Using Multidisciplinary Care to Optimize Atopic Dermatitis Treatment

Raj J. Chovatiya, MD, PhD: Korey, could you touch on your thoughts on multidisciplinary care, when there are multiple providers involved, and how we can educate and arm our patients and caregivers so they understand the true burden and depth of this condition?

Korey Capozza, MPH: This is a condition that often does require multiple providers because so many of these children also have asthma, food allergies, and other things. I wanted to say that a huge proportion are also facing mental health issues. This is an aspect of eczema that we’re still learning about, but it’s emerging to be a prominent feature of the condition. As we talk about multidisciplinary care, we need to start thinking about how we address that aspect of, I say “eczema” because that’s what we call it in the patient community. There are a lot of players here, you definitely need a quarterback. I say to patients, if that’s your pediatrician, if that’s your dermatologist, someone needs to coordinate so that you have a full picture of what’s going on, and it’s not chaos out there. That’s really important. And then, starting to look at how to address the anxiety, the depression. Bringing that piece in, so these children who are experiencing those symptoms get help early and we don’t see a progression in that psychiatric march over time.

I loved what you just said, Lisa, about shared decision-making, and I know that’s a buzz term, but it’s important as these new treatments come. Each family, each patient has different preferences. Some will never do an injection, they just won’t. They have concerns about needles or trauma around that, and they’re not ever going to do an injectable treatment. Others would prefer a pill. For some, the time requirements of these topical treatments are too much for them. There are concerns about topical steroids. There’s a lot there, and I think laying it out there and letting people pick is the way to go. We see in our own research on shared decision-making that control of eczema symptoms is associated with shared decision-making. It’s not just a buzzword, it’s not window dressing. Although, this was not a controlled study where we can say definitively, it does seem like shared decision-making, supporting patients with self-management, those are things that are associated with better control of symptoms. It’s logical if you think about it. Those are the additional comments I would add.

Raj J. Chovatiya, MD, PhD: I appreciate that, Korey. We have the value of having a patient here, Taylor. Korey highlighted something important about mental health when it comes to atopic dermatitis. It’s something that I know that we are all trying to get out there because we know it’s such an important burden, whether it be anxiety, depression, ADHD [attention-deficit/hyperactivity disorder]. There are studies that suggest that there’s increased suicidal ideation for people with bad forms of atopic dermatitis. Could you touch on this for us and tell us about your journey with mental health and your atopic dermatitis?

Taylor Capps: She [Korey] highlighted the effects that atopic dermatitis can have on your mental health. It wasn’t until recently that I realized that the two are in tandem. There are more studies that do show how bodily inflammation is directly correlated to mental health. It wasn’t until you explained that inflammation is the underlying cause of atopic dermatitis that it all began to make a lot more sense. If you go back to what my mom was speaking of earlier, the doctor told me that I had an anxious stomach as a child. There was no reason I should have had anxiety at 7 years old. I had a fantastic life, and my childhood was picturesque. But if you go back to a lot of the things, I was extremely anxious. I’m very outgoing, but I have social anxieties associated with it, and it has continued into my adult life, as well. It’s something I have been constantly battling with over the last few years, that mental health element. It’s something I have been seeking treatment for through different therapy. I was recently diagnosed with celiac disease as well, so some of those things all go together.

But to go back to Korey’s point, you need someone who’s looking at you holistically. It’s so important to find doctors who are working with and studying your medical history from maybe the gastroenterology side, and how that might tie in to what you’re doing. Then what other things you might be struggling with because it definitely is all tied together. It wasn’t until I’ve taken a step back and seen the holistic diagnosis of each piece, and having a medical professional who’s helped me realize how they all are intertwined, that I have been able to start getting a grasp on things.

Raj J. Chovatiya, MD, PhD: You make an important point, and thank you for sharing that element of your journey. There are a lot of things tied into that. Let’s talk about the mental aspect, mental health, psychosocial, quality of life. Obviously, the disease itself, there are comorbidities, the symptoms of atopic dermatitis. We know there are strong links between the constant severe itch and sleep problems that people experience related to the atopic dermatitis itself, as well.

Transcript Edited for Clarity