recurrent intermittent eyelid bruising for several years. She denies a history of trauma to her face, pain, or other associated symptoms.

Her medical history is significant for hyperlipidemia, hepatitis C (diagnosed >30 years earlier), osteoporosis, celiac disease, and idiopathic proteinuria for several years. Her surgical history includes appendectomy and carpal tunnel repair.

Pertinent family history includes her mother dying of multiple myeloma and her father of complications of diabetes.

Review of systems is significant for vague symptoms of gastrointestinal discomfort. On more directed questioning, she reports the eyelid purpura is temporally related to the Valsalva maneuver/ strained bowel movements. Her medications include atorvastatin, risedronate sodium, a daily multivitamin, calcium, vitamin D, and aspirin.

Her examination reveals no bruising elsewhere and no findings of interest on skin or mucous membranes.

B. Allergic contact dermatitis, purpuric type

Eyelid bruising was observed on a 64-year-old woman during routine skin cancer follow-up. She denied trauma or pain. What does this look like to you? 

Image IQ

Image IQ: Recurrent Eyelid Purpura 

A real-world analysis of nearly 2,000 patients with atopic dermatitis reveals a significant treatment gap, with only 8.61% of patients with moderate-to-severe disease using systemic therapies despite clinical guidelines recommending these medications for more severe cases.

The study, conducted by researchers at the National Eczema Association and presented at Revolutionizing Atopic Dermatitis 2025, June 6-7, in Nashville, TN,  found that systemic treatment usage has actually declined compared to previous years, dropping from 22.4% to 8.61% among individuals with moderate-to-severe disease. 

The research team, led by Isabelle J. Thibau, MPH, examined data from EczemaWise, a mobile health app, to understand how people with atopic dermatitis use systemic treatments in real-world settings. The investigators analyzed information from 1,950 US residents between May 2024 and April 2025, comparing their findings with data from 734 individuals in a previous period from August 2022 to July 2023. The study population consisted primarily of patients themselves (97.95%) vs caregivers, with women representing 79.69% of participants; the majority of the population )65.7%) was White. 

Thibau and colleagues measured disease severity using the Patient-Oriented Scoring Atopic Dermatitis (PO-SCORAD) scale and itch intensity through numerical rating scales tracked within the mobile application. They defined systemic treatment usage as patients who documented tracking a systemic medication within the app during the study period. The research team also examined demographic variables including age, gender, race, ethnicity, urbanicity, and relationship to the patient to identify potential disparities in treatment access.

The findings revealed concerning patterns in treatment utilization. Among participants with mild disease, 91.39% used non-systemic treatments while 8.61% used systemic therapies. Surprisingly, those with moderate-to-severe disease showed nearly identical patterns, with 92.13% using non-systemic treatments and only 7.87% using systemic options. Thibau et al observed similar trends when examining itch intensity, with participants with high pruritis scores showing systemic treatment usage rates of just 7.87%.

Investigators also reported geographic disparities in use of systemic AD therapies. Individuals in micropolitan, small town, or rural areas showed lower systemic treatment usage (7.64%) compared to those in metropolitan areas (8.86%), a difference that reached statistical significance (

=.027). This geographic gap suggests that access barriers may disproportionately affect patients in less populated areas.

When Thibau and colleagues compared the current data with that from 2 years earlier, a downward trend emerged. The current study population showed a higher average age (34.85 years versus 26.13 years in the previous period) but dramatically lower rates of systemic treatment use among the adults with moderate-to-severe disease. The decline from 22.4% to 8.61% for individuals  with moderate-to-severe PO-SCORAD scores and from 21.1% to 7.87% for patients with higher itch levels represents a substantial reduction in systemic therapy utilization.

The investigators conclude that despite moderate-to-severe disease severity or high itch levels, many individuals report limited systemic treatment use, indicating a significant gap between clinical need and actual care received. They identify multiple potential barriers contributing to this treatment gap, including access limitations, clinical hesitancy among healthcare providers, and patient reluctance to use systemic medications. Thibau et al noted that the barriers are particularly pronounced in rural areas, where people face additional challenges in accessing specialized dermatologic care.

The research, supported solely by the National Eczema Association, highlights the need for improved strategies to ensure that patients with more severe atopic dermatitis receive appropriate systemic treatments that could significantly improve their quality of life and disease control.

Source: Thibau IJ, Mantell B, Smith  Begolka W. Real-world assessment of systemic treatment usage for atopic dermatitis. Poster presented at: Revolutionizing Atopic Dermatitis 2025; June 6-7, 2025; Nashvhille, TN. 

For more RAD 2025 meeting coverage, please click here.

RAD 2025: Mobile health data reveal a troubling decline in systemic treatment  for moderate to severe atopic dermatitis, underscoring issues in access and clinical inertia. 

Persistent Underutilization of Systemic Therapy for Atopic Dermatitis Highlights Gap Between Need and Care 

"Seemingly insignificant impacts on a patient can really change the trajectory of their life so it's very important to treat [atopic dermatitis] early."

Why is Early Treatment of Atopic Dermatitis So Important? Mona Shahriari, MD, Says it Could Change a Life

 Revolutionizing Atopic Dermatitis (RAD) 2025 

meeting in Nashville this month, Mona Shahriari, MD, assistant clinical professor of 

 at the Yale University School of Medicine, gave a presentation titled, "The Psychosocial Impact of Atopic Dermatitis" that focused on the cumulative life course impairment associated with the disease. During an interview at the meeting, 

 asked Shahriari what she hoped might be different in understanding of the emotional 

 if she made the same presentation at RAD 2026. 

"One moment during the session really struck me. I asked the audience how many were familiar with the term cumulative life course impairment. Only 3 or 4 hands went up. That was eye-opening," she said. Her hope for what might be different about this talk next year reflects what she hopes dermatologists at this year's meeting took home with them: 

When a patient with AD walks into your clinic, it might feel like just another rash on the schedule. But for them, it could be the reason they don’t leave the house. It could be the reason they don’t fall in love. It could be the reason they stop dreaming. Taking the time to ask the right questions, to understand the full burden of disease, and to start effective treatment—those things can genuinely transform lives.

Shahriari said she hopes that the research in the area of cumulative life course impairment in AD will have progressed and awareness increased so that when she asks the same question next year, there will be just 3 or 4 hands that do not go up. 

Mona Shahriari, MD is an assistant clinical professor of dermatology at Yale University School of Medicine in New Haven, CT and co-founder of Central Connecticut Dermatology in Cromwell, CT. 

Atopic dermatitis is not just "another rash on the schedule. It could the the reason that patient doesn't leave the house."  

Why Is Early Treatment of Atopic Dermatitis So Important? Mona Shahriari, MD, Says It Could Change a Life

Janus kinase (JAK) inhibitors provide rapid efficacy in the management of atopic dermatitis (AD) but present safety concerns for some heath care professionals because of the FDA black box warning across the class, a high-level precaution required following clinical trials of tofacitinib in rheumatoid arthritis.

in Nashville, Tennessee, June 6-7, Leon Kircik, MD, clarified misconceptions around  the boxed warning, placing the caution in context and then shared his excitement about the "very rich pipeline in atopic dermatitis." He met with Patient Care following his presentation at the conference, 

Janus Kinase (JAK) Inhibitors in Atopic Dermatitis (AD) Management.

Kircik is the founder and medical director of DermResearch and Physicians Skin Care, both in Louisville, as well as clinical professor of dermatology at Indiana University Medical Center in Indianapolis and at the Icahn School of Medicine in New York City.

Patient Care: What was the focus of your presentation at RAD on use of JAK inhibitors for treatment of atopic dermatitis?  

 We discussed all the JAK inhibitors, both topicals and orals and the benefits of this class, that is their efficacy and also their rapid onset of action. As you know, the JAK inhibitors do have a black box warning,

RAD 2025: Renowned AD investigator Kircik provides the history behind the classwide black box warning, highlights JAK inhibitor efficacy, and toplines exciting AD research.    

Leo Robert

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