Expert Perspectives in the Management of Atopic Dermatitis in Skin of Color - Episode 3
Andrew Alexis, MD, MPH, FAAD: We know from multiple studies that there’s an increased frequency of sleep disorders, anxiety, and even depression among patients with atopic dermatitis [AD] compared to the general population.
How big of a problem is sleep disruption in your experience, Jamie? Are you seeing that a lot in your patients?
Jamie Weisman, MD: Oh, absolutely. I also do clinical trials. I remember in one trial with this child, you were supposed to draw on the scale of 0 to 10 with how much sleep are you losing and how much itch. This one child couldn’t put it on the scale. He was so honest, I appreciated this. He would just draw over here, and I would say, I really need it in these lines. He was adamant that these lines were not going to capture the degree of sleeplessness and the amount of itching that he had. And this broke my heart because that same child, his mother was pregnant. He said, “When I say my prayers, I pray the baby doesn’t have what I have.” If that doesn’t make you cry, I don’t know what will. It articulated so powerfully to everyone in the room what effect this was having on this child.
We need to get the children and the parents, and—for lack of a better word—stakeholders involved in understanding and agreeing to a treatment pattern. Kids are honest. I remember when I was a resident, the pediatric dermatologist would insist that we let every child try all these samples. Because she said, if you put something on them that stings, they’ll never let you do it again. Adults may brave it up, but kids are honest. They don’t want to be in pain.
Andrew Alexis, MD, MPH, FAAD: True. Does anyone else have anything to add about the quality of life impact of atopic dermatitis?
Candrice Heath, MD: Yes, I definitely want to add school. A big part of what a child does is that they attend school. Well pre-pandemic, they attended school. I would often hear reports of, “Oh, the child is very fidgety and they can’t keep still. Do we need to work them up? Do they have attention deficit [disorder]? What’s going on?” I take the time to speak with parents to see how school is going, if there are any issues, and have the parents pay attention, especially for the elementary students. Do they come home in the same clothes that you sent them to school in? Notice if all of a sudden they are removing everything with tags, with wool, or anything that triggers itch. It helps the parents to be able to plan.
Also, speak with the child’s teachers so that they understand atopic dermatitis, allowing the children to apply a moisturizer while at school and how critical that is. It can definitely make the difference between an inattentive, very itchy, fidgety child and one who feels a little more comfortable in their skin.
Andrew Alexis, MD, MPH, FAAD: Indeed. It’s been shown that the degree of disease control, so well managed AD, while it still has a tremendous impact on quality of life, will have a less severe impact than poorly controlled AD. It speaks to the importance of ongoing and effective longitudinal management. And we’ll talk about therapy later on in the program.
Transcript Edited for Clarity