A nationwide clinical survey and expert evaluation conducted across Italy has revealed that only half of participating specialists systematically record formal treat-to-target goals at every clinical visit for patients managing moderate-to-severe atopic dermatitis. Published in Dermatology and Therapy, the investigation examined real-world clinical practices, therapeutic priorities, and persistent systemic hurdles encountered by physicians treating this chronic inflammatory skin disorder. Atopic dermatitis represents a widespread, relapsing condition characterized by intense pruritus, profound skin barrier dysfunction, and systemic immune dysregulation primarily driven by type 2 inflammation. While recent pharmacological developments, including targeted biologics and Janus kinase inhibitors, have supported a treat-to-target management framework that prioritizes predefined therapeutic milestones through regular monitoring, the investigators identified significant heterogeneity in how these evidence-based principles are translated into routine medical care across different institutional settings.
The study was designed as an exploratory, cross-sectional, survey-based investigation paired with qualitative expert panel interpretation. To construct the underlying instrument, a scientific board comprising ten Italian key opinion leaders convened for an initial virtual meeting in November 2025 to establish the core rationale, scope, and specific domains of inquiry. The resulting nineteen-item questionnaire was subsequently deployed online between December 2025 and January 2026 to clinicians actively managing adult patients with moderate-to-severe disease. Following data collection, the same panel of ten experts met again to contextualize the descriptive statistical outputs within daily dermatological practice. The authors emphasized that the panel operated as a pragmatic working group rather than a formal Delphi consensus, focusing on integrating practitioner responses with clinical experience to clarify persistent therapeutic gaps.
A total of fifty-nine physicians completed the initial demographic section of the survey, comprising fifty-eight dermatologists and one allergist, with fifty-eight specialists completing the detailed treat-to-target questions. The respondent cohort represented substantial geographic diversity, with 35.5 percent practicing in Northern Italy, 20.3 percent in Central Italy, and 44.1 percent in Southern Italy and the Islands. Clinicians were primarily based in institutional environments, with 52.5 percent working within hospitals and 40.7 percent in university clinics, while only a small minority operated in territorial outpatient clinics, private practice, or alternative settings. The participants possessed considerable clinical experience: 67.8 percent reported five to ten years managing moderate-to-severe atopic dermatitis, 10.2 percent reported ten to fifteen years, 10.2 percent had fifteen to twenty years, and 11.9 percent possessed over twenty years. High patient volumes were common, with 39.0 percent managing more than two hundred adult patients annually, and 84.7 percent reported high knowledge of international management guidelines.
Despite strong reported familiarity with clinical guidelines, the formal documentation of treat-to-target goals exhibited marked inconsistency in everyday practice. Exactly 50.0 percent of respondents reported recording treat-to-target milestones in the medical record at every visit, whereas 34.5 percent did so only occasionally, 10.3 percent documented goals solely at baseline, and 5.2 percent never recorded them. When initiating systemic treatment, physicians reported utilizing both clinician-reported outcomes and patient-reported outcomes frequently, although clinician-assessed scales demonstrated slightly higher routine uptake. The expert panel noted that while the simultaneous application of clinician and patient tools is recommended by international initiatives such as Harmonising Outcome Measures for Eczema, routine co-administration remains challenging in high-volume settings, potentially allowing discrepancies to persist between clinical evaluations and the personal disease burden experienced by patients.
The survey identified a pronounced temporal evolution in therapeutic benchmarks, demonstrating that clinicians adopt progressively more demanding efficacy standards between three and six months of treatment. At three months, the most widely targeted milestones included achieving an Eczema Area and Severity Index reduction of at least 75 percent, selected by 63.8 percent of clinicians, a Pruritus Numerical Rating Scale score of four or lower, chosen by 62.1 percent, and a Dermatology Life Quality Index score of five or lower, targeted by 51.7 percent. A minor portion of 19.0 percent accepted a modest 50 percent index reduction at three months. By six months, clinical ambitions shifted substantially toward near-complete clearance, with 53.4 percent targeting a 90 percent index improvement, 86.2 percent aiming for a pruritus score of zero or one, and 67.2 percent striving for a quality of life score of zero or one. Complete skin clearance rose from 1.7 percent at three months to 24.1 percent at six months.
When evaluating structural obstacles that impede systematic goal setting, participants identified severe institutional constraints as the dominant deterrents. Lack of time was cited by 69.0 percent of respondents as a major barrier, while 36.2 percent pointed to limited clinic resources and infrastructure. Additional challenges included patient compliance, identified by 20.7 percent, access or medication reimbursement hurdles, noted by 13.8 percent, and general treatment adherence issues, reported by 13.8 percent. Practical integration of monitoring instruments into electronic medical records was selected as an obstacle by 8.6 percent of clinicians. The expert panel observed that these persistent workflow restrictions frequently prevent specialists from administering comprehensive multidimensional evaluations, which reinforces the need for streamlined, user-friendly monitoring algorithms that can be realistically incorporated into time-pressured outpatient appointments.
When rating specific determinants governing therapeutic selection on a five-point Likert scale, safety and tolerability emerged as the leading consideration with a weighted mean score of 4.50, closely followed by overall clinical efficacy at 4.48 and efficacy in sensitive anatomical areas at 4.45. In examining long-term disease management, clinicians assigned high importance to maintaining therapeutic responses after treatment discontinuation, which scored 4.21, as well as the ability to extend dosing intervals, which scored 4.09. With respect to specific safety profiles, oncological risks and cardiovascular hazards received the highest vigilance, recording mean scores of 4.21 and 4.07, respectively. Overall drivers of treatment selection were dominated by baseline disease severity at 4.36, general safety profile at 4.29, impact on patient quality of life at 4.26, and the involvement of sensitive areas at 4.19.
The management of sensitive anatomical areas surfaced as both a critical treatment determinant and a substantial clinical vulnerability. Head and neck involvement and hand involvement were ranked as the most influential regional presentations guiding drug choice, earning mean importance scores of 4.26 and 3.88, respectively. However, clinicians expressed only moderate satisfaction with the real-world performance of available therapies in these regions. Perceived effectiveness was lowest for the head and neck at 3.48, compared to hands at 3.69, feet at 3.50, and genital areas at 3.71. Across distinct clinical phenotypes, perceived therapeutic efficacy remained highest for classic atopic dermatitis at 4.36, whereas lower effectiveness was reported for prurigo nodularis-like presentations and generalized inflammatory forms. Ineffective management of sensitive sites and failure to maintain sustained disease control were identified as the foremost barriers to long-term success.
In contextualizing these therapeutic ratings, the authors reviewed the complementary profiles of targeted systemic options currently reshaping clinical practice. Biologics directed against interleukin-4 and interleukin-13 pathways demonstrate robust long-term safety, though class-specific adverse events such as conjunctivitis and paradoxical facial erythema require ongoing management. Certain agents, including tralokinumab and lebrikizumab, have formal label provisions for extending dosing intervals during maintenance, whereas dupilumab interval spacing occurs as an off-label practice supported by real-world observations. Conversely, Janus kinase inhibitors offer rapid symptom relief and marked initial efficacy, particularly for intense pruritus and refractory localized manifestations. However, their use necessitates rigorous screening for dyslipidemia, hematological changes, infections such as herpes zoster, and considerations regarding major cardiovascular events or malignancies in vulnerable populations, prompting many clinicians to prefer biologics for higher-risk individuals.
The study authors highlighted several methodological limitations inherent to their design that warrant cautious interpretation. The investigation relied on an exploratory, cross-sectional survey of fifty-nine physicians without direct patient-level clinical records or patient participation, meaning the findings reflect clinician perceptions rather than objective health outcomes or direct patient experiences. Furthermore, the survey instrument was not formally validated, which introduces the possibility of reporting and recall bias, and analyses were entirely descriptive without inferential hypothesis testing. Economic variables, resource expenditures, and payer perspectives were also omitted, preventing any conclusions regarding Italian health policy or reimbursement frameworks. The authors noted that larger, prospective investigations across broader international cohorts will be necessary to validate these patterns and refine treat-to-target protocols in routine clinical environments.
Ultimately, the Italian survey demonstrates that while the conceptual principles of treat-to-target management are widely accepted, their real-world execution requires overcoming substantial logistical constraints and persistent clinical gaps. Achieving durable disease control in moderate-to-severe atopic dermatitis demands therapeutic approaches that balance rapid symptom alleviation with long-term tolerability, dosing adaptability, and proven efficacy across difficult-to-treat anatomical zones like the head and neck. Bridging the divide between formal recommendations and daily practice will necessitate the widespread adoption of feasible monitoring tools, increased institutional support to alleviate specialist time pressures, and greater integration of patient-reported outcomes to align therapeutic goals between clinicians and the individuals they treat.
Subject of Research: Clinical implementation of treat-to-target strategies and unmet therapeutic needs in moderate-to-severe atopic dermatitis
Article Title: Treat-to-Target in Atopic Dermatitis: An Italian Survey and Expert Opinion on Clinical Practice and Unmet Needs
Article References: Ferrucci, S., Galluzzo, M., Guanti, M. B., Hansel, K., Napolitano, M., Nettis, E., Ortoncelli, M., Pezzolo, E., Rossi, M., Narcisi, A., A. D.-T2T Working Group, Angileri, R., Francesca, A., Tania, B., Francesca, B., Bassi, A., Bellinato, F., Bertoldi, A., Bianchi, L., … Zussino, M. (2026). Treat-to-Target in Atopic Dermatitis: An Italian Survey and Expert Opinion on Clinical Practice and Unmet Needs. Dermatology and Therapy. https://doi.org/10.1007/s13555-026-01965-x
Image Credits: AI Generated
DOI: 10.1007/s13555-026-01965-x
Keywords: atopic dermatitis, treat-to-target, dermatology, clinical practice, patient-reported outcomes, biologics, JAK inhibitors, disease management, Atopic, Dermatitis, Italian, Survey
News Source: Ophelia Keating. (November 6, 2026). Italian Survey Reveals Major Gaps in Treat-to-Target Care for Atopic Dermatitis. Scienmag.
