Optimizing Treatment of Pediatric Atopic Dermatitis - Episode 4
Lawrence Eichenfield, MD: Who’s taking care of the patients, and at what point do the patients typically seek care? Start with the question at what point do they seek care, and then who are they seeking it from? Is there a prolonged duration without care? Does that differ with different severities?
Fred Ghali, MD:For the mild patients who are maintained with just over-the-counter regimens, they will probably continue that at home. For patients who may have more mild to moderate, moderate to severe disease, they see us out of frustration. They’re frustrated with the options. They’re really tired of seeing their child itch all night. We’ve talked about the impact of quality of life, sleep, and school performance. This is what usually brings them in to seek care for their children when they see that the over-the-counter regimens are not quite adequate for their child.
Lawrence Eichenfield, MD: Peter, do you want to comment on who’s diagnosing and treating patients? Do you see patients with prolonged duration without adequate care?
Peter Lio, MD: Yes. We like to think that dermatologists and allergists are the atopic dermatitis specialists. We are the ones to see them, but we know we are outnumbered quite a bit. In many communities, there are simply not any dermatologists or allergists who can help. When I talk to people from around the country they say, “We do have a dermatologist somewhat nearby, but they’re only seeing adult patients,” or “They’re doing only surgical stuff, so they’re not accessible.” When you look at it from a population standpoint, it’s almost exclusively treated by primary care physicians and pediatricians. They really bear the burden, and we rely on them to pick those patients where they’re having trouble, where they are not getting the gains and improvement they expect, and then refer them appropriately, but that doesn’t always happen in my own practice. I’m sure for all of us, we have many patients who come in really frustrated. They feel hurt, they feel burned by the medical system, and they’ve sometimes seen multiple people. But they really haven’t gotten the correct answer, or at least been able to sit down for a very frank discussion. It’s tough. There’s a lot of burden.
Lawrence Eichenfield, MD: One of the takeaways I’d want for people in the primary care communities, such as pediatricians and family care doctors, is that we do have better tools to manage the disease now, and we want them to help change parental and patient expectations, so that their disease can be managed effectively. I have a lot of patients come in who I call train-wreck patients with eczema. They come in in terrible shape, and Peter will reflect, they just got turned off from the system, or they got scared from topical steroids because they were uncomfortable with the regimen. They wanted to know what the cause was. No one explained it to them, at least to their understanding, the particular cause. They think there’s something they’re allergic to, and they just have to find it. The point is, if those patients are out there now, it’s a great time to send them to your local specialist, dermatologist, or allergist because our management options are much greater, and we can get better outcomes. Fred, do you see patients who you would like to have seen a year or 2 earlier?
Fred Ghali, MD:For sure. Access to care is our biggest obstacle, and I wish we could help identify those patients. That way, the pediatrician or the primary care provider can call us and let us know that this patient needs to get in earlier, especially for that moderate to severe patient population. That’s our biggest obstacle.
Lawrence Eichenfield, MD: The issue with primary care is not diagnosing atopic dermatitis. I would say it’s identifying the more persistent, severe patient. Elaine, do you agree with that? Do you think it’s good verbiage?
Elaine Siegfried, MD: Absolutely. We know from claims data analysis that the great majority of patients with atopic dermatitis never see a specialist—not an allergist, not a dermatologist, often not a pediatrician. A lot of this disease is being taken care of on the fly because of the flares. People seek urgent care centers or maybe emergency departments. They see people they’re not used to seeing all the time, and it’s a chronic disease. It’s really important for everyone who sees these patients to really know that we can do better. Sometimes it’s not that hard to do better. You just have to understand what the principles are.
Transcript Edited for Clarity