At the recent 2023 Fall Clinical Dermatology Conference, several encouraging findings on nonsteroidal anti-inflammatory topical medications for atopic dermatitis (AD) were presented for attending dermatologists. However, when topical steroids fail patients are often transitioned to systemic treatment.
In this exclusive MedPage Today video, Peter Lio, MD, of Northwestern University Feinberg School of Medicine in Chicago, discusses the important elements clinicians should think about when patients have been treated with topicals and there is a question about transitioning to systemic therapy.
Following is a transcript of his remarks:
It’s always a tough situation because, on the one hand, before you go to that next level of treatment, we have to do a couple of things. First, we always want to make sure, do we have the correct diagnosis? Are we sure it’s atopic dermatitis, or could it be atopic dermatitis plus something — typically, contact dermatitis.
Sometimes they’re allergic to some component of the treatments we’re giving them. Maybe it’s propylene glycol or cocamidopropyl betaine in the cleanser or what not. So we’re always trying to figure out could there be something else driving this.
The next question is, are they actually using the treatments? Sometimes people say, yeah, I tried it. The cream didn’t help, and then you’re like, did you actually even fill it? Did you actually use it? So I like to make sure we’ve established that rapport, because if they didn’t use it, there could be a really good reason. I need to know that. But I don’t want to just escalate them up to something if they don’t need it.
So, we’re trying to make sure. And then we also want to make sure that they really do have a big impact on quality of life because, again, the systemic treatments, while not necessarily dangerous per se, they generally carry with them more risks than topicals.
So once we’ve kind of jumped over those hurdles, then we have that shared decision-making piece, and we say, okay, these are sort of our options for systemic therapy. We have a heck of a lot more than we did even just a handful of years ago, but it’s still relatively limited. And I always like to kind of break down that discussion.
And I even always like to include phototherapy, because even though it doesn’t always get the most love, it’s not the sexiest thing, I still think phototherapy is a powerful, powerful treatment modality for many patients, and at least I like to consider it even if they say, “nope, it’s not going to work for me, it’s not going to work with my schedule.” I love having at least covered that.