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Collaborative Management in Pediatric Atopic Dermatitis - Episode 8

Role of Pediatricians in Management of Pediatric AD

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Brittany Craiglow, MD, and Angela J Lamb, MD, share closing thoughts on the role of pediatricians and emerging treatments in the pipeline for pediatric AD.

Brittany Craiglow, MD: Another thing to talk about with topical corticosteroids is that I have a lot of patients come in with hypopigmentation and areas of atopic dermatitis. They have been told that that is from their hydrocortisone or maybe triamcinolone. We need to dispel the myth about topical corticosteroids causing dyspigmentation because that’s very unusual. In these patients, it’s almost always a post-inflammatory change. Do you see the same thing?

Angela J. Lamb, MD: Yes, it’s usually post-inflammatory. You’re right. Sometimes people don’t know what they’re looking at, and it’s the same way with post-inflammatory hyperpigmentation. They’ll say, “My eczema is still there.” I’m like, “The eczema is fine. Are you itchy? I don’t feel any plaques. Your skin is very flat. This is the scar that’s left over after the atopic dermatitis is gone.”

Brittany Craiglow, MD: Post-inflammatory hyperpigmentation can take a long time to resolve. That’s another thing we have to think about when treating patients. Every time they get a patch of eczema, they’re getting a darker patch left behind for months or longer. That’s a big deal for them. Thinking about that as another component of treatment is useful.

Angela J. Lamb, MD: That’s almost as important because sometimes people are traumatized by that. They’ll say, “I had a period in my late teens when my eczema was on fire. Now I’m in my 20s or 30s, and I still have patches.” That can be devastating, especially for patients who have more melanin in their skin.

Brittany Craiglow, MD: Yes, for sure. We saw this a little more before dupilumab, but some kids are very itchy, scratching so much that they have dyspigmentation sometimes. We can’t get back from that. That’s a sequel that shouldn’t happen. In closing, there’s a lot of reason to be hopeful in atopic dermatitis. This isn’t a thing that kids should have to live with. Maybe they’ll get better over time, but this is having an impact on them and their family, so we need to treat it.

Any closing thoughts about the role of the pediatrician and our job as dermatologists and working together to get the best for our patients?

Angela J. Lamb, MD: Stay in close contact. I’m not like you. I’m not double-board certified. But I’ve had the good fortune to train at a program with a robust pediatric dermatology program. I trained under some great pediatric dermatologists. I’ve always felt comfortable managing some intense dermatology stuff. I know I’m outside my genome dermatosis when I’m outside my wheelhouse. I have a lot of experience in this space. The pediatric practice downstairs refers patients exclusively to me. Having that close relationship and accessibility is critical. Children are coming through their parents. If your child is suffering or in pain, you want a response right now. Having that close contact. Also, educate them and let them know there are exciting things in the pipeline. I’m excited about the JAK inhibitors, hoping we get good approvals for those in this pediatric population. It’s really exciting.

Brittany Craiglow, MD: For sure. We have baricitinib approved down to age 12 now. That’s for patients who fail dupilumab, because there are some. We have even another option, and this is the beginning. It’s exciting for us to have more tools, but also for patients. Sometimes the conversations take a bit longer. There’s more education, but if you can help 1 of these children and their families, there’s no better feeling. Talk about burnout and all these things that we have to deal with in medicine. Ultimately, we all do this to help people. When you have that feeling that you helped somebody, you changed their life—the child is sleeping through the night or going to school—that feels good. That helps sustain us. Remember that when you’re taking a bit more time, it will pay off in the end.

It’s been fun to talk with you. Thank you for watching this Contemporary Pediatrics® Recognize and Refer program. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming programs and other great content in your in-box.

Transcript edited for clarity