Managing Pediatric Patients with Atopic Dermatitis; Most Patients Do Not Outgrow the Disease

Austin physician Lucia Diaz reviewed management of atopic dermatitis (AD) with an emphasis on pediatric management. AD is the result of a skin barrier dysfunction and immune dysregulation that presents within an inflammatory loop. Up to 15% of children in the U.S. and 7% of U.S. adults suffer from AD. While the majority of patients will have disease improvement with time, most patients do not outgrow AD with persistence of disease in up to 80% of patients. Dr. Diaz reports she finds AD patients as a rewarding challenge where a provider can make a big difference in the quality of life of patients. A holistic approach to AD patients and their families was encouraged, which incorporates the evaluation of parental concerns, triggers, skin care and medications, comorbidities, history of infections and hospitalizations and patient and family quality of life.

COVERAGE: SDPA Annual Summer Dermatology Conference, June 16-19, 2022, Austin, Texas

Echoing other presenters at the SDPA’s Summer Conference, it is imperative to evaluate what information and misinformation families may have about atopic dermatitis and treatment options. After careful review of the AD patient’s history, the clinician should perform a detailed evaluation of the disease distribution and clinical findings. Dr. Diaz reminded attendees the presentation of AD in people of color can vary. Patients of color may present with more hyper or hypopigmentation and more follicular prominence. Additionally, evaluating erythema in skin of color can be more challenging. She encouraged the use of scoring scales to document disease severity and impact, frequency of flares, pruritus ,and sleep as well as progress with treatment.

When tailoring treatment for the AD patient, it is important to review expectations of the patient and their family and explore adherence barriers. It is best to approach with simplicity and show families how to use prescribed medications in the office. Dr. Diaz reports she uses an eczema action plan, has patients return for frequent appointments, and reviews with patient’s families what to do when patients get “in trouble” or when their disease flares. All treatment plans should share the goal of prevention of ED visits and control significant cost to the healthcare system and families.

Dr. Diaz reviewed step-up treatments, newer topicals, and new and old systemic medications for the AD patient. When prescribing topical treatments, it is important to utilize body surface area equations to ensure proper dosing. Systemic treatment is an appropriate next step when topical aggressive treatment is not adequately controlling disease. Dr. Diaz presented a comprehensive review of the use of the immunomodulator, dupilumab, for the treatment of AD, which is now approved in patients six months and older. When initiating treatment, patients and families should be adequately prepared to expect treatment for 1 to 2 years before spacing out dosing or stopping the medication. Benefits include a decrease in inflammation and incidence of staph aureus, help with control of patient’s asthma, improvement of the epidermal barrier, decreased pruritus, and a response within weeks.

Byline: Sarah B.W. Patton, PA-C

Pictured: Lucia Diaz, MD, Dell Medical School