Team-Based Telehealth Model Matches In-Person Care for Atopic Dermatitis

Patients with atopic dermatitis (AD) often struggle to access dermatologic care, facing long wait times, travel barriers, and the need to miss work or school for appointments. Primary care physicians (PCPs), meanwhile, can find it challenging to sustain treatment plans without continuous specialist support. A trial published in JAMA Dermatology found that a telehealth model circumvents those obstacles and still delivers equivalent outcomes to in-person visits.

Telehealth vs In-Person Equivalence Trial

The trial consisted of 300 individuals aged 1 year or older with broad eligibility criteria, including both children and adults with physician-diagnosed AD who could establish or had already established care with practitioners. Patients were recruited from the general population across Southern California and received treatment across 8 ambulatory dermatology clinics.

The participants were split into 2 randomized 1:1 groups: online or team-based connected health (TCH) care (n = 149) and in-person care (n = 151). Online participants were required to have internet access and a digital photograph-capturing device meeting minimum quality requirements. Patients were enrolled between August 2019 and May 2024, with each participant followed for 12 months.

EASI, POEM, vIGA Show Equivalent Outcomes

Participant retention was strong with quarterly assessment completion rates ranging from 97.0% (291 patients) at month 3 to 95.3% (286 patients) at month 12, showing a minuscule decrease. The study assessed 3 outcome measures: the Eczema Area and Severity Index (EASI), the Patient-Oriented Eczema Measure (POEM), and the validated Investigator Global Assessment (vIGA). All 3 were measured for both groups at baseline and reassessed every 3 months through the 12-month mark.

For the primary outcome, the difference in mean change in EASI scores between the TCH and in-person groups was –0.01 (95% CI, –0.22 to 0.20), well within the prespecified equivalence margin of ±6.5. Secondary outcomes showed similar results: the difference in mean change for POEM was 0.38 (95% CI, 0.03-0.73), within a margin of ±3.4, and for vIGA was 0.06 (95% CI, 0.00-0.11), within a margin of ±0.5. Online patients averaged 0.07 in-person visits, compared with 2.40 for the in-person group.

Across all 3 outcome measures, differences between the 2 groups fell within the study’s prespecified equivalence margins, confirming that TCH care produced clinically equivalent results to in-person treatment.

Adverse event rates were comparable between the 2 groups, occurring in 16.1% of the TCH group and 14.6% of the in-person group. Serious adverse events were rare, affecting 1 patient (0.7%) in the TCH group and 2 patients (1.3%) in the in-person group, and none were considered related to either treatment approach. No deaths occurred during the study.

Dermatology Access and Reimbursement Implications

The trial's results carry meaningful implications for dermatologic care access. Sancy A. Leachman, MD, PhD, at the time a professor at Oregon Health & Science University, highlighted at the 2026 American Academy of Dermatology (AAD) Annual Meeting that 68% of US counties lack a dermatologist.² Patients in underserved or geographically remote areas often face wait times extending for months to see a dermatologist, leading to delayed diagnoses and deferred treatment. More broadly, these delays, along with transportation barriers, can result in missing work or school to attend an appointment.

By connecting patients directly with dermatologists while keeping PCPs informed on treatment plans, the TCH model addresses these barriers without sacrificing clinical outcomes—only 4.0% of patients in the TCH group needed an in-person dermatology visit.

The researchers suggest these findings could inform reimbursement and health system policy around incorporating digital platforms into chronic disease management, positioning TCH as a scalable model rather than a temporary fix.

Team-Based Connected Health Limitations

The trial did come with its own limitations. The study population was majority female, reflecting the higher prevalence of AD in women rather than a recruitment imbalance, and baseline disease severity was relatively mild among participants. Environmental circumstances, such as an overlap with the COVID-19 pandemic during a portion of the trial, potentially played a role in increasing individuals’ openness to using an online model, though both online and in-person visits remained available throughout the study. The trial also required sufficient internet access and a quality camera, which not all patients may have.

Atopic Dermatitis Telehealth: A Scalable Model for Real-World Care

Results from this trial comparing online vs in-person care for AD show that online, team-based care is a legitimate alternative to in-person eczema care, which comes with its own set of accessibility barriers.

“As health systems continue to integrate digital platforms, TCH offers a scalable model that can maintain clinical quality while addressing the everyday challenges patients and clinicians face in managing chronic diseases,” the authors concluded.

References

1. Armstrong AW, Roberts AM, Kostandy G, et al. Online vs in-person care for atopic dermatitis: a randomized clinical trial. JAMA Dermatol. Published online June 24, 2026. doi:10.1001/jamadermatol.2026.1959

2. McCormick B. PCP support, community outreach help close rural dermatology access gaps. AJMC. Published March 28, 2026. Accessed July 9, 2026. https://www.ajmc.com/view/pcp-support-community-outreach-help-close-rural-dermatology-access-gaps