Describing atopic dermatitis in real-world clinical practice: a retrospective health system analysis

Effective management of atopic dermatitis (AD) is hindered by gaps in the comprehensive documentation of clinician-observed signs and patient-reported experiences. Our objective was to assess the comprehensiveness of AD documentation in clinical practice. A retrospective analysis of electronic health records from a regional health system (2010-2022, n = 17,053) was conducted. Manual review of 2,193 records confirmed 600 AD patients. Documentation of skin signs, disease burden, and disease progression was evaluated. Narrative descriptions of lesion morphology and location were documented in 76.2% and 92.7% of notes, respectively. Only a minority commented on chronicity (6.2%), signs other than erythema (<= 25.0%), disease extent (38.2%), or severity (IGA/PGA: 26.8%; EASI: 4.7%). Itch, skin pain, sleep disturbances, and mental health symptoms were reported in 58.7%, 14.5%, 10.2%, and 1.0% of notes, respectively, with numerical rating scales rarely applied. Patient-assessed global severity was recorded in 6.2% of notes, and QoL impact in 3.8%. Documentation of flare frequency, duration, and post-treatment changes was rare. Our findings reveal strikingly incomplete clinical documentation of AD, underscoring the need for a structured approach to better document activity and address true disease burden.