Atopic Dermatitis: Comorbidities and Treatment Challenges

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Atopic dermatitis (AD) poses a substantial burden for patients in various dimensions.¹ Research shows a link between AS and numerous atopic and nonatopic comorbidities, impacting both the physical and mental health of individuals affected.² The American Academy of Dermatology has established guidelines acknowledging the associations between AD and a range of comorbidities, shedding light on the multifaceted challenges faced by those living with this skin condition.³

However, while efforts have been made to identify the conditions linked with AD, there remains a gap in understanding the financial and treatment burdens experienced by patients with AD who are dealing with comorbidities. Past studies have revealed the challenges of managing AD, including issues related to polypharmacy, high out-of-pocket costs, and insurance coverage problems for AD-specific prescriptions.⁴ Yet, there is limited information on the additional burden associated with obtaining and affording prescription treatments for managing comorbid conditions.

In response to this gap, the National Eczema Association conducted an online survey to investigate the prevalence of atopic and nonatopic comorbidities, the utilization of prescription treatments for these conditions, and the barriers encountered by patients in accessing these treatments.⁵ The survey targeted adults aged 18 years or older in the United States who self-reported an AD diagnosis or were caregivers for pediatric patients with AD. This research aimed to provide insights into the challenges faced by patients and their caregivers in managing both AD and its associated comorbidities.

Out of the 1291 survey respondents, 913 individuals met the inclusion criteria. The majority were adults (82.4%), predominantly female (67.9%) and White (70.6%), and primarily reported having moderate AD. The study revealed that 66.7% reported at least 1 atopic comorbidity, with allergic rhinitis being the most prevalent (53.3%). Anxiety (41.7%) and depression (30.7%) were reported more frequently, possibly due to self-reporting rather than clinical diagnosis.⁵

Over half of the respondents (58.6%) used 2 or more prescription treatments to manage their comorbid conditions. Among those utilizing prescription treatments, a quarter faced challenges in obtaining these treatments, primarily due to out-of-pocket costs, step therapy, and prior authorization. Additionally, a high percentage of those needing a prescription for atopic comorbidities encountered issues in obtaining it.⁵

The survey results bring attention to the substantial treatment management experience of patients with AD who often have multiple concurrent conditions. On average, patients in the study utilized around 5.7 prescriptions in a year to manage their AD and related conditions. Notably, individuals encountering issues with their comorbid condition prescriptions also reported insurance coverage problems for their AD prescriptions in the same period, exacerbating the negative impacts from coverage issues for AD treatments.

Understanding the intricate relationship between AD and its comorbidities is crucial for developing effective treatment plans. Certain treatments for AD may not only alleviate the skin condition but also mitigate associated comorbidities. On the other hand, newer treatments might introduce new risks. Therefore, future research is essential to explore how AD treatments impact comorbidities, potentially reducing the need for additional prescriptions and lessening the significant cost and access burdens patients face.

In conclusion, this survey highlights the prescription treatment access challenges faced by individuals living with AD and its comorbidities, emphasizing the need for a holistic approach to treatment and underscoring the importance of comprehensive strategies that consider the interconnected nature of these conditions to improve the overall well-being of patients with AD.

References:

1. Silverberg JI, Gelfand JM, Margolis DJ, et al. Patient burden and quality of life in atopic dermatitis in US adults: a population-based cross-sectional study. Ann Allergy Asthma Immunol. 2018;121(3):340-347. doi:10.1016/j.anai.2018.07.006

2. Schonmann Y, Mansfield KE, Hayes JF, et al. Atopic eczema in adulthood and risk of depression and anxiety: a population-based cohort study. J Allergy Clin Immunol Pract. 2020;8(1):248-257.e16. doi:10.1016/j.jaip.2019.08.030

3. Davis DMR, Drucker AM, Alikhan A, et al. American Academy of Dermatology guidelines: awareness of comorbidities associated with atopic dermatitis in adults. J Am Acad Dermatol. 2022;86(6):1335-1336.e18. doi:10.1016/j.jaad.2022.01.009

4. Chovatiya R, Smith Begolka W, Thibau I, Silverberg J. Atopic dermatitis polypharmacy and out-of-pocket healthcare expenses. J Drugs Dermatol. 2023;22(2):154-164. doi:10.36849/JDD.7038

5. Loiselle AR, Thibau IJ, Johnson JK, Guadalupe M, Begolka WS. Financial and treatment access burden associated with atopic dermatitis comorbidities. Ann Allergy Asthma Immunol. 2023;S1081-1206(23)01343-1. doi:10.1016/j.anai.2023.10.015