Understanding The Heterogenous Nature of Atopic Dermatitis

This Dermatology Times Expert Perspectives series delves into the multifaceted landscape of atopic dermatitis (AD) care and treatment. Through interviews with 4 leading dermatologists, this series explores key benchmarks, emerging trends, personalized medicine approaches, long-term safety considerations, and the integration of novel therapies in the management of AD. Each episode provides valuable insights into navigating the heterogeneity of AD presentations, selecting appropriate treatment plans tailored to individual patient needs, and incorporating the latest guidelines from the American Academy of Dermatology (AAD). From discussing the nuances of patient education and shared decision-making to addressing the intersection of comorbidities with AD management, this series equips dermatology clinicians with the knowledge and strategies necessary to optimize patient outcomes and enhance the quality of care.

In this episode, Mark Lebwohl, MD, dean for clinical therapeutics at the Icahn School of Medicine at Mount Sinai in New York, New York, emphasizes the importance of considering various factors, including severity of itch and interference with sleep, when determining treatments for patients with AD, even with presentation may not include typical symptoms.

Episode Transcript

Lebwohl: AD is a heterogeneous group of diseases. Now that we have treatments, we know how heterogeneous it is because all of the conditions that are part of what has been called the atopic complex, are treatable with medications like IL-4 and IL-13 inhibitors. For example, idiopathic pruritis responds beautifully to an IL-4 blockade. Nummular eczema, hand dermatitis, dyshidrotic eczema, and prurigo nodularis are all manifestations of this heterogeneous group of diseases that we call AD.
When managing AD, it's very important to look at a number of factors such as severity of disease. If it is extensive, topical therapy is not going to be adequate. If it is severe and not responsive to topical therapy, then of course, it would be. So, severity of disease is one of the most important factors.
There are a number of other factors that have to be considered. I always ask the patient if they get worse in the summer or the winter. So turns out many patients are worse in the wintertime. And for them, things like humidifiers. moisturizing, and reducing excessive bathing might be helpful. In the summertime, sweat is usually an exacerbating factor and air conditioning is important. So all of those factors have to be considered when taking care of patients with AD. Severity of itch and interference with sleep for example, is another important factor. If a patient is itching so severely that they can't sleep, that would justify moving to a more aggressive therapy.
Transcript has been edited for clarity