John Browning, MD, explains dermatological questions to ask, answer in primary care

John Browning, MD, Chief of Dermatology at Children’s Hospital of San Antonio and Organon Health Partner, encouraged pediatricians to feel confident initiating treatment for atopic dermatitis (AD) using steroid-free creams when evaluating patients during routine visits.

“I believe that pediatricians should be very confident to prescribe a steroid-free cream. They should feel like they can and should do that when they see a patient,” Browning said. He noted that AD is often first observed during routine physicals or skin checks and emphasized that early, informed intervention can help prevent prolonged suffering or delays in care.

“Having a safe, steroid-free cream at their fingertips is great,” Browning said. “And I think that they should all know about what’s out there, so that they can help their patients. Otherwise, those patients are going to suffer before they’re finally going to be seen by a pediatric dermatologist.”

Browning explained that many families presenting to pediatric care have already tried over-the-counter products, including low-potency corticosteroids or general moisturizers. He recommended pediatricians ask specific questions about past use: “What kind of moisturizer? Has it helped? Has it not helped?”

Given the chronic nature of AD, Browning noted that a recurrent pattern of flare-ups is common, especially following the discontinuation of hydrocortisone.

“There may be a rebound flare when they finish using the hydrocortisone or other topical steroid,” he said. “There’s also some other characteristics with AD, such as a symmetric nature to it. In kids, we see the flexural surfaces, so the front of the arms, back of the legs, sometimes it’ll be the neck, and around the face and eyes.”

Recognizing these locations and distribution patterns can help general providers distinguish AD from other rashes. Browning also recommended screening for co-occurring conditions.

“There may also be some co-morbid conditions with AD, such as allergic rhinitis, seasonal allergies, or maybe some food allergies or asthma. Those are also good things for them to ask about.”

By incorporating these questions into the clinical encounter and staying informed on evolving nonsteroidal therapies, Browning said pediatricians can play a key role in initiating safe, effective treatment for children with eczema.