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In this interview, Dr. Yu explains several important pieces of information regarding atopic dermatitis that he believes clinicians should be aware of.
JiaDe (Jeff) Yu, MD, MS, spoke with the HCPLive editorial team about several important aspects of current treatment of atopic dermatitis (AD), in honor of October being Eczema Awareness Month.
Yu is a board-certified dermatologist and pediatric dermatologist at Massachusetts General Hospital, in addition to being a Society for Pediatric Dermatology member.
“Atopic dermatitis continues to be a heavily burdensome disease for our patients, especially about 20% of the country as well as the world have atopic dermatitis,” Yu said. “It tends to affect children a little bit more than adults and it tends to present usually before the age of 5. So a lot of the patients that I see our kids who are coming in with either atopic dermatitis for the first time or have had atopic dermatitis for a long time, that is now flaring.”
That being said, Yu noted that in the last 20 years or so, the treatment paradigm for AD has rapidly shifted from a more broad strategy of putting on emollients, topical steroids, other topical treatments, and even light therapy to much more targeted treatments.
“So if we were to get atopic dermatitis at any point in the last decade or two decades or so, now is probably the best time to do it,” Yu said. “Because we've never seen the number of choices and the number of therapeutic options that we have to provide for patients. So it's an exciting time to be in that field and be able to offer these to our patients.”
Yu added that everybody experiences their AD differently, depending on the patient.
“I think for us clinicians, it's hard to look at you and say, ‘Well, you are experiencing it more or less than the next person,’ just because of certain clinical features that we see,” he said. “I think everyone has unique perspectives. Everyone has a unique day-to-day life, the things that they deal with, and eczema can affect them differently. Whether it's going to sleep, whether it's going to school, whether it's affecting personal relationships, I think everyone's perspective is probably more important than what I see, clinically.”
Yu added that one of the most important questions to ask one’s patients is how much does their eczema bother them and exactly how it bothers them.
“Because maybe they might look like they have a little bit of disease manifesting on the skin,” Yu said. “But in terms of psychosocial effects or just the daily quality of life, if it affects them in a great deal, I think those are the patients that you are going to be slightly more aggressive in terms of offering different types of treatment options, versus the person that maybe says, ‘My eczema bothers me just sometimes, I scratch here and there, but nothing that a little bit of topical moisturizer or topical medication can’t do.’ Even though they might look like they have a bit more disease, they might not be the right person for that stronger systemic treatment that we may be offering patients who are more heavily affected.”
Yu stressed the importance of getting the patient's perspective, whenever dermatologists are coming to a decision about what the treatment is. He added that this kind of joint decision making is important.
Later, Yu was asked about what key messages or resources clinicians could share with their patients and the broader community to raise awareness.
“Number 1, I think all patients who are patients with eczema, who are perhaps seeking more treatments should see a board-certified dermatologist who may be most aware of the different types of treatments that are currently available,” Yu said. “Whether it's coming from topicals or systemics, associated factors, and just a lot of a lot more skincare recommendations that we can perhaps provide to the patients.”
Yu added that access is an issue when it comes to dermatologists, but pointed out that efforts to reach out and see if clinicians can find a dermatology colleague who will be able to see those who are experiencing flares.
“I have heard many patients stories of people who are just floundering with their current disease,” he said. “They bounce from urgent care to the IDI to primary care doctors to whoever who had less expertise in terms of treating the disease, and then they are going on recurrent courses of oral prednisone or inappropriately using topical medications, but just not really getting their disease state under control.”
For further information from Yu’s discussion, view the full video segment above.
The quotes contained here were edited for clarity.