Getting into the Roots of Childhood Atopic Dermatitis - Episode 5

Burden of Atopic Dermatitis in Pediatric Patients

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Expert pediatric dermatologists Elizabeth Swanson, MD, and Joshua Zeichner, MD, discuss the burden of pediatric atopic dermatitis.

Joshua Zeichner, MD: Let’s change gears and talk about the burden of the disease on patients and quality of life. Lisa, I’m going to turn this over to you. Talk to us about how atopic dermatitis affects the quality of life of patients and their families.

Elizabeth Swanson, MD: It does so in a huge way. A lot of the quality-of-life impact boils down to a couple of main things. Itch is the most burdensome symptom of atopic dermatitis. Patients itch until they bleed because the pain is better than the itch. The itch is a major burden that they deal with on a daily basis. Because of the itch, sleep is disturbed. Sleep is disturbed for not only the patient but also their family members. If it’s a child with atopic dermatitis, it results in loss of sleep for the parents. If it’s an adult with atopic dermatitis, it probably results in loss of sleep for their partner. The issue with sleep disturbance is a big one that wreaks havoc on a patient’s quality of life and the quality of life of their family members.

The other thing is that atopic dermatitis can sometimes result in a slow creep of worsening over years. Sometimes patients and their families might not fully understand the burden it’s having on them until they go on therapy or a treatment plan that makes them better. There’s the expression, “You can boil to death in a slowly heating bathtub.” For some patients, the atopic dermatitis is the slowly heating bathtub. When they finally go on a therapy that helps them, they think, “My gosh, I can’t believe I was suffering so much before.” Sometimes they don’t realize that impact until it gets better for them.

Joshua Zeichner, MD: I see that all the time. People accept it and can’t imagine their life being any different. Then when you get them on a therapy, like a systemic biologic for atopic dermatitis, they can’t believe the difference.

Elizabeth Swanson, MD: Definitely. The other thing that our patients with atopic dermatitis have to deal with are comorbidities. Atopic comorbidities include asthma, allergies, and eosinophilic esophagitis. There have eye comorbidities, such as keratoconus, conjunctivitis, and blepharitis. There have been recent studies linking increased risk of cardiovascular disease. We have increased risk of growth issues, osteoporosis, osteopenia, fractures, anxiety, depression, ADHD [attention-deficit/hyperactivity disorder], and learning disabilities. All these comorbidities have been well established in our literature and are a big reason for us to take atopic dermatitis seriously and advocate to make it better for our patients and their families.

We talk about adverse effects of potential therapies. That’s appropriate, but these comorbidities are the adverse effects of not controlling the atopic dermatitis. It’s important to emphasize that we now have tools in our toolbox that can make this better for them. It’s not all about topical steroids anymore. It’s important to encourage families to take control of their atopic dermatitis and let us help them make it better.

Joshua Zeichner, MD: That’s great. Like so many other dermatologic conditions, atopic dermatitis is much more than skin deep, and getting early effective treatments has such a profound impact on quality of life in general.

Transcript Edited for Clarity