Case 2 Continued: Impressions and Recommendations

EP: 1.Characteristics of Type 2 Inflammation and the Impact of Itch

EP: 2.Mechanism of Action for Agents Used to Treat Pediatric Atopic Dermatitis

EP: 3.Psychological Impact of Atopic Dermatitis in Pediatric Patients

EP: 4.Presentation and Diagnosis of Atopic Dermatitis in Pediatrics

EP: 5.Burden of Atopic Dermatitis in Pediatric Patients

EP: 6.Pharmacological Options for the Treatment of Pediatric Atopic Dermatitis

EP: 7.Case 1: 2-Year-Old Male With Atopic Dermatitis

EP: 8.Case 1 Continued: Clinical Impressions

EP: 9.Case 1 Continued: Treatments Beyond Topical Agents and the Use of Dupixent

EP: 10.Case 2: 7-Year-Old Female With Atopic Dermatitis

EP: 11.Case 2 Continued: Addressing Injectable Medications in Children

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EP: 12.Case 2 Continued: Impressions and Recommendations

EP: 13.Case 2 Continued: Barriers to Treatment Adherence

EP: 14.Case 2 Continued: Importance of Combination Therapy and Shared Decision Making

EP: 15.Case 3: 12-Year-Old-Female With Atopic Dermatitis

EP: 16.Case 3 Continued: Impressions

EP: 17.Case 3 Continued: How to Have Conversation About Risk of Biologics and Length of Therapy

EP: 18.Take-Home Points

Joshua Zeichner, MD: Let’s open this up to the group. Based on the patient’s age, the location of the rash, and the challenges associated with her treatment plan, what do you guys recommend?

Vikash Oza, MD: One thing in this case is the significant involvement of facial dermatitis. For people who see adults, maybe that’s something we see a lot. But in a 7-year-old who has such significant facial involvement and then only limited involvement on the extremities, it isn’t the most common prototype of a patient you’d see. That would make me wonder whether a contactant could be involved here. This has become increasingly common, even in our field of pediatric dermatology.

Before prescribing systemic agents, should we be evaluating and ruling out allergic contact dermatitis? There are certain scenarios—persistent hand dermatitis, unusual facial dermatitis—where maybe the first step is to take a step back and say: “Is there a contactant in your skin care products?” There’s a lot of exposure for children who are chronically using multiple skin care products. Then there is an increasing use of “organic” skin care products and essential oils. The number of different contactants that they’re exposed to has also increased. That might be my first step. Is what you’re looking at a pure flare of their underlying atopic dermatitis? Or is there a component of allergic contact dermatitis involved in their presentation? It’s important to take that step back when you’re seeing children who have less prototypical involvements.

Joshua Zeichner, MD: That’s such a good point, because if there’s an allergic contact dermatitis component, then putting them on a biologic medication for atopic dermatitis isn’t necessarily going to be an effective treatment, because you’re constantly exposed to that allergic contact allergen.

Vikash Oza, MD: Potentially. It also sometimes depends on the contactant. But I totally agree. When you have a suspicion, it might be something that you want to rule out.

Transcript edited for clarity