Practice Pearls for the Management of Atopic Dermatitis


Alexa Hetzel, MA, PA-C; Lakshi Aldredge, MSN, ANP-BC, DCNP, and Matthew Brunner, PA, share practice pearls and clinical management tips for the care of pediatric patients with atopic dermatitis.

Melodie Young, NP: As we come to a close on this discussion, I sincerely appreciate all 3 of you taking your time to talk about atopic dermatitis; you’re all seasoned, work in well-known clinics, and are definitely leaders among your peers. Do you have any pearls, hints, words of encouragement, or topics that you’d say make sure you discuss with your patients and teach colleagues without your wealth of experience? Whether you’re talking about triggers, hints for adherence, or talking about all the features and facts associated with the disease. Everybody pick something and tell me the one thing that you must say, to make sure that these youngsters who don’t know everything, I know that I could pass along to them. Matthew, what would be your thing that you would tell new PAs [physician assistants] or colleagues who haven’t seen as much atopic dermatitis as you have?

Matthew Brunner, PA: I go back to the thing we learned when we were in our training: listen to your patient, they will tell you what’s wrong with them. Part of that is taking a good history, talk to them about their family, their personal history, things like asthma, hay fever, and sinus allergies. I always ask patients if pollen bothers them when the pollen season is bad. We have a terrible pollen season here in Georgia. I think those things help you. “Have other family members had rashes like you?” Talk to them about their experience. Sometimes the elderly patients have forgotten their history of childhood, but they’ll say, “I had a brother who had asthma.” Talking through those things and getting that history up front, that’s been the most valuable thing for me in terms of differentiating between a patient with atopic dermatitis and a patient who may just be having a single episode of eczema.

Melodie Young, NP: Alexa?

Alexa Hetzel, MA, PA-C: My big thing is, we just talked about the future of 2023 and all these exciting things, to not be afraid to have a low threshold for topical therapy. Because we just spent an hour talking about how eczema is a systemic disease, so you wouldn’t treat diabetes with a topical, you would treat diabetes with an oral therapy. That’s how we look at psoriasis, and that’s how we’re going to start looking at eczema. If somebody is not responding well with topical therapy, we need to discuss and educate our patients and their parents on what else is out there because we don’t want these patients to suffer, and they truly do suffer. Itch and infection are horrible, and constant antibiotics, oral steroids, and topical steroids are not good for our patients, and long term we know that’s not good as well. We have many safe options in the biologic space and potentially in the oral space such that we are OK to have a low threshold on when it’s time to get to that next level.

Melodie Young, NP: Perfect. Lakshi, what’s your pearl?

Lakshi Aldredge, MSN, ANP-BC, DCNP: My pearl, first, for NP [nurse practitioner] or PA colleagues who are novices, is to get excited about treating atopic dermatitis. It may not be the new sexy disease on the page right now, but it is a very rewarding career to treat these patients and become the expert in your clinic for managing atopic dermatitis. Your ability to transform patients’ lives, treat these patients, and see them grow and thrive is extraordinary. Feel comfortable with this disease, become involved in your national societies, go to meetings where there are atopic dermatitis experts lecturing, and become comfortable in your algorithm and in your treatment plan. There are many resources available for you with up-to-date information so that you can become comfortable and an expert in managing atopic dermatitis.

My pearl for [working with] patients is to teach them that you are excited about treating them. When I walk in the room with a new patient with eczema or even psoriasis, I tell them how excited I am that they’re here and that I’m going to be their partner through this entire disease. Then I ask them this pivotal question, “What is it about this disease that is keeping you from finding joy in your life or living your best life? If you give me time and your trust, I’m going to help you find that joy. I’m in this with you and partnering with you to help you live the best life that you can.” I think those are 2 important things that patients want to hear from us as dermatology providers and for us to recognize within our patients, that this disease can be consequential for them and their happiness, and their ability to thrive in their lives.

Melodie Young, NP: One thing I always think about that’s really important is to help them understand that it’s not their fault. There are triggers, we know it can be pollens, it can be animal dander. There are certain things that can trigger patients with atopic dermatitis that you might have some control over, but this is a disease. It’s a disease that involves a lot of components, a poorly functioning barrier, and an inappropriate cytokine response to triggers, but it is a disease. It’s not their fault, so they must understand that they’re not doing anything wrong.

For my colleagues, I would say practice evidence-based medicine, don’t get caught up in people saying, “But if I don’t eat this, or I use this CBD [cannabidiol] oil, or I use whatever, I’m a little better, or this helps.” They’re searching, and you have to say, “Look, here’s the deal, I know a little about that, but I can tell you what the science and the evidence say.” We’ve got excellent data now that explain what this disease is, what’s going wrong, and how these medicines are specific to try to treat it. So know your medicine. If you’re going to prescribe it, and diagnose and treat these patients, medicine is a wonderful thing, so make sure you really understand that.

Thank you for this insightful discussion and thank you to the audience for watching this HCPLive® presentation with Alexa, Matthew, and Lakshi. I hope that you have learned something and that you will take this information to heart the next time you see a patient and you start thinking this child could have atopic dermatitis. As Alexa says, have a low threshold for moving along and getting them pediatric-approved therapies and get them going. You’re going to change some lives and be heroes to these patients, and really make a big difference. Thank you.

Transcript edited for clarity

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