Expert Perspectives in the Management of Atopic Dermatitis in Skin of Color - Episode 15

Final Thoughts on the Management of Atopic Dermatitis in Patients of Color

Andrew Alexis, MD, MPH, FAAD: Let’s go around and share some final comments about atopic dermatitis in skin of color or in general. Let’s start with Jamie. Any parting thoughts?

Jamie Weisman, MD: I’d like to just build on what you said earlier about underrepresentation in the clinical trials. That is something that we have to pay attention to. For skin of color, of course we’ve been talking a lot about the Black community, but that also represents Asian, Southeast Asian, Euro-Asian, Latino. We want all these people in our clinical trials because we want to drill down on the genesis of their disease, challenges in treating their disease. I echo Heather’s encouragement of being in clinical trials.

People who have insights and who come from those communities should investigate getting involved in clinical trials. Language can be a barrier, and not just Spanish and French but languages from other areas of the world. We need representation in academics so we have people who can speak the language and explain the consents because it’s highly regulated, but also, we need representation from the patients.

Flipping back, my final word would be that it is so gratifying to treat atopic dermatitis, both in children and in adults. A story I frequently tell from 1 of my dupilumab clinical trials was of a woman who had incorrigible atopic dermatitis since babyhood. Her mother had wrapped her and had splinted her arms so that she couldn’t scratch all night. This woman was in her 60s, and she had been on multiple systemic medications, UV [ultraviolet] light therapy complicated by skin cancers and infections. 

When she finally got better in this clinical trial, when she finally could have a good night sleep, she was so excited that she could use shampoo that had any fragrance in it. She brought her mother from the nursing home to thank us. It was a high point of my medical career, and I’m not sure I deserved credit. Dupilumab really deserved most of the credit, but it was etched in my memory as the kind of thing that you go into medical school to experience. 

I have colleagues who do primarily different forms of dermatology, but those of us who do medical dermatology get to have moments like that, and they’re priceless.

Andrew Alexis, MD, MPH, FAAD: Great story. Thank you for sharing that. Candrice, final words?

Candrice Heath, MD: I just want to emphasize that if you have patients who have skin of color, and they have itching and chronic rash, even if they have itching and you’re not able to see a rash, we definitely welcome all physicians, primary care providers, nurses, nurse practitioners, physician assistants, emergency medicine— whatever your specialty—to consider referring those patients to a dermatologist. As you’ve learned through this program, they can be some of the most severely affected, and we have to think about this as a chronic conditions.

The reason I bring up the entire house of medicine is because atopic dermatitis requires teamwork. We think about the teamwork between the dermatologist or the physician and the patient, but teamwork also involves the caregiver. It also involves the other loved ones of the patient who has it. It involves their school. Atopic dermatitis can send ripples through someone’s entire life, and we have to work as a team to get the patients to care, encourage them and also definitely let them know that we know how they’re feeling. We understand how it feels and how this is impacting you. Just by saying that out loud, you can start a conversation with that patient and their family. They will be so grateful that you have taken the time to really understand what it’s like to have atopic dermatitis.

Andrew Alexis, MD, MPH, FAAD: Great. Thank you, Candrice. Heather?

Heather Woolery-Lloyd, MD: I would echo what Jamie and Candrice said. This whole meeting is about skin of color and atopic dermatitis, and the biggest take-away is that we really need to address the fact that this is much more common and much more severe. As caregivers, as clinicians, we should not be scared of being aggressive. Aggressive meaning me using a higher-potency steroid. Don’t be scared to use it because that patient may really need it. Or using a systemic agent, because as we’ve heard, it can have a tremendous impact on the quality of life. 

The key take-away is know that in skin of color, atopic dermatitis is more common and more severe, so don’t undertreat it.

Andrew Alexis, MD, MPH, FAAD: Great point, Heather. Great points from all our panelists. I will just reemphasize and add a comment or 2 to those very insightful closing remarks. I’ll start where Heather left off about the importance of avoiding undertreatment.

The real key to optimal outcomes in the management of atopic dermatitis, particularly in skin of color, is early diagnosis and effective, longitudinal management of the disorder. Moving away from episodic flare management by putting out fires, which contributes to not only a very poor quality of life for the patient but also in the patient of color to those pigmentary sequelae. Because if the underlying inflammatory condition is not well controlled, guess what? You’re going to get new areas of hyper- and hypopigmentation and keep cycling with new inflammatory lesions, leaving postinflammatory lesions and basically creating an existence for the patient in which they’re constantly battling 1 or the other or both at any given time.

Thankfully, we have the tools to efficaciously and comprehensively manage our patients with atopic dermatitis over a long period of time using agents like dupilumab, topical crisaborole, our topical calcineurin inhibitors, and so on. Let’s not forget the nonpharmacological strategies that we talked about: moisturization and bathing practices and some lifestyle modification.

This is a very exciting time to be managing patients with atopic dermatitis because we have so much to offer and, as we all know, the pipeline is rich as well. In the coming years, we will certainly have a lot more to offer too. 

With that, I’d like to thank you all for watching the HCPLive® Peer Exchange. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming Peer Exchanges and other great content in your in-box. And a special thank-you to our panelists, Dr Woolery-Lloyd, Dr Heath, and Dr Weisman. Thank you for sharing your insights. It’s been wonderful having this conversation with you.

Transcript Edited for Clarity