A Survey on the Burden and Gaps in the Management of Atopic Dermatitis: Perspectives From Indian Dermatologists

Background: The burden of immuno-inflammatory diseases, such as atopic dermatitis (AD), is increasing, and data on their epidemiology and management from Indian settings are scarce. This study assesses the perspective of Indian dermatologists on AD burden, management, and unmet needs. Methodology: This was an online questionnaire-based survey that captured the perspectives of 150 Indian dermatologists on AD prevalence, signs and symptoms, management, and treatment adherence. Results: Most dermatologists reported that 5-10% of their patients had AD, with pediatric-onset comprising >60% of cases. The reported severity was mild in 41-60% of cases, moderate in 21-40%, and severe in <20% of cases. As per participating dermatologists, >60% and 21-40% of patients had a family history of atopy and AD, respectively. The most commonly reported signs and symptoms included itch, dryness, and sleep disturbances, with itch being proportional to disease severity in more than 60% of patients. Most mild AD cases experienced one to five flare-ups per year, as reported by 84.67% of dermatologists. Moderate cases had one to five flare-ups annually, as per 64.67% of the dermatologists. Severe cases were reported to experience six to 10 flares/year. Flare triggers included hot/humid conditions, stress, and a history of atopy. Topical corticosteroids and calcineurin inhibitors were the preferred first-line therapies for mild/moderate AD, whereas severe cases often required systemic conventional therapies and off-label drug usage with targeted therapies. Topical calcineurin inhibitors and moisturizers were the most commonly preferred for AD maintenance. Most dermatologists reported nonadherence to treatment due to loss of follow-up in <25% of patients. Notably, 78% believed that newer steroid-sparing options would improve adherence. Regional variations in onset and treatment preferences were also observed. Conclusion: Significant gaps exist in the management of AD in India. Targeted therapies and newer steroid-sparing options could enhance patient outcomes. Challenges encountered included delayed diagnosis, preference for alternative medicine, and inappropriate treatment. Nonadherence to treatment was influenced by steroid phobia, lack of awareness, and cost of therapy. The findings should be interpreted with caution due to limitations, including recall bias and the lack of patient-level data.