Eczema Action Plans: Personalized Tools for Empowering Patients and Enhancing Care
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In this interview, Wendy Smith Begolka and Jessica Johnson of the National Eczema Association (NEA) discuss the evolving role of eczema action plans (EAPs) in atopic dermatitis (AD) management, highlighting findings from a national survey conducted by NEA. The conversation explores the clinical rationale for EAPs, barriers to adoption, and strategies for integrating personalized, actionable plans into dermatology practice. With insights on improving patient confidence, adherence, and shared decision-making, Smith Begolka and Johnson also preview NEA’s forthcoming next-generation digital EAP tool and outline future research priorities.
The Dermatologist: How did you get interested in applying the concept of action plans to AD?
Wendy Smith Begolka: We were interested in this area because we had seen that action plans were already being used to facilitate disease management in other chronic disease spaces. We were aware of some individuals in our community using them—either health care providers putting them in place for their patients or patients using them with their providers. Our focused work in this area began as a result of a previous effort we were involved in with several NEA collaborators, which found that increased patient treatment satisfaction was correlated with patients who had received a written EAP.1 Broadly, the concept of an action plan fits into our goal to enhance and improve eczema care through shared decision-making. That initial finding was really our gateway into some of the research we will talk about today, as well as our next steps.
The Dermatologist: Given the heterogeneity of AD, what role do you see EAPs playing in improving individualized care for patients?
Wendy Smith Begolka: I really appreciate the wording of that question because it underscores what we see as the primary point of an action plan: to provide and reinforce an individualized care approach for each patient. This is especially important in a disease with such a wide range of presentations and clinical courses.
There are 3 main ways an action plan can help. First, it serves as a quick reference guide—a place where a patient or caregiver can understand what to do, when, where, and how. We have heard from our community that eczema care can be complex. Patients often leave the physician’s office with multiple treatments and little clarity or confidence on how to manage them. An action plan helps document that guidance in one place and supports confidence, reduces anxiety, and improves self-management. Second, it enhances treatment adherence and appropriate use—knowing how and when to use each treatment. And third, it supports shared decision-making. An action plan invites a question: Is this plan working? If yes, great. If not, we have opened the door to revisiting and adjusting the plan.
The Dermatologist: Survey data suggested that only about 40% of respondents had heard of EAPs. Why do you think awareness remains relatively low, and how might clinicians better integrate EAPs into routine practice?
Jessica Johnson: Timing likely plays a significant role. Historically, action plans were studied primarily in asthma, a condition that shares similarities with AD—both have stepwise treatment approaches and flares. In the asthma community, action plans have shown value, and personalized asthma plans were recommended nearly 35 years ago. In contrast, the concept of EAPs did not appear in the literature until around 2014. Although they may have been used informally before that, they are still relatively new in dermatology. Many clinicians may be less familiar with EAPs, particularly if their training occurred before EAPs were introduced. In addition, there is limited guidance on what an EAP should include, which leads to variability in how providers perceive their role and utility. This inconsistency makes it harder to integrate them into routine workflows. Also, because eczema is such a variable condition, some clinicians may underestimate the value of structured management plans. And, of course, time constraints during visits and competing priorities make it difficult to introduce, explain, and review a new tool. Clinicians can improve integration by using digital tools that are compatible with existing care platforms to support shared decision-making.
The Dermatologist: What elements do you believe are critical to include in an effective EAP and what strategies do you recommend for creating more personalized and actionable plans in a busy clinical setting?
Jessica Johnson: Traditionally, EAPs have used the red-yellow-green format borrowed from asthma action plans to describe disease control. From our qualitative and quantitative research, we have learned that format is no longer ideal. The plan should be clear, actionable, and patient-centered. Daily eczema management requires attention to many changing factors and a fully comprehensive tool can quickly become overwhelming, so it is critical to simplify the treatment plan into 3 parts: daily maintenance, flares or worsening of symptoms, and a contingency plan for when the flare protocol is not working. Specifically, it should include medication names; dosing; and where, how, and how long to apply treatments.
The goal is to reduce confusion once the patient or caregiver is home and managing the condition themselves. The instructions should also clearly state when to seek additional support if symptoms are not improving. One suggestion we have seen work well is to include a QR code or link to additional resources. Patients often want information on sleep, stress, or mental health—things that support overall care without overloading the action plan itself. Lastly, for an action plan to be truly useful, it needs to be a living document. It should be easy to update, shareable across the care team, and seamlessly integrated into the clinic’s workflow.
The exciting news is that NEA is developing a next-generation EAP, built with input from patients, caregivers, and health care providers, which brings all these key elements to life. We look forward to sharing that later this year.
The Dermatologist: The survey found that most patients who used an EAP referred to it between visits. How can dermatologists leverage this engagement to enhance long-term disease control?
Jessica Johnson: It is very encouraging that patients with an EAP are referring to it between visits. Dermatologists can build on this engagement in a few key ways. First, they can treat the EAP as a dynamic tool, updating it alongside patients as their treatment evolves. This strengthens shared decision-making during the visit and reduces patient or caregiver uncertainty between visits. Second, during appointments, clinicians can actively ask patients: What has been working? What challenges have come up? How have symptoms changed? NEA’s free app, EczemaWise, supports these conversations with features like symptom, trigger, and treatment tracking, helping improve alignment between patient and provider. Finally, digital delivery of EAPs can improve real-time updates and patient adherence. NEA’s upcoming digital EAP tool is designed exactly for that. It provides a structured way to support communication, clarify treatment goals, and help patients feel confident managing their care, ultimately improving outcomes.
The Dermatologist: Looking ahead, what research or clinical initiatives are needed to better understand provider perspectives on EAPs and evaluate their impact on measurable outcomes in AD care?
Wendy Smith Begolka: The study of EAPs, especially digital or next-generation versions, is still fairly new, so there is a lot of important research ahead. Much of it will fall under quality improvement research: How do EAPs affect clinical and patient-reported outcomes? Which outcomes are most impacted? Do they streamline care delivery? How do they support education and shared decision-making? We also need to understand which elements of the EAP are most effective for achieving those outcomes. It is equally important to study this from both the patient and provider perspectives, ideally looking at the same clinical encounter from both sides. This will help us better understand how these tools are being used and where the gaps are. And we will need to do this across different care settings because eczema is managed by both primary and specialty care providers. The next-generation EAP we are developing is a starting point, and we are hopeful that ongoing research will help us refine and improve it based on real-world use.
Reference
- Chiesa Fuxench ZC, Smith Begolka W, Simpson E. Treatment satisfaction in adults with atopic dermatitis: a cross-sectional, population-based study examining patient and physician perspectives in the US. Arch Dermatol Res. 2024;316(6):239. doi:10.1007/s00403-024-03078-x
