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Determining Systemic Therapy Eligibility in Patients With Atopic Dermatitis

Article

Andrew Blauvelt, MD, MBA, shares highlights from his RAD session, "Battle of the Titans 2: Challenging Patient Cases: Who is Eligible for Systemic Treatment in Atopic Dermatitis?"

Andrew Blauvelt, MD, MBA, is a board-certified dermatologist and investigator at Oregon Medical Research Center. In a dual-speaker session Sunday, Blauvelt discussed systemic treatment eligibility alongside Jonathan Silverberg, MD, PhD, MPH.

Blauvelt: Hi, everyone. My name is Dr. Andy Blauvelt. I'm a dermatologist from Portland, Oregon. I work at the Oregon Medical Research Center, which is a clinical trial center in dermatology.

Dermatology Times®: What are key takeaways from your session, "Battle of the Titans: Who Is Eligibile for Systemic Treatment in Atopic Dermatitis?"

Blauvelt: We see the adolescent focusing much more on their disease and just wanting relief of their disease, wanting relief of the skin lesions, wanting relief of the pruritus, wanting to interact in their social life, in their sports life, and their academic life, and having that big impact of AD in those areas. So a little bit of disconnect, the family member all about side effects and the adolescent ad patient more about their skin disease. And so we gave some suggestions, we gave some hope. We did mention that, you know, in the past, we really only had cyclosporine, methotrexate, phototherapy to use for those folks who needed systemic therapy. And in recent years though, we have excellent options for teenagers, much better than those older agents, in my view. So again, the pros and cons, if you will, of systemic therapy have shifted, I think to be more favorable towards systemic therapy, and that adolescent patient, and you can use that in your discussions with caregivers and adolescents. And as far as you know, if you have a caregiver that wants it, and the patient who doesn't want it, and the patient who does want it, which is a pretty common situation. We suggested definitely giving the options, putting out all of the options to that caregiver, stating what you think, would be the best for the patient, highlighting the impact of the disease of the teenager's life, the problems, if you will, of not treating with systemic therapy, and how that would go and so forth. But you can't obviously force caregivers to do it. But we gave some advice and tips such as those in caring for that type of patient. And then in terms of the adult, the African American patient, we highlighted the fact that erythema is often under assessed, if you will, or under diagnosed, or under evaluated, and these in these patients, erythema especially if dermatologists haven't trained at a time or in a place where they've seen lots of skin of color. They may not be as experienced at seeing erythema or assessing it. So that's really important in those patients. Then sometimes looking at postinflammatory hyperpigmentation, realizing it's not always postinflammatory pigmentation. Sometimes it's frank inflammation, or active inflammation, appearing as darker lesions. So I think that was one of the main points: don't under-treat those patients where you see, let's say, widespread hyperpigmentation, where you're assuming it may be old disease. I would do just the opposite. I would assume that is active disease. Count that in the body surface area in your evaluation of whether the patient needs systemic therapy. So I think the point being for both types of cases, and both types of situations, I think dermatologists in general, in my view, are more shy if you will, or more reticent in treating adolescent patients with moderate-to-severe AD with a systemic therapy, and African American patients with moderate-to-severe AD with a systemic therapy. So I think again, kind of boosting confidence, giving some tips, realizing the situation there, and hopefully, doing the right thing for the patient. Mentioning the options, the good options that we have now for these patients, and how it can impact their life in a positive way. So that was the session. Thanks for watching.

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