Treatment Preferences Among Systemic Therapy-Naïve Patients with Atopic Dermatitis or Psoriasis in Germany: A Multicentre Study

Dermatol Ther (Heidelb) (2026) 16:977–992 https://doi.org/10.1007/s13555-025-01615-8 ORIGINAL RESEARCH Treatment Preferences Among Systemic Therapy‑Naïve Patients with Atopic Dermatitis or Psoriasis in Germany: A Multicentre Study Svenja Royeck · Anna Daphne Bamidis · Conrad Weckbecker · Silke C. Hofmann Sonja Ständer · Natalija Novak · Galina Balakirski · · Dagmar Wilsmann‑Theis Received: November 2, 2025 / Accepted: November 26, 2025 / Published online: December 13, 2025 © The Author(s) 2025 ABSTRACT Introduction: Despite the expanding range of approved systemic therapies for atopic dermati‑ tis (AD) and psoriasis (PSO), data on patient pref‑ erences remain limited. It is largely unknown whether patients wish to initiate systemic Prior Presentation: Selected contents of this manuscript were presented in the form of a poster at the European Academy of Dermatology and Venereology (EADV) Congress 2025 in Paris (P0599). Galina Balakirski and Dagmar Wilsmann-Theis contributed equally. Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s13555-025-01615-8. S. Royeck (*) · S. Ständer Pruritus Medicine Section, Department of Dermatology, and Center for Chronic Pruritus (KCP), University Hospital Münster, Von‑Esmarch‑Str. 58, 48149 Münster, Germany e-mail: A. D. Bamidis · S. C. Hofmann · G. Balakirski Centre for Dermatology, Allergology and Dermatosurgery, Helios University Hospital Wuppertal, University of Witten/Herdecke, Wuppertal, Germany C. Weckbecker · N. Novak · D. Wilsmann‑Theis Centre for Skin Diseases, Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany treatment, which route of administration (oral versus subcutaneous) they prefer, or what fac‑ tors drive their treatment preferences. This study evaluated the desire for systemic therapy among systemic treatment-naïve patients with AD or PSO, including disease-specific influencing fac‑ tors and preferences for administration routes (subcutaneous injections vs. tablets). Methods: Eligible patients with AD or PSO were recruited at two German university hospi‑ tals. Questionnaires collected demographic and clinical data, including disease severity, pruritus and pain intensity, quality of life (QoL) impair‑ ment, and desire for systemic therapy. Data anal‑ ysis comprised Mann–Whitney U tests (betweengroup comparisons), and Spearman correlations (factors influencing therapy desire). Results: From 253 recruited patients, systemic treatment-naïve patients with moderate-tosevere disease severity exclusively using topical therapies were selected (56 with AD, 63 with PSO); 77.8% of patients with PSO and 67.9% of patients with AD desired systemic therapy, mainly for superior efficacy, QoL improvement, and pruritus reduction. Administration prefer‑ ences differed significantly (PSO 57.1% injec‑ tions; AD 73.7% tablets; p < 0.005). The desire for systemic therapy moderately correlated with pain intensity (ρ = 0.422, p < 0.001) and QoL impairment (ρ = 0.379, p < 0.005) in AD and with male sex in PSO (ρ = 0.347, p < 0.005). Vol.:(0123456789) 978 Conclusions: Most topically treated patients with moderate-to-severe AD or PSO desire sys‑ temic therapy, with distinct disease-specific administration preferences. PLAIN LANGUAGE SUMMARY Atopic dermatitis and psoriasis are long‑lasting inflammatory skin diseases that can strongly affect daily life. Both cause itching, pain, and visible skin changes, which may lead to emo‑ tional distress and social burden. In this prospec‑ tive cohort study, we wanted to find out whether patients with atopic dermatitis or psoriasis who have never received systemic treatments wish to start one, and which form they would pre‑ fer (oral tablets or injections). We also explored what factors influence these preferences. This study was conducted at two university hospi‑ tals in Germany. A total of 253 adults completed questionnaires on symptoms, disease severity, quality of life, and preferred treatments. Only patients treated with creams or ointments were included in the evaluation (56 with atopic der‑ matitis, 63 with psoriasis). Most patients with moderate‑to‑severe atopic dermatitis (68%) or psoriasis (78%) expressed a desire for systemic therapy. The main reasons were better treat‑ ment results, improved quality of life, and less itching. Preferences for treatment type differed: patients with atopic dermatitis mainly preferred tablets, while those with psoriasis favoured injections. The wish for systemic therapy was linked to stronger pain and poorer quality of life in atopic dermatitis, and to male sex in psoria‑ sis. Our study showed that patients’ preferences are shaped more by how much their condition affects their daily life than by objective disease severity. Discussing these preferences, such as route of administration and quality‑of‑life goals, can help dermatologists involve patients in shared decision‑making and improve satisfac‑ tion and adherence. Keywords: Atopic dermatitis; Patient preference; Psoriasis; Systemic therapy; Topical therapy; Trust Dermatol Ther (Heidelb) (2026) 16:977–992 Key Summary Points Why carry out this study? This multicentre study was conducted to explore treatment preferences among sys‑ temic therapy‑naïve patients with atopic dermatitis (AD) or psoriasis (PSO) in Ger‑ many, aiming to understand factors influenc‑ ing their choice between oral and injectable therapies as treatment options increase. What was learned from this study? Most patients with AD or PSO without prior systemic treatment desire systemic therapy for improved efficacy, quality of life (QoL), and pruritus reduction, showing divergent preferences: patients with AD favour oral administration, whereas patients with PSO prefer injectables. In AD, the desire for systemic therapy cor‑ related moderately with pain intensity and QoL impairment; in PSO, it correlated with male sex. The findings highlight subjective disease burden as the primary driver of treatment preference, not objective severity. Systematic integration of patient preferences regarding route, QoL goals, and manage‑ ability may enhance adherence and satisfac‑ tion, supporting shared decision-making and alignment of medical recommendations with individual expectations in AD and PSO care. INTRODUCTION Atopic dermatitis (AD) and psoriasis (PSO) rep‑ resent the most prevalent chronic inflamma‑ tory skin diseases worldwide, with estimated adult prevalences in industrialized nations ranging from 2.1% to 4.9% for AD and from 0.9% to 8.5% for PSO [1, 2]. Both AD and PSO involve significant systemic inflammation and many comorbidities [3, 4]. AD is often linked to allergic asthma, allergic rhinitis, and other Dermatol Ther (Heidelb) (2026) 16:977–992 immune-mediated inflammatory diseases like Crohn’s disease or ulcerative colitis [5, 6]. PSO commonly presents with psoriasis arthritis and metabolic syndrome [7]. Both diseases increase risks f (...truncated)