A New Look at Atopic Dermatitis Management: Fresh Approaches for Primary Care - Episode 4
Addressing Current Topical Management of Atopic Dermatitis in Primary Care
A panelist discusses how structured assessment tools like the itch Numeric Rating Scale, combined with a flexible, patient-centered approach to topical therapies—including both traditional steroids and newer non-steroidal agents—can improve atopic dermatitis management in primary care by enhancing treatment tracking, patient education, and access to appropriate care.
The speaker begins by stressing the importance of structured assessment in managing atopic dermatitis (AD), based on their own shift toward using patient-reported outcomes like the Numerical Rating Scale for itch. Even a simple tool like this, used consistently, can enhance treatment tracking, improve patient communication, and justify medication access or referrals. Quality of life (QOL) is another major consideration—though more severe AD correlates with greater QOL impact, even mild disease can be disruptive. When deciding on treatment, clinicians must consider effectiveness, safety, patient preference, and cost, all of which vary depending on the health care setting and individual patient context.
Treatment guidelines from the American Academy of Dermatology support the use of both older and newer topical agents. Topical corticosteroids remain the mainstay but should not be used indefinitely on the same areas due to risk of skin thinning. The speaker criticizes the standard electronic health record instructions—"use for 2 weeks and stop”—as overly simplistic and potentially misleading. Instead, they recommend educating patients about rotating application sites and considering steroid-sparing options for chronic problem areas. These include nonsteroidal topicals such as calcineurin inhibitors (tacrolimus and pimecrolimus), PDE4 inhibitors (crisaborole and roflumilast), the aryl hydrocarbon receptor agonist tapinarof, and the topical Janus kinase inhibitor ruxolitinib, though the latter carries boxed warnings.
Polling data from the audience shows that most still rely on topical steroids as the initial treatment, which the speaker acknowledges is practical due to familiarity and cost—but they express hope that as newer agents become more affordable, clinicians will increasingly shift away from steroids. In subsequent treatment steps, providers take a range of approaches: Some escalate to nonsteroidal topicals, others try a different steroid, some refer to dermatology, and a few move to systemics. The speaker encourages confidence in trying newer agents and affirms that primary care providers are fully capable of prescribing these nonsteroidals. For those who prefer to refer, that’s fine too, but the key is having a flexible, informed, and patient-centered approach.
