Online vs In-Person Care for Atopic Dermatitis

Importance: 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. Objective: To determine whether an online, team-based connected health (TCH) model provides equivalent improvements in AD severity compared to in-person care. Design, Setting, and Participants: 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. Intervention: 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. Main Outcomes and Measures: 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. Results: 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. Conclusions and Relevance: 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. Trial Registration: ClinicalTrials.gov Identifier: NCT03981926.