Atopic Dermatitis: Patient Factors in Selecting Therapy


A brief review of patient and disease factors that inform selection of therapy for atopic dermatitis.


Lawrence Eichenfield, MD: Let’s move over to prescriptions. Lisa, when you’re figuring out what to prescribe, what factors do you consider?

Elizabeth Swanson, MD: Tons of things. First, the age of the patient, the extent of the atopic dermatitis, the areas of involvement, the overall severity of the disease, and the quality-of-life impact. I always use the analogy to acne. We’ve all seen the patient with mild acne who’s affected severely. That happens in atopic dermatitis too. It’s important to suss out previous treatments they’ve tried and failed, and then the patients’ or families’ desires and preferences for how they want to proceed with treatment. I often will say, “I’m the navigator, and you’re the captain. It’s my job to tell you which ways we can go. It’s your job to choose which way we head.” All those things bundle up to my decision-making process. Most commonly, I’m presenting them with a list of options of where we can go, and I let them steer the ship.

Lawrence Eichenfield, MD: Any other approaches?

Raj Chovatiya, MD, PhD: I like the idea of thinking about atopic dermatitis as not 1 specific thing that should determine severity in your mind, because there’s a whole host of patient and clinician factors that influence it. You can’t hang your hat on body surface area. You can’t hang your hat on looking in the flexures. You can’t hang your hat on how red or scaly it is. You can’t hang your hat on just itch and pain. The quality of life, burden of comorbidities, all this stuff. Often when I talk to my residents, I’m always asking, “What do you look at?” The answer is yes, we’d look at all these things when it comes to making a holistic decision and deciding the best therapeutic plan for a patient.

Lawrence Eichenfield, MD: If I can bring up a pearl, 1 thing I’ve learned is that in pediatric atopic dermatitis and with teenagers, there’s often a history of the disease that preceded the patient I’m taking care of. I’ve learned to ask about parental experience with atopic dermatitis, because sometimes the parent had atopic dermatitis. It’s increased in kids whose parents or siblings had atopic dermatitis. I do that for 2 reasons. No. 1, I’m trying to get a sense of their experience, but also sometimes they’re colored in terms of their perspectives on prescriptives, and I’d rather get that out there so I can deal with it if it’s a patient for whom nothing has ever worked. I need to know why it didn’t work.

I have patients who are loaded with concerns about topical steroid withdrawal syndrome. In pediatrics, it’s shockingly rare because we don’t use enough prolonged topical corticosteroids to have that. But if they’re that concerned, I’m going to need to put that into my management schema in terms of how I might use topical steroids and nonsteroids in regimens of care.

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Transcript edited for clarity.

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