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The Burden of AD on Pediatric and Adult Patients


Shawn Kwatra, MD, and Peter Lio, MD, FAAD, discuss the burden of atopic dermatitis (AD) and how it may affect pediatric or adult patients.


Shawn Kwatra, MD: Hello and welcome to this Dermatology Times® DermView titled, “The Power of Topical Creams: Combining BSA and Itch Data for Effective Atopic Dermatitis Management”. I am Shawn Kwatra, the director of the Itch Center and an associate professor of dermatology at the John’s Hopkins School of Medicine in Baltimore, Maryland. Joining me today in this discussion is Peter Lio, a clinical assistant professor of dermatology and pediatrics at Northwestern University's Feinberg School of Medicine. He is the founding director of the Chicago Integrative Eczema Center in Chicago, Illinois. Thank you for being here. Let's get started with our discussion today. Briefly we want to chat a little bit about the burden of atopic dermatitis. Peter, have you noticed any similarities, or differences between adults vs kids with atopic dermatitis?

Peter Lio, MD, FAAD: Definitely. I do think that the burden especially is something that everybody faces. That's one thing we can sort of ground that everybody feeling this disease is going to have issues with the itch with sometimes pain that they're going to have a huge impact on their quality of life overall. Many of the patients, especially as we get more moderate to severe, and I know you know this too, even in the pure itch group, sleep is destroyed. When your sleep is disrupted, I feel like the repercussions are just endless; it just affects the mind and body health, and it affects your ability to function during a workday and school day. There's a lot of similarities. When I trained, the thinking at that point was 'Well, maybe adult-onset atopic dermatitis is fundamentally different, maybe it's really a different disease'. But now we all kind of agree that there may be some differences, but we can't really see them, that by in large they are pretty similar. What's your experience been?

Shawn Kwatra, MD: You know, it's a great question. What I see in a lot of children is that there can be an incredible burden because of their development pathway. If folks aren't sleeping, especially for these young kids, that can have so many devastating aspects across domains, social functioning, or how they do at school; It's very fundamental. I'm an adult with atopic dermatitis myself and I can tell you that one of the things that I don't like about the disease and that is very scary to me is that I don't know when a flare will happen. It's one of the key differences between atopic dermatitis and psoriasis. Psoriasis tends to be a little bit more stable in its disease intensity, but atopic dermatitis, it comes and goes. To be honest, I had terrible seasonal allergies recently, and I'm one of those people who have asthma and allergies, eczema, and hives; they all go together. Recently, the pollen was just terrible and then, my eczema came out of nowhere and I actually had to leave my lab meeting just so I could scratch and dig in on myself. I hated it because then, I had to give a talk and I was presenting and I didn't have my creams or other things, and it's the unpredictability which is something additional and unique to atopic dermatitis.

Peter Lio, MD, FAAD:That is such a great point and I totally agree. I was making a rollercoaster ride kind of graphic because I feel like that's how my patients tell the story and it sounds like you're living it where things are pretty good for a while and then, often times without any clear trigger, you're in a flare up.

Shawn Kwatra, MD: Absolutely.

Transcript edited for clarity.

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