Practical Management of Atopic Dermatitis: Nurse Practitioner and Physician Assistant Perspectives - Episode 16

Atopic Dermatitis: Counseling Patients About Their Disease

September 11, 2021
Melodie Young, MSN, RN, ANP-C, Mindful Dermatology and Modern Research Associates

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Douglas DiRuggiero, DMSc, PA-C, Skin Cancer and Cosmetic Dermatology Center

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Keri Holyoak, PA-C, MPH, Dermatology Center of Salt Lake

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Susan Tofte, DNP, MS, FNP-C, Oregon Health & Science University

Strategies that can be used by healthcare professionals to help address patient concerns around atopic dermatitis.

Melodie Young, MSN, RN, ANP-C: Let’s focus on adequately addressing the inflammation and all of the other complexities that you need to in that visit, when you’re talking about sleep and the mental health that you were talking about with that person, and then the education.

Douglas DiRuggiero, DMSc, PA-C: There is a lot to have to go through, so it’s really not my goal to go through all of it in a first visit, or in just 1 visit. I’ve learned that, at least in my practice, there is a concept of progressive revelation. You can overwhelm the patient by saying, “You know that you’re going to get skin infections, and you’ve got a higher chance of having molluscum [contagiosum], and you could have warts, and now we’re finding out these other comorbidities.” We need to get people in touch with an organization like the National Eczema Association, and train your staff to be an extension of you because the nurses stay in the rooms afterward, and they can follow up with patient education. You have to address each patient visit a little differently. This is the art of medicine, and it’s hard to tell someone who’s brand new in dermatology and seeing their first patient with atopic dermatitis, these are the 5 points you must hit every time. The big points are giving them hope, finding out how this disease affects their life, asking those questions, finding out what kind of things they would like to do if their skin were clear, and then letting that guide in your decision-making process on which therapy it is. Even if that therapy ends up starting off being topical only, I always introduce the idea and let them know there may be things beyond creams that we may consider in the future.

I’m always planting seeds for the next visit to talk to them about this disease. I try to emphasize that this is not just a disease that you see on the surface, but there’s more going on underneath the surface, and we’re learning about that right now and we may want to address those issues. If it’s an adult, I’m making sure that they’re seeing their primary care physician and doing their routine annual examinations and blood work, because we know that some of these other things may be cropping up because of this. I’m making sure my [pediatric patients] are keeping up with their vaccination schedule so I have options in the future, that parents are doing that and getting back to their pediatrician. The key is being a hope giver, a good history taker, and a good options presenter. If you approach it with that mindset, I think you’ll have patients who will be loyal to you and will trust you.

Melodie Young, MSN, RN, ANP-C: It’s going to be a challenge for us with so many new therapies to learn about in the next couple of years and try to have that evidence to guide them through that decision process.

Douglas DiRuggiero, DMSc, PA-C: For folks who have not been in practice for as long who listen to this, it’s not beyond you. That’s one thing we want to leave everyone with. We thought that we’d be too overwhelmed in the psoriasis world with 11 biologics, but we now know that we can manage that and we’re capable of managing those things, and it’s important for us to take the time. Just like sprinters practice running all week long, this is our profession. Let’s take some time to participate in these events and read journals and keep up with things, but it’s worth the effort because you can see the lives of your patients change because of it.

Melodie Young, MSN, RN, ANP-C: Thank you for watching this HCPLive® Peer Exchange. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming Peer Exchange segments and other great content right in your inbox.

Transcript Edited for Clarity

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