Topical Treatments in Atopic Dermatitis: An Expansive Review

Abstract

Atopic dermatitis (AD) is a common inflammatory skin condition found worldwide. It impacts patient quality of life (QoL) and is thought to arise as an inflammatory response to epidermal barrier dysfunction and hypersensitivity. AD can lead to large out-of-pocket costs and increased healthcare expenses over a lifetime. An analysis of all randomized control trials conducted since 1990 on topical therapies for AD were reviewed, including 207 trials in the final analysis. It was found that an average of 226 patients were enrolled over 2.43 arms. Common topical treatments included corticosteroids, calcineurin inhibitors, JAK inhibitors, and phosphodiesterase inhibitors. The most utilized tools to identify treatment efficacy were the EASI, IGA, SCORAD, and PGA. There was a paucity of data on trials that evaluated efficacy, QoL, and cost of treatment simultaneously. This review highlights the need for comprehensive trials that evaluate multiple aspects of treatment, including financial cost and QoL impact, to ensure each patient has the best treatment modality for the management of their AD.

Keywords: atopic dermatitis; cost of treatment; inflammatory skin conditions; over-the-counter treatments; quality of life; steroids; topical therapy.

Figure 1

PRISMA-based flow diagram depicting inclusion and exclusion criteria. In total, 207 unique studies were included in this analysis.

Figure 2

Graphical representation of commonly used metrics for measurement of disease severity and treatment progression in AD.