A NEW multicentre study from Germany highlights a strong unmet need for systemic treatment among patients with moderate-to-severe atopic dermatitis (AD) and psoriasis (PSO) who have so far been managed exclusively with topical therapies. The research provides valuable insight into patient preferences for treatment initiation and route of administration, an area that has remained underexplored despite the rapid expansion of systemic options.
The study enrolled 253 patients across two German university hospitals. From this cohort, investigators focused on 119 systemic therapy-naïve patients with moderate-to-severe disease, 56 with AD and 63 with PSO, who were using topical treatments only. Participants completed detailed questionnaires assessing disease severity, pruritus and pain intensity, quality of life (QoL) impairment, and their desire for systemic therapy.
Overall, the majority of patients expressed a clear wish to escalate treatment. Nearly 78% of patients with psoriasis and 68% of those with atopic dermatitis reported a desire to start systemic therapy. The most common motivations were expectations of better efficacy, meaningful improvements in quality of life, and better symptom control, particularly relief from pruritus.
Systemic Therapy Preferences Differ Between Atopic Dermatitis and Psoriasis
Importantly, preferences differed markedly between disease groups when it came to the route of administration. Patients with psoriasis more frequently favoured subcutaneous injections (57.1%), whereas patients with atopic dermatitis showed a strong preference for oral therapies, with almost three-quarters (73.7%) opting for tablets. This difference was statistically significant and underscores the need for disease-specific, patient-centred discussions during treatment planning.
The analysis also identified factors influencing patients’ desire for systemic therapy. In atopic dermatitis, the wish to escalate treatment showed moderate correlations with higher pain intensity and greater QoL impairment, highlighting the burden of symptoms beyond visible skin lesions. In psoriasis, male sex was moderately associated with a stronger desire for systemic therapy, suggesting possible demographic influences on treatment attitudes.
Implications for Shared Decision-Making in Systemic Therapy
The authors conclude that many patients with moderate-to-severe AD or PSO remain undertreated with topical therapy alone, despite a strong willingness to initiate systemic treatment. They emphasise that understanding patient preferences, particularly regarding administration routes, should play a central role in shared decision-making.
These findings reinforce the importance of proactive treatment discussions in dermatology clinics and may help clinicians better align therapeutic strategies with patient expectations in an era of increasingly personalised care.
Reference
Royeck S et al. Treatment Preferences Among Systemic Therapy-Naïve Patients with Atopic Dermatitis or Psoriasis in Germany: A Multicentre Study. Dermatol Ther (Heidelb). 2025; doi: 10.1007/s13555-025-01615-8
