Optimizing Treatment of Pediatric Atopic Dermatitis - Episode 2
Transcript: Lawrence Eichenfield, MD: I want to discuss the quality-of-life impact on parents and caregivers of pediatric AD [atopic dermatitis], specifically the issue of sleep disruption. Obviously, for the rashes of atopic dermatitis, the pruritus of atopic dermatitis, and the secondary infections of atopic dermatitis, sleep disturbance is a huge thing. We discussed some of the comorbidities, but we haven’t mentioned asthma, which is 1 that develops as well. A lot of ocular disease, which we’ve come to recognize more than in the past, that include conjunctivitis, keratitis as well as keratoconus are pretty common, especially in those patients who are really quite allergic. The sleep disturbance stuff is fascinating. There were 2 particular studies that were really good. We had a variety of nice studies that looked at individuals over time and the quality of their sleep that showed tremendous sleep disturbance in atopic dermatitis. And then there were these 2 large studies that were published in 2019 by Faustine Ramirez at UCSF, where they did these big data sets. They showed an incredible amount of sleep disturbance and impaired sleep. Poor-quality sleep is 50% more common in patients with eczema than patients without atopic dermatitis.
Then they did a second look. They were looking at maternal exhaustion, and the data were pretty telling. Basically, they showed that the sleep disturbance is a family affair, that it’s not just the patients who have it, but it’s the moms as well, and the maternal sleep disturbance went on until the kids were age 11 years. So it’s not just younger kids climbing into bed, or being up at night who were keeping them up. Obviously the psychosocial impact isn’t just on the individual; it’s on the parent as well. Psychosocial impact of the disease, anxiety, and depression. Something that we’ve really got to recognize a lot, even more so in the last few years. I’ve seen that in my practice, I ask a lot more about depression, as well as the data on ADHD [attention deficit hyperactivity disorder]. There was a real nice data set showing the impact on life. Anything I forgot, or anything that anyone wants to augment about disease impact?
Elaine Siegfried, MD: Practically speaking, 1 of the easiest things to monitor is actual sleep. Onset of sleep latency, and then how many times a night are they waking up, and then how many nights a week? Oftentimes, people don’t remember that impact as you treat them. As their disease improves, you can follow that. It’s a really easy parameter to measure.
Lawrence Eichenfield, MD: Your outcome should be minimal rash, minimal symptoms but also minimal sleep disturbance or no sleep disturbance.
Peter Lio, MD: I’m so glad there’s renewed interest in looking at the caregivers, but it ripples out even further. Not only the direct caregiver but the rest of the family, the social circle, and sometimes even school and work are all affected by absenteeism, presenteeism, and all these pieces of the puzzle. When you get somebody better, you watch all the pieces settle in all the way around them. There is quite a radius around it.
Lawrence Eichenfield, MD: That’s probably a good way to end our review of atopic dermatitis. Thank you.
Transcript Edited for Clarity