Keywords: atopic dermatitis, healthcare access, treatment adherence

Background: Atopic dermatitis (AD), also known as eczema, is a common chronic skin condition that often requires specialized dermatologic care for effective management. Limited access to treatment is associated with poorer health outcomes, including increased emergency department visits and hospitalizations. Disparities in healthcare utilization among children with AD are well documented, yet the specific factors driving these inequities—particularly challenges in navigating the healthcare system—remain poorly understood. These disparities not only impact clinical outcomes but also contribute to broader healthcare inequities and quality of life burdens for affected families.

Objective: To identify and assess barriers to pediatric dermatology care for children with atopic dermatitis.

Methods: In the Santa Monica UCLA Pediatric Dermatology clinic, we distributed a validated Barriers to Care Questionnaire to caregivers of children with atopic dermatitis. 134 patients were enrolled. The 43-question survey assessed five categories: pragmatics, skills, marginalization, knowledge/beliefs, and expectations. We then assessed medication adherence at 2 months via telephone through a parent-completed Brief Medication Questionnaire evaluating prescribed medications and adherence.

Results: Preliminary findings indicate that pragmatic concerns—such as transportation, cost, and wait times—are the most frequently reported barriers. 46% of respondents reported significant pragmatics barriers. At 2-month follow-up, 23% of families were nonadherent to their child’s atopic dermatitis medication regimen. Treatment nonadherence was associated with higher marginalization barriers (linear regression coefficient of -2.89, 95% CI: -5.62 to -0.16).

Conclusions: Pragmatic barriers to pediatric dermatology care remain high for children with atopic dermatitis, suggesting that interventions such as telehealth, direct-access online delivery models, insurance reform, and rural workforce initiatives may be crucial for improving access. Our findings also highlight marginalization, caregiver expectations, and health beliefs as meaningful contributors to gaps in care and potential targets for intervention. Addressing these barriers may require not only individual-level interventions but also structural reforms to promote equity in pediatric dermatology care.