Managing Patients With Atopic Dermatitis—Key Talking Points, Action Plans, and Shared-decision Making
In this Roundtable Wrap-Up, we offer an abbreviated version of the roundtable discussion on the evaluation, treatment, and management of patients with moderate-to-severe atopic dermatitis (AD).
For more expert insights, watch the full Multidisciplinary Roundtable.
The content below has been edited for space and clarity.
Robert Sidbury, MD, MPH on the key talking points for discussing mild AD with parents
I always talk first and foremost about good skincare. Moisturizing is key. I don't stress too much about the frequency of bathing. I advise parents to keep the bath simple—not too hot of water and not too long. Just 5 or 10 minutes. But most importantly, moisturize immediately afterward, within a few minutes, whether they bathe once a day or once a week.
Jason Caldwell, DO on topical steroids vs non-steroid topicals for children with mild AD
I rarely use non-steroid topicals. Some of them can sting and children don't like it. Correct use of topical steroids along with the moisturization regimens that we provide in our action plans seem to be just fine and are tolerated very well with low side effects.
Dr Sidbury on ways to mitigate stinging for children treated with non-steroid topicals
There is no question that some non-steroid topicals can sting and that can be a barrier to their use. We have ways to mitigate that, such as treating the active inflammation with the steroid and getting it better first. If the rash is just starting to come back and you need a non-steroid, use it then because things sting less on less inflamed skin.
Steven Feldman MD, PhD on the need for standard written action plans for patients
Between the moisturizing, the bathing recommendations, the use of steroids, and the use of non-steroids, the regimens get pretty complicated.
Dr Sidbury on what to include in your action plan
What the patient is presenting to you in the clinic that day is not necessarily what they'll be presenting at home tomorrow. And so you need to have an action plan that matches both the mild end of the spectrum and the more severe end of the spectrum for that individual patient, whatever that may be.
Dr Caldwell on working patients and being open to different approaches
We have an action plan, but I also make sort of a verbal contract with the patient (or parent/guardian) to do it for at least 4 weeks. And if they're no better, then we can adjust our plan. If I get buy-in with that, then I think we could have some success.
Dr Sidbury on the differences between treating patients with mild and severe AD
When I was talking about the mild end of the spectrum, it’s focusing more on irritancy and things like wool fabrics that are just scratchy feeling, rather than a true allergy. But for severe atopic dermatitis, now we're talking about leaving no stone unturned. We consider using topical steroids, incorporating bleach baths or wet wraps, phototherapy, or the systemic medications such as the older school medications like methotrexate and cyclosporine. We also consider using newer medications that are now FDA approved down to 6 months of age like dupilumab. We would then talk about these options and through shared decision-making, try to match the patient with the best therapy.