JAK inhibitors for the Management of Atopic Dermatitis (AD) - Episode 3

Approaching Treatment of Atopic Dermatitis

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Drs Eric Simpson, Alexandra K. Golant, and Raj J. Chovatiya share their approaches to atopic dermatitis care.

Linda Stein Gold, MD: When the patient comes into the office, I want to give each of you a little bit of a tip: It can be daunting. You have a new atopic patient coming in. Can you just give us a tip about how that initial consultation goes? How long does it normally take? What do you do to establish that relationship and set appropriate expectations? Eric, do you have some tips for a busy practitioner when a new atopic patient comes in?

Eric Simpson, MD, MCR: Yeah. They're not going to financially like this tip, but my first tip is at least a 30-minute consultation. I'm in the university setting, so we can do that, but it usually takes longer than that. A little time investment early on will make it easier and more efficient later on. Just invest in that first visit primarily. I try to do 2 things. The first thing is that I want to confirm the diagnosis and to make sure mentally that I've gone through the steps and that I'm not anchoring. I want to just go through it even if it's obvious to make sure that they don't have CTCL [cutaneous T-cell lymphoma] or allergic contact dermatitis. Once I have the diagnosis right, then I want to see where the patient's understanding is—like if they're coming in with this agenda of, I want a cure. I need to know that. Usually, there's a tip. If they've seen 4 other dermatologists or they haven't been told that there's no cure for this. That's a really tough step. You have to build that rapport and let them understand that. Sometimes, it's challenging, or they've never been told that before. Once I understand where they're coming from and what their understanding of the disease is, then we can work from there together on coming up with a treatment plan, but that's my general approach.

Linda Stein Gold, MD: I agree with you. You have got to establish that trust and that relationship and let them know that we each have our part to do. You do your part as the patient; I'll do my part, but it really is a team approach. Ally, any other suggestions for a busy practitioner?

Alexandra Golant, MD: Yeah. Similar to Eric, I also practice in an academic setting, but the first visit, which I always call the “disease state”: sometimes disease state reeducation, particularly for patients that have had this disease for many decades, and bring them up to speed about how we view atopic dermatitis now as a systemic chronic inflammatory skin disease. That understanding and that acceptance, particularly for our systemic-eligible or our moderate-to-severe patients, makes a big difference because it helps them to understand why this visit's going to be different. We're not going to just talk about creams and ointments; we're going to talk about systemic treatments that we need to get you clear. The only other thing that I'd add on to that is goal setting and understanding what the patient's goals for their treatment are. Are you OK with having to use a topical sparingly? Do you want to be clear? Do you want to be completely free of it? Where is your goal, and how we can partner together to get you closer to that goal? How is it different than where I'm seeing you right now? Those are things that have been helpful to me, but the visits are lengthy. I completely agree with that.

Linda Stein Gold, MD: Raj, do you provide your patients with resources or handouts, or send them to the Internet? How do you end that visit or make sure that they have the information that they need?

Raj Chovatiya, MD, PhD: Sure. They could go Googling and find anything and everything about what you're going to talk about. Much like my colleagues have said, getting the information that you want in that first visit is key. There are a lot of good sources of reliable information out there. I like to review some of that with them. There are great resources through the National Eczema Association, the American Academy of Dermatology, and things that have been vetted by a variety of experts, patients, and caregivers themselves that I know and trust. I have my own handouts that I make for my patients. Something that providers can do ahead of time is to just come up with the bare bones, or to even fill that version of what you think the eczema action plan should be for your patients so you don't have to be writing this from scratch every time. Largely, there should be some editable areas for the things that you're going to be doing, but that's going to be the backbone of what you're talking about every time that they come back. The 1 thing that I tell my residents is that if you feel like you're repeating yourself at subsequent visits, you're doing a good job because this is a chronic condition. A lot of it just requires coaching and keeping up the spirits of dealing with the normal flares and remissions that come along the disease course.

Linda Stein Gold, MD: I agree with you. You can say it, say it again, and say it at every visit. Hopefully, at 1 point, they’ll actually hear you.

Transcript Edited for Clarity