Collaborative Management of Atopic Dermatitis - Episode 5

Diagnosis of Atopic Dermatitis

January 27, 2021
Lawrence F. Eichenfield, MD, Rady Children’s Hospital-San Diego

Rady Children’s Hospital-San Diego

Jeffrey M. Bienstock, MD, FAAP, PediatriCare Associates

PediatriCare Associates

Peter A. Lio, MD, Northwestern University Feinberg School of Medicine

Northwestern University Feinberg School of Medicine

Elizabeth A. Swanson, St. Luke’s Children’s Hospital

St. Luke’s Children’s Hospital


Peter A. Lio, MD: As a dermatologist and someone who’s really focused on atopic dermatitis, I would love to think that I could help take care of everybody. But the truth is that I take care of a tiny fraction of the patients. The bulk of the work is done by primary care physicians, pediatricians, and family practitioners. Because it’s such a common disease, and there are so many patients with it, dermatologists are a tiny group and often not very accessible. I’m sad to admit that. Many times, I’ll be speaking to different groups of doctors and they’ll say, “We would love to send patients to a dermatologist, but it’s a 6-month wait.” Or even worse. Sometimes they’ll say, “Oh, the dermatologist in our neighborhood or in our community doesn’t see kids. They really focus on adult issues and skin cancer, things like that.”

It can be difficult, and that’s why it’s so important that we empower our primary care physicians and practitioners with the right skills, so they can feel comfortable doing it, because they ultimately have to do it. Overall, they’re doing a really good job, but it’s a difficult disease even with all the right tools. Many times, I think, “They’re left wanting for new ideas, new approaches, and a streamlined way to treat the disease and manage it because they have a lot of other things on their plate.”

In general, primary care practitioners do a very good job of taking care of these patients and getting them to specialists when they need, there’s no doubt that sometimes it can be really difficult for the proper triage to happen. Sometimes misdiagnosis and undertreatment in particular can be a real problem. I find it difficult to treat still, and this is my main focus and what I’ve devoted more than 10 years to studying and working on. If I think it’s difficult, you can imagine that for someone who’s dealing with a whole bunch of other problems and has to keep up in a whole bunch of different areas in medicine, this is going to be that much harder.

There is the potential for trouble if we don’t have the proper support and educational backup mechanisms for our primary care physicians, who are truly on the front line.

Transcript Edited for Clarity