Most APPs Authorized to Independently Prescribe Advanced AD Therapies

A US survey of 108 advanced practice providers (APPs) found nearly all reported independently diagnosing, treating, and counseling patients with atopic dermatitis (AD), with most authorized to initiate and renew biologic and Janus kinase (JAK) inhibitor therapies.¹ Findings from the 2025 Adelphi Real World NPPA AD Wave II Disease Specific Programme were presented at the PANP360 conference in Scottsdale, Arizona, from May 29 to 31, 2026.¹ The survey included 40 nurse practitioners (NPs) and 68 physician assistants (PAs) managing 561 adults with AD.¹

Survey Provides Snapshot of APP Roles in AD Care

As biologics and targeted oral therapies become increasingly central to AD management, APPs continue to take on expanding responsibilities in dermatology practice. However, real-world evidence describing APP prescribing patterns and treatment decision-making has remained limited.² The survey offers insight into APP prescribing authority, confidence with advanced therapies, and the treatment goals they prioritize when caring for adults with AD.¹

The 2025 Adelphi Real World NPPA AD Wave II Disease Specific Programme was a US cross-sectional survey with retrospective data collection conducted over approximately four months beginning in September 2025.¹ Eligible APPs were affiliated with a dermatologist or allergist and actively managed at least 8 patients with AD each month.¹ Patients included in the survey had a confirmed diagnosis of AD and were not enrolled in clinical trials.¹

APP Independence Extends Across AD Care

All 108 APPs reported an independent role in counseling and educating patients, presenting treatment options, conducting physical examinations, and participating in nearly every aspect of AD management, with every surveyed responsibility reported by at least 94.6% of respondents.¹³

Most APPs were also authorized to independently initiate and renew advanced therapies for AD, including biologics (97.2%; 95% CI, 92.1-99.4), topical JAK inhibitors (97.2%; 95% CI, 92.1-99.4), and oral JAK inhibitors (95.4%; 95% CI, 89.5-98.5). Only 1 respondent reported having no prescribing authority for AD therapies.¹

The American Academy of Dermatology guideline was the most commonly followed treatment guideline, cited by 75.9% (95% CI, 66.8-83.6) of APPs.⁴

APP Comfort and Treatment Priorities

Although authorization to prescribe advanced therapies was nearly universal, confidence varied considerably across treatment classes. Most APPs reported feeling comfortable prescribing biologics (86.9%; 95% CI, 79.0-92.7), compared with oral JAK inhibitors (41.7%; 95% CI, 32.3-51.6), systemic corticosteroids (39.8%; 95% CI, 30.5-49.7), and traditional systemic immunosuppressants (11.1%; 95% CI, 5.9-18.6).¹³

When selecting therapy, APPs most frequently rated relief of pruritus and itching (80.6%; 95% CI, 71.8-87.5), long-term safety (78.7%; 95% CI, 69.8-86.0), and long-term disease control (76.9%; 95% CI, 67.8-84.4) as extremely important treatment goals.¹

APPs also identified which AD symptoms they perceived as most challenging to manage and most burdensome for patients. Scarring (treatability score, 66.3) and blistering (60.4) were rated as the most difficult symptoms to treat, while sleep disturbance (QoL impact score, 78.8) and pruritus/itching (84.2) were considered to have the greatest impact on patients' quality of life.¹⁴

Clinical Takeaways for APPs

The survey highlights the expanding role of APPs in advanced AD management and demonstrates that most independently prescribe biologics and JAK inhibitors in routine practice. At the same time, the gap between prescribing authorization and comfort with non-biologic systemic therapies suggests opportunities for additional education as newer treatments continue to enter clinical practice.¹

Investigators noted that the cross-sectional design allows only for identifying associations rather than causal relationships and that prescribing authority may vary according to state regulations and institutional policies, potentially limiting the generalizability of the findings.¹

References:

1. DiRuggiero D, Cheever E, Heim J, et al. Prescribing patterns of advanced practice providers managing adults with atopic dermatitis: results from a US cross-sectional survey. J Skin. 2026;10(4):S794. doi:10.25251/80kexf52. https://www.researchgate.net/publication/409460921_Prescribing_Patterns_of_Advanced_Practice_Providers_Managing_Adults_With_Atopic_Dermatitis_Results_From_a_US_Cross-Sectional_Survey
2. Samynathan A, Silverberg JI. Navigating the atopic dermatitis toolbox: challenging scenarios and shared decision-making. Ann Allergy Asthma Immunol. 2024;132(3):337-343. doi:10.1016/j.anai.2023.12.020. https://pubmed.ncbi.nlm.nih.gov/38145707/
3. Augustin M, Costanzo A, Pink A, et al. Real-world treatment patterns and treatment benefits among adult patients with atopic dermatitis: results from the Atopic Dermatitis Patient Satisfaction and Unmet Need Survey. Acta Derm Venereol. 2022;102:adv00830. doi:10.2340/actadv.v102.3932. https://pubmed.ncbi.nlm.nih.gov/36479885/