In this 4.5-minute video, Aaron Drucker, MD, SCM, FRCPC, discusses why dermatologists need to think beyond BSA, EASI, and Itch NRS scores when it comes to managing patients with atopic dermatitis.
Dr Drucker is a scientist at the Women's College Research Institute; a dermatologist with the Women's College Hospital; assistant professor, division of dermatology, department of medicine, at the University of Toronto; and an adjunct scientist of ICES in Canada. He also serves on the Council Executive Committee of the National Eczema Association.
Transcript
Dr Drucker: Atopic dermatitis can take over patients' lives in many different ways, whether it's the itch of the condition making them uncomfortable throughout the day and making it difficult for them to sleep, or whether the appearance of it makes them less likely to want to socialize if the condition is impacting their productivity at work or their ability to go into work or to be paying attention at school.
These are all things that atopic dermatitis can have a major impact on. When we're treating atopic dermatitis, we have to have that front of mind because treating this condition is not about just making the skin clear and then calling it a day. It's about addressing all of these different issues. If the treatments that we're using aren't addressing this burden, aren't improving quality of life to the extent that is going to make a patient happy and feel like their life is improved, then we're not doing enough.
We have all kinds of different treatment options for every different level of severity. It's not like one treatment regimen is necessarily the best or the only treatment that is available for any patient, so helping a patient identify what triggers they may have, if any.
It may be the case that a patient can't identify any specific environmental triggers or their environmental triggers are things that they can't avoid, like it's cold out and they live in Canada. [laughs] You can't do anything about that unless you're willing to move to Florida.
There is an important role for identifying triggers. Sometimes if you focus on that too much, then you end up losing the forest for the trees and missing out on other things that you can do to improve eczema, like frequent moisturizing and using different topical medications that we know are effective. If you can identify triggers, that's great. For a lot of patients, they can't identify any trigger that's going to make a meaningful impact on their atopic dermatitis.
Shared decision-making is still crucial. Even if, let's say, you move beyond those triggers, you still need to think about what topicals are you going to use? Is it going to be a cream? Is it going to be an ointment? What's the patient preference?
There's no one moisturizer that's the best for eczema. It's all about what the patient is going to use because they like it, and so it's really important to involve the patient in those decisions.
One other element that I think is important to help patients in managing their disease is to decrease the burden of things that we as physicians and as other health care providers are placing on them.
We talk about basic skin care, and the word basic makes it sound like it's really easy. We're asking a lot of patients, moisturize a few times a day, put on your topical medications, try to do it this time of day, try to do it after the bath, try to identify triggers. This is a lot for a patient or a caregiver to manage and to bring into their life. Anything that we can do to mitigate some of that burden that we place on patients is welcome.
One thing that I try to do is to prescribe most topical medications, particularly topical steroids, as once-a-day treatment. There's some evidence that once a day is just as good as twice a day, and if we can at least get rid of one thing off a patient's to-do list for their eczema, I think that's going to be really appreciated by a lot of patients.
We always need to be aware of our limitations as dermatologists and do what we can to help our patients with atopic dermatitis and recognize when we need help from some of our colleagues.
If a patient has severe asthma, personally, as a dermatologist, I don't want to be making treatment decisions that might impact their asthma without also getting the opinion of their respirologist and making sure that we're on the same page and the treatment plan that I'm coming up with for their atopic dermatitis will also help with their asthma.
