Online Team-Based Care Demonstrates Equivalent Outcomes to In-Person Management for Atopic Dermatitis

Clinical summary

• Pragmatic randomized equivalence trial: 300 adults and children with physician-diagnosed atopic dermatitis across 8 California dermatology clinics (August 2019–May 2024); asynchronous team-based connected health (n=149) versus in-person care (n=151) over 12 months.

• Mean between-group differences were −0.01 for EASI (95% CI, −0.22 to 0.20), 0.38 for POEM (95% CI, 0.03–0.73), and 0.06 for vIGA (95% CI, 0.00–0.11); all met prespecified equivalence margins.

• Online care produced equivalent improvements in AD signs and symptoms. Limits include California outpatient settings and 12-month follow-up; no next steps were reported.

An online team-based connected health (TCH) model provided clinical outcomes equivalent to conventional in-person care for patients with atopic dermatitis (AD), according to a pragmatic randomized clinical equivalence trial.

Accessible long-term management remains a challenge for many patients with AD, particularly across geographic regions where specialist access may be limited. Investigators evaluated whether a scalable, collaborative telehealth model could achieve outcomes comparable to traditional office-based care.

The trial enrolled 300 adults and children with physician-diagnosed AD from 8 outpatient dermatology clinics in California between August 2019 and May 2024. Participants were randomized 1:1 to receive either asynchronous online care through the TCH model or standard in-person management.

Patients assigned to the TCH arm received online access to dermatologists, who reviewed clinical histories and patient-submitted photographs before providing assessments and treatment recommendations. The control group received conventional face-to-face dermatologic care.

The primary endpoint was change in Eczema Area and Severity Index (EASI) score over 12 months. Secondary outcomes included changes in the Patient-Oriented Eczema Measure (POEM) and validated Investigator Global Assessment (vIGA), which were assessed quarterly.

Among the 300 enrolled participants, 149 were assigned to the TCH model and 151 to in-person care. The mean differences between treatment groups were −0.01 (95% CI, −0.22 to 0.20) for EASI, 0.38 (95% CI, 0.03 to 0.73) for POEM, and 0.06 (95% CI, 0.00 to 0.11) for vIGA. All results fell within the prespecified equivalence margins.

According to the authors, “the online TCH model resulted in equivalent improvements in AD signs and symptoms compared to in-person care.”

Reference
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