Novato, Calif. – October 01, 2026 -- Only about 6.9 million of the estimated tens of millions of Americans with atopic dermatitis (AD) had a documented diagnosis in 2023, roughly one in five of those believed to be affected, according to a new CDC-funded report from the National Eczema Association (NEA).
The State of Atopic Dermatitis Indicator Report, conducted by Milliman and released with 51 state-level briefs covering all 50 states and Washington, D.C., establishes the first national baseline on AD diagnosis, treatment and specialist access. It anchors the four-year State of AD initiative and NEA's October Eczema Awareness Month campaign.
Prevalence estimates far exceed documented diagnoses
Published estimates put AD prevalence at 6.0% to 16.9% among children and 4.9% to 10.4% among adults, yet clinical records capture only a fraction of this population. "Atopic dermatitis too often goes unaddressed, both by patients who don't realize their symptoms are worth raising, and in visits where it isn't the main concern," said Kristin Belleson, President and CEO of NEA.
Specialist shortages concentrate in states with above-average diagnosed prevalence
Thirteen percent of Americans live in counties with no dermatology or allergy/immunology practitioners, with specialist supply skewed toward higher-density counties. Alabama, Delaware, Hawaii and Nevada show above-average diagnosed AD prevalence paired with fewer specialists per capita, creating access barriers for patients who could benefit from advanced treatment.
Treatment patterns lag current clinical guidelines
Topical corticosteroids are filled by 42% to 52% of diagnosed patients, while systemic corticosteroids still reach 4% to 5% despite guidance against routine use. The most commonly used guideline-recommended biologic reaches only 2% to 4% of patients depending on insurance market.
Co-occurring conditions and lifespan impact are extensive
In 2023, approximately 783,000 diagnosed AD patients also had documented asthma, and 703,000 experienced secondary skin infections. Diagnosed prevalence peaks at 10.4% among commercially insured children ages 0 to 2, but rebounds to 3.1% among Medicare fee-for-service beneficiaries 65 and older, the highest rate of any adult group surveyed.
Primary care carries the bulk of AD visits as telehealth use stays low
Primary care practitioners deliver 36% to 52% of AD-related visits, and 1.2% to 4.6% of patients had an AD-related emergency or observation visit, with rates highest in Medicaid. Telehealth accounted for just 1.2% to 1.3% of AD-related dermatology visits, compared with 5.0% to 5.5% of primary care appointments and 3.8% to 6.2% of allergy and immunology visits.
"What stands out in this data is how much eczema touches all stages of life, from infants to adults 65 and older, often alongside conditions like asthma and skin infections," said Wendy Smith Begolka, Chief Program and Mission Officer at NEA.