Jonathan Silverberg, MD, PhD, MPH, George Washington University School of Medicine and Health Sciences, discusses results from a recent study for which he was the lead author.
Data suggest that patients aren't satisfied with their topical therapies for atopic dermatitis (AD), even among patients with milder symptoms, says Jonathan Silverberg, MD, PhD, MPH, professor of dermatology and director of clinical research and patch testing at the George Washington University School of Medicine and Health Sciences.
What are some of the biggest burdens you identified in your recent study on the unmet needs in atopic dermatitis?
This study was an international survey-based study that looked at folks with atopic dermatitis from a variety of different countries—Canada, the US, Spain, etc, many other countries—and looked at over 2000 people with atopic dermatitis, with a strong focus and attention on the impacts of itch in this disease.
I think we all acknowledge that itch is the most common and universal symptom of the disease and certainly a very burdensome symptom. But this study provides some very important insights that I think were previously not shown before and maybe are not on our radar in clinical practice.
One, even among patients who had pretty mild lesional disease—they didn't have 50% or 100% body surface, even amongst patients with body surface area less than 10%—but if they had severe itch, they had major, major impacts in terms of sleep and quality of life. And it turns out that it was actually a pretty common subset of patients to have less-extensive lesions and yet have pretty profound itch.
I think, to me, it illustrates why it's so important for us to ask patients about their itch in clinical practice and not just assume their itch is a certain severity based on what we're able to look at on the skin. Because what we're able to see doesn't always pick up the patient experience and how bad the itch can be and how bad the quality-of-life impacts can be.
What we found was that even in this patient population, of more than 90% of which had less-extensive disease—and you would argue, by definition, should be considered to be milder—most of the patients reported having sleep disturbances on a regular basis, had to see a health care provider on a regular basis to address their itch and address their atopic dermatitis, illustrating that reducing itch was their top treatment goal.
I thought this was actually a little surprising: That among those who are on topical therapies, most of them are actually not satisfied with their therapy. And I think we all encounter this in clinical practice, yet the mainstay of how we manage our patients is with topicals. I think we just kind of assume most patients are probably fine with it. These data suggest that most patients were not satisfied with their topical therapies, even in the milder spectrum of patients.
So, this study really highlights how common bad itch occurs in patients with atopic dermatitis, even in milder disease, and how important it is for us to try to get better control of that itch.