Atopic Dermatitis: Pathophysiology Driving Management Decisions - Episode 3
Linda Stein Gold, MD, discusses the impact atopic dermatitis has on the quality of life of pediatric and adult patients.
Peter A. Lio, MD: I wonder, Linda, if you could tell us about the impact of atopic dermatitis on both kids and adults, and how those are the same and how they differ. What have you seen in your practice? Patients sometimes say, “Everyone just said, ‘It’s just a little rash, why are you worried about it,’” but does it have some powerful impact on quality of life?
Linda Stein Gold, MD: Having a chronic disease takes a tremendous toll, whether you’re a child or an adult, and it can impact the entire family. If you think about these patients, first of all, they don’t feel like they look nice because their skin is red, flaky, and oozy; 86% of patients are itching every day, and over 60% say it’s intolerable. Imagine walking around all day; some of the patients say that they have itching for more than 12 hours a day. When you think about the sleep, half these patients are affected 5 nights a week from sleep. If it’s a child, and they’re not sleeping, that means the whole family’s not sleeping.
If you put all this together, imagine that you have a rash. Children are bullied over this. My patients tell me about what happens on the playground. Even for young kids, when their skin looks funny, they feel upset and angry. You can imagine that you don’t feel like you look your best. You’re itchy, and you’re not sleeping. Wrap all this up together, and you find that the incidence of depression and suicidal ideation is high in these patients. In children, we have an increase in ADHD [attention-deficit/ hyperactivity disorder] and an increase in anxiety. It is imperative for us to take the pulse of that patient and understand the entire impact of the disease.
Peter A. Lio, MD: I couldn’t agree more. You put it beautifully, and you captured the idea that it doesn’t just affect the patient, but it affects the family, the community, and beyond as well. These are important considerations. Thank you.