The State of AD: Why We Are Building the First Indicator Report of Its Kind
For all the progress in atopic dermatitis (AD) treatment over the past decade, a basic question remained surprisingly hard answer at scale: How is AD being managed throughout the nation, state by state, and across the full range of patients who live with the disease? Prevalence estimates existed. Care access data existed. Quality-of-care research existed. What had not existed, until now, was a single source that brings all 3 together, across every US state, for patients of every age and every major insurance type. That gap is what the National Eczema Association (NEA) set out to close with the State of AD Indicator Report, which launched October 1 as part of Eczema Awareness Month.
Three Years in the Making
Under a multi-year grant from the Centers for Disease Control and Prevention, NEA spent the past 3 years building what is the first comprehensive national, state-level, and sub-state estimates of AD burden in the country. Not limited to 1 age group or 1 type of insurance coverage, the report spans commercial, Medicare, and Medicaid populations and covers AD wherever it shows up across the lifespan, including differences between urban and rural areas. Other efforts have looked at pieces of this picture. NEA’s report is the first to pull those pieces together into 1 baseline.
The result is a resource built specifically for the people making decisions about AD care: public health professionals, health care providers, policy makers, payers, and advocacy stakeholders who need reliable national and state-level evidence, not fragmented estimates, to guide where resources and attention go. It also gives patients and caregivers something they have not had before: national and state-level data that validate what many already know from experience. AD is everywhere, affecting people of all ages, and it engages the health care system through a wide variety of doors, from primary care to dermatology to urgent care and beyond. It often co-occurs with or leads to other conditions, including infections and asthma, and care remains inconsistent; where you live can shape the care you receive.
What the Report Covers
At a category level, the State of AD Indicator Report brings together 3 types of data, nationally and for every state:
• Prevalence—how many people have engaged the health care system with a diagnosis of AD, across age groups and insurance types
• Care access—the who, where, and what of how patients reach and receive treatment
• Quality of care—indicators of whether the care patients receive is meeting the standard it should and unmet needs
Every state is included. This is a nationwide issue, and the data suggest every state has something to work on. The report is not designed to rank states against each other, but rather to give each state a clear picture of where it stands and where it can improve.
The data show AD is a significant, underrecognized public health burden in every US state. For the first time, state-level findings reveal concrete opportunities to close gaps in diagnosis, access, and care; a foundation for targeted action, not just awareness.
For example, despite biologics and JAK inhibitors now representing first-line systemic therapy for moderate-to-severe AD, use remains low across insurance types. Only 2% to 4% of patients with diagnosed AD used any of the available targeted systemic therapies in 2023, whereas systemic corticosteroids, which clinical guidelines recommend against for AD, were used more often by 4% to 5% of patients. This gap points to an opportunity to enhance the use of appropriate systemic treatment for eligible patients to alleviate disease burden.
A meaningful share of AD-related acute care is also happening in in the emergency department (ED) and at urgent care facilities rather than through planned follow-up. AD-related visits account for up to 8.2% of all ED visits and up to 12.2% of urgent care visits among these patients, with rates varying by insurance type. This points to an opportunity for dermatologists and other health care providers to strengthen post-acute follow-up, address acute care needs proactively, and support stronger referral pathways from primary care.
Why Timing Matters
The report’s release coincides with Eczema Awareness Month, deliberately. AD is often underestimated and underappreciated for its impact, dismissed as an easily managed skin condition rather than understood as a disease that can carry real, sometimes severe, effects on physical well-being, mental health, work and school functioning, and quality of life. Releasing these data during the month in which the AD community is already working to raise visibility gives the report a natural audience and a natural moment to act on.
What Is Next?
The State of AD Indicator Report, along with state-by-state briefs, is available now at StateofAD.org. Look for the November/ December issue of The Dermatologist, which will dig into the findings themselves and what they mean for dermatology practice moving forward.
