Special Report: Practical Communication Strategies for Skin Pain in Atopic Dermatitis

Eliciting accurate information about skin pain in atopic dermatitis requires more than a generic symptom checklist.

In this video, Andrew Mastro, MS, PA-C, describes a deliberate approach to patient interviewing that normalizes skin pain and invites deeper reflection on its impact. Rather than asking, “How are you doing?” he begins by explaining many individuals with eczema experience more than itch and then asks directly whether the skin ever feels painful. He supplements this with targeted questions about pain location (surface vs deeper), functional limitations, and activities patients avoid because of discomfort. This structured yet conversational approach can be particularly valuable for populations less likely to report pain, such as male patients, or those who have never had their symptoms framed as “pain” rather than a routine itch.

In this video, part of a 6-part Special Report series on switching therapeutic classes in atopic dermatitis, host Mona Shahriari, MD, reflects on how her own patient interviews have evolved with the expansion of targeted therapies. She notes in the pre–biologic and pre–small molecule era, clinicians often limited follow-up to a brief assessment of “Is it better?” without probing specific symptom domains. Now, with more nuanced treatment options, both she and Mastro emphasize the importance of asking about burning, soreness, and other qualitative descriptors of skin pain, as well as using multiple adjectives so patients can better recognize and articulate their experience. Shahriari underscores patients do not always know which symptoms are relevant to report, making clinician-led inquiry essential.

The discussion also highlights a broader mindset shift: moving from viewing “eczema in room 8” to viewing “a person with eczema in room 8.” Mastro describes consciously referring to patients by name rather than diagnosis to counteract dehumanization in busy, high-volume settings. He teaches trainees to see each visit as an opportunity to connect emotionally, not just clinically, and to avoid skipping deeper questions during seemingly “routine” biologic or small-molecule checks.

Relevant disclosures for Shahriari include AbbVie, Apogee, Arcutis, Bristol Myers Squibb, Dermavant, Galderma, Incyte, Johnson & Johnson, LEO, Lilly USA, Novartis, Regeneron, Sanofi-Genzyme, Takeda, UCB, Pfizer, and others. Mastro has no relevant disclosures to report.

References:

Silverberg JI, Gooderham M, Katoh N, et al. Combining treat-to-target principles and shared decision-making: International expert consensus-based recommendations with a novel concept for minimal disease activity criteria in atopic dermatitis. J Eur Acad Dermatol Venereol. 2024;38(11):2139-2148. doi: 10.1111/jdv.20229

Silverberg JI, Bunick CG, Hong HC, et al. Efficacy and safety of upadacitinib versus dupilumab in adults and adolescents with moderate-to-severe atopic dermatitis: week 16 results of an open-label randomized efficacy assessor-blinded head-to-head phase IIIb/IV study (Level Up). Br J Dermatol. 2024;192(1):36-45. doi: 10.1093/bjd/ljae404