Online vs In-Person Care for Atopic Dermatitis: A Randomized Clinical Trial

Accessible and effective management of atopic dermatitis (AD) across geographic boundaries is important. Scalable, collaborative care models that integrate patients, primary care practitioners, and specialists remain an unmet need.

To determine whether an online, team-based connected health (TCH) model provides equivalent improvements in AD severity compared to in-person care.

In this pragmatic, randomized clinical equivalence trial, 300 patients with AD were enrolled from 8 outpatient dermatology clinics in California from August 2019 to May 2024 and randomized 1:1 to online or in-person care. Eligible participants were at least 1 year old and had a physician diagnosis of AD, internet and photograph access, and established or new clinician care.

The TCH model provided asynchronous, online access to dermatologists. Dermatologists reviewed patients' clinical histories and photographs and provided assessments and treatment recommendations online. The control arm provided conventional, in-person care.

The primary outcome was 12-month change in the EASI (Eczema Area and Severity Index); secondary outcomes were changes in the POEM (Patient-Oriented Eczema Measure) and validated vIGA (Investigator Global Assessment), assessed quarterly.

Among 300 adults and children with AD (mean [SD] age, 34.6 [17.7] years; 211 [70.3%] female), 149 were assigned to TCH and 151 to in-person care. The difference in mean change between the 2 groups was -0.01 (95% CI, -0.22 to 0.20) for the EASI, 0.38 (95% CI, 0.03-0.73) for the POEM, and 0.06 (95% CI, 0.00-0.11) for the vIGA. All differences fell within prespecified equivalence margins.

In this randomized clinical trial, the online TCH model resulted in equivalent improvements in AD signs and symptoms compared to in-person care. Telehealth models may serve as effective tools for managing chronic diseases like AD.

ClinicalTrials.gov Identifier: NCT03981926.