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A Multidisciplinary Approach to the Management of Atopic Dermatitis

Opinion
Video

A dermatologist and a patient discuss the importance of having a multidisciplinary team approach to treating atopic dermatitis.

Diego Ruiz Dasilva, MD, FAAD: Dermatologists are the experts in eczema or atopic dermatitis, however, because it’s a disorder connected with other atopic conditions, collaboration with allergy and immunology as well as pulmonology can be very important for some. Other atopic disorders include asthma, seasonal allergies, and food allergies, all of which can be severe and then would be best managed by a multidisciplinary team. Historically, patients with atopic dermatitis were subjected to lifelong repeated courses of systemic steroids, as we mentioned earlier, which can cause lots of negative adverse effects such as cataracts, hypertension, diabetes, osteoporosis, cardiovascular disease, infections, and that would require the management of numerous other specialists too. That’s why the patient-provider relationship and partnership are crucial in atopic dermatitis.

Treatments can be burdensome, and can involve significant lifestyle changes, such as changing soap, detergents, personal care products, moisturizing aggressively, and often applying different topical medicines to different body sites. It’s absolutely key that you work with the patient to understand which of these interventions are a good fit for them. Sometimes giving numerous complicated instructions will only alienate the patient or cause confusion, and they become overwhelmed.

Furthermore, preference for topical vs oral vs injectable treatments and the benefits and risks of each have to be discussed so a patient is comfortable with the plan and will adhere to it. I personally try to work with the patient to come up with an individualized plan that fits their lifestyle, because I think when you try to give everyone a cookie-cutter approach, you’re going to end up with a lot of failures and a lot of suffering patients.

Treatments are really individualized. It depends on what you need for each individual patient or what comorbidities they have. I’d say probably the most common one I see is asthma. I’m not a pulmonologist, so I’m often asking the patients, “How’s your asthma been doing lately? Do you see a pulmonologist regularly? Are you on any treatments for that? Please let me know if it improves or worsens on my eczema treatment.” Or if it’s something brand new that they experiencing, they might say, “Oh, yeah, I do have trouble breathing” or “I think I have food allergies, but I’ve never seen someone,” I’ll help them find someone.

But it’s not all the time that that’s necessary, and there’s not an easy pathway to say, “Call this number, and they’re going to see you next week.” It is a bit of finding someone in the patient’s neighborhood or someone I trust in my community who has seen my patients and the patients are happy with. But I think having more eyes on a patient, especially if they have more than 1 symptom, as in the skin is not the only thing that bothers them, is super helpful. And depending on what you’re using, if it’s a medication that affects a different organ system, then you want them to be plugged in with somebody so they can help out.

Transcript edited for clarity

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