Flare-Ups in Atopic Dermatitis

Lawrence F. Eichenfield, MD: Jeff, from a pediatrician’s perspective, give us a sense of what triggers you think are causing flare-ups in your patients. What’s your sense of underlying inflammation without visible skin lesion?

Jeffrey M. Bienstock, MD, FAAP: There are many triggers. Some of this depends upon where you live. Where you are in San Diego, the weather is pretty temperate. It’s not really cold. It’s not really hot. That’s why your skin always looks so well.

However, you take care of patients who have poor skin. We know foods play a big role. A lot of children we’re starting on some highly allergic foods at 4, 5, or 6 months of age are starting to show signs of atopic dermatitis, whether the allergies are to eggs, nuts, peanuts, soy, or milk. That plays a big role.

Stress in some of the older children can play a role. Detergents can be a big factor as a trigger. Lisa Swanson mentioned good skin care. It’s important to make sure we’re not using anything that’s too harsh in detergents. It’s wonderful when I get samples of certain products to use in the laundry. I can bring it home to my children to use who have suffered and to my granddaughter who is suffering as well. Those scented products sometimes are really bad. 

Fabrics are also important. We know about wool and synthetics and trying to keep these kids on cotton. Airborne allergens can play a role. Of my older children in the practice who have the triad between asthma, allergies, and atopic dermatitis, many of them could be sensitive to dust and dust mites. I’m worried about skin infections. They can play a big role. I’m sure you’ll talk a little about that as well. Hormonal imbalances can sometimes play a role.

I see a lot of babies drooling with saliva all over their cheeks and how that turns their skin red, itchy, and weepy. It’s almost hard to look at from a pediatrician’s perspective. If we could do something about that, then the grandparent will be happy.

Lawrence F. Eichenfield, MD: The cheeks are a high-traffic area. Jeff, you did a great job listing so many things, which shows why it’s so complex. While Peter Lio was saying we’re so far ahead in 1 element in terms of our new interventions and biologic agents and other topical and oral JAK inhibitors coming down the pike, when it comes to understanding triggers and necessarily identifying them, it’s very tricky.

Even in San Diego, where you’re saying we have temperate weather, I have a picture of 1 of our weather people pointing out that in a community that’s close to the water, it was 42% humidity. Then 20 minutes away, it was 10% humidity. That probably matters if you have skin that’s sensitive to varying humidity. If you have skin that’s compromised, it’s probably another stress.

Jeffrey M. Bienstock, MD, FAAP: I wrestle with this with parents who have young children or infants about what the temperature and ambient humidity should be in their house. This has been a somewhat unusual winter in the Northeast with the amount of snow and cold weather. I’m telling the father, who’s trying to save money on heat, but then the mother may think it should be warmer. The grandmother is in the background as well. A lot of this is before COVID-19, when we had the whole team of parenting with us. It makes it very hard. In my mind, it’s a key factor to try to get those parents to understand how important the ambient humidity and temperature is.

Transcript Edited for Clarity