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Collaborative Management in Pediatric Atopic Dermatitis - Episode 2

Patient Journey to Treatment for Pediatric AD

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Brittany Craiglow, MD, and Angela J Lamb, MD, review a pediatric patient’s journey to diagnosis and treatment of AD.

Brittany Craiglow, MD: Let’s talk about a typical journey of a pediatric patient with atopic dermatitis. Who do you think is usually diagnosing these patients and then treating them? And are those people different?

Angela J. Lamb, MD: Most good pediatricians worth their stock can generally recognize most atopic dermatitis. Again, they may get off target a bit depending on what the patient’s symptoms look like. As we discussed earlier, if they’re missing some of the erythema, or it’s not in some of the classic places where they think of atopic dermatitis, they may say it’s an allergy or something like that. But in general, most pediatricians do a good job. Where they may do more referral to us is when they find that they’ve tried a low potency topical steroid and now they’re a bit stuck. They may not be as familiar with some of the nonsteroidal options or feel as comfortable stepping it up potency-wise with the steroids.

Brittany Craiglow, MD: I agree. A lot of kids with mild disease are managed by their pediatrician, and are managed quite well. Access also has a lot to do with it. In a place where it’s not terribly hard to get in to see a dermatologist those patients are maybe referred earlier, but there are some places where it’s hard. Pediatricians are having to do more of the heavy lifting. Let’s talk about the role of the pediatrician, and our role. When should a pediatrician say to their patient, “I think you might need to see a dermatologist”? What are those signs or flags that maybe the patient just needs to be presented with different options?

Angela J. Lamb, MD: It’s important. Being a physician…I believe strongly, especially as medical director of our access center, in a multidisciplinary integrative approach. Again, mild atopic dermatitis, most pediatricians can handle. One of the main things that I think initiates that referral is when that patient needs a bit more time and needs somebody who has a bit more experience understanding just general skin hygiene and barrier protection, understanding which products to recommend, how to put them on. Do they understand the soak-and-smear strategy? Do they understand wet wraps and some of these more nuanced things that dermatologists are the experts in? Then, let’s say they do understand those things when they recommend them, and someone maybe is not as adherent as they’d like. Again, you’re in a pediatrician’s office, they’re managing your immunizations, and things like that. They don’t always have long written sheets like someone would receive in my office about how to take care of your skin with atopic dermatitis. Then it’s medication management. When medications are necessary, there’s a lot of information out there. For instance, for medium to high potency steroids, that you only use them a day or two, or things like that. They may not understand how to integrate some of the newer nonsteroidal treatments that are on the market, how to add them into the regimen, when to use them, which ones are appropriate. Those are the main things that I see that initiate those referrals.

Transcripts edited for clarity