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The Patient Journey to Diagnosis of Atopic Dermatitis


Trinity Flint, a patient with atopic dermatitis, talks about the initial symptoms she had as a child that led her to see a doctor for diagnosis.

Diego Ruiz Dasilva, MD, FAAD: Hello, and thank you for joining this Dermatology Times®patient perspective program titled “Diagnosis to Treatment: Exploring the Patient Journey in Atopic Dermatitis.” I’m your host, Dr Ruiz Dasilva. I’m a board-certified dermatologist practicing at Forefront Dermatology in Virginia Beach and Hampton, Virginia. I’m joined by Trinity Flint, who’s going to share the details of their journey with atopic dermatitis. Thank you for joining us. Let’s begin.

Atopic dermatitis [AD] is a common but devastating dermatologic disorder with external and internal factors leading to its pathogenesis. These patients have a compromised skin barrier that allows for the introduction of environmental toxins and allergens to the immune system, which in turn triggers cytokines that increase inflammation and pruritus. When they scratch, they further damage the epidermal barrier, creating a vicious cycle. In the past, it was felt that this was primarily a disorder of childhood and predominantly hereditary. But our knowledge has evolved to an understanding that this is a complex interaction of epidermal barrier dysfunction and immune dysregulation environment; therefore, it can occur at any point in life.

Acute AD often presents as weepy, red-crusted patches with remarkable itching. Subacute disease typically comprises drier, scaly red plaques with overlying excoriations. Finally, chronic disease can be underappreciated. It may not be very red, but the skin has formed thick, scaly plaques with lichenification, which is a hallmark of the long-standing inflammation itching. Ms Flint, tell me more about some of your initial symptoms and what prompted you to see a doctor for diagnosis.

Trinity Flint: For as long as I can remember, I had with eczema, but I didn’t get an actual diagnosis until I saw you and had a skin biopsy. But every doctor I had ever spoken to about it as a child said the same thing. They all said that I had eczema. For as long as I can remember, I’ve struggled with that.

Diego Ruiz Dasilva, MD, FAAD: What were some of the initial things that you dealt with as a small child that your parents noticed vs when you remember thinking about it?

Trinity Flint: I definitely had the itching and the rashes. It was usually triggered by outside sources, like allergies, stress, and stuff of that sort. My mom also struggled with eczema as a child, so my parents started to pick up on that quickly because of the symptoms I was having.

Diego Ruiz Dasilva, MD, FAAD: I can imagine the unpredictable nature of the symptoms was disruptive when you were a kid.

Trinity Flint: Oh, yeah.

Diego Ruiz Dasilva, MD, FAAD: When you were a young child first diagnosed, did your doctors call it eczema, or was there a question about what you had when you were first having symptoms?

Trinity Flint: It was pretty immediate. For as long as I can remember, it was eczema because my mom had it for so long as a child. My symptoms and eczema were correlated to each other. But it was known for a while.

Diego Ruiz Dasilva, MD, FAAD: What are some of the thoughts you had about it? When you remember taking care of yourself and taking control of your health as a late teenager, what are some things you remember from that?

Trinity Flint: It was definitely a struggle, especially socially. I didn’t have a great time in school with eczema because it progressively got worse as I got older. My mom ended up growing out of it as she got older, but I grew into it. It was liberating when I was finally able to find something that stuck as a treatment because I had been through other topical creams and all sorts of cream treatments or ointments, and I never had long-term success with those. But it was very discouraging for a long time.

Transcript edited for clarity

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Video 2 - "Atopic Dermatitis and Contact Dermatitis: Navigating Intersecting Pathways and Optimal Management Strategies"
Video 1 - "Decoding Atypical Atopic Dermatitis: Unraveling Complex Cases and Advanced Diagnostic Strategies"
Elizabeth Kiracofe, MD, an expert on atopic dermatitis
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