Experts in dermatology discuss the rapidly expanding treatment landscape of atopic dermatitis and how these new treatment options have changed the management of AD.
Jonathan I. Silverberg, MD, PhD, MPH: Hello, and thank you for joining this Dermatology Times® Around the Practice® series titled “Atopic Dermatitis First-Line Treatment Options: Systemic Therapies for Moderate to Severe Atopic Dermatitis. I’m Dr Jonathan Silverberg, and I’m a professor of dermatology at the George Washington University School of Medicine and Health Sciences in Washington, DC. In this series, I’ll moderate a discussion and case study review of the clinical and practical management of our patients with atopic dermatitis. Joining us are Dr Brad Glick, a board-certified dermatologist and dermatologic surgeon practicing in Margate and Wellington, Florida; Dr Andrew Blauvelt, a board-certified dermatologist and investigator at Oregon Medical Research Center in Portland, Oregon; and Dr Lisa Swanson, a board-certified dermatologist and pediatric dermatologist at Ada West Dermatology in Boise, Idaho. Let’s get started.
First, let’s discuss an overview of atopic dermatitis and conventional therapy. I want to start with an opening question. Since the approval of dupilumab in 2017, the toolbox has changed and everything has changed in terms of the treatment landscape. What value have all these new treatments added to our armamentarium? I’ll start with those in practice. How are you using them? Let’s get some different ideas.
Elizabeth Swanson, MD: The added value is huge. Our world has truly changed. If I’m giving a talk to a group of people, I’ll ask them if anybody in the room has been practicing for less than 6 years. If there is, I’ll tell them, “You don’t know how much we struggled trying to manage bad atopic dermatitis.” It’s a different world now, which is so much better for us and more rewarding to be able to help people. It’s a game changer for our patients and their families. It’s a wonderful time to be in practice.
Brad Glick, DO, MPH, FAOCD: I couldn’t agree more. We have not only new systemic agents but also a new generation of nonsteroidal topicals. Others are on the way, and they’ve been a godsend for our patients because we can treat patients collaboratively.
Jonathan I. Silverberg, MD, PhD, MPH: One of the challenges is that we have so many options now, so it’s hard to figure out where to position everything and how to use all of them or combinations. How have they shifted your management with so many options to choose from?
Elizabeth Swanson, MD: I’ve even seen a change in what patients I consider for dupilumab therapy from when it first emerged and was approved. The first patients I put on it were patients with truly horrible atopic dermatitis. As time has gone on and the age indication has gotten younger, my thinking of dupilumab for my patient population has increased incrementally.
Brad Glick, DO, MPH, FAOCD: I’ll echo that. The longer we have the product and then the decrease to different age ranges expands our benefits for safety. The more indications, the more decreases down to different age groups makes me more comfortable in prescribing the therapy.
Jonathan I. Silverberg, MD, PhD, MPH: One of the big questions that comes up is positioning and sequencing of all the different medications. Do you have any specific algorithm that you like to use? It’s hard because every patient is different.
Elizabeth Swanson, MD: I could share what I do. When I’m seeing a new patient with atopic dermatitis, I explain that atopic dermatitis is caused by 2 things: skin barrier dysfunction and immune system hyperactivity. That’s how we explain how we treat the condition. I go over sensitive skin care products. I have my favorite things list that I give them, and then I flip it over and write out the different categories of treatments that are available for them in whatever age group they are. I list topicals first, and then I draw a line and write any systemic agents that are approved in their age group. I talk thoroughly and efficiently about each and lay it all out there for them, so they’re aware of what’s out there. Many patients who have been dealing with AD for years gave up on us a few years ago. It’s nice to show them that we have choices now. “Look at how many things we could choose from. You can choose what feels right to you and your family.” That’s how I tend to do it.
Brad Glick, DO, MPH, FAOCD: Severity assessment is really important. Mild, moderate, severe—you can take a stepwise approach. Depending on the presentation, the age of the patient is going to help you choose your therapeutic regimen. I start from the outside. Barrier restoration is important to me. Like Lisa, I handwrite care plans for my patients because that helps with compliance and adherence.
Transcript edited for clarity