Some rash decisions may be good ones

Atopic dermatitis — one of the most common of childhood skin conditions — brings fear to parents and may bring uncertainty to some dermatologists determining how best to treat it.

Vikash Sudhir Oza, MD, FAAD, a pediatric dermatologist at NYU Langone Health in New York City, and Karen Chernoff, MD, FAAD, a pediatric dermatologist at Weill Cornell Medicine in New York City, discussed how doctors and parents can collaborate in the treatment and management of pediatric skin conditions during U077 – Atopic Dermatitis in Young Children: Controversies, Concerns, and Current Guidelines.

Sorting out fear and facts

“Having an infant with atopic dermatitis is often fraught with anxiety (for parents), so a successful visit includes being able to address a number of concerns,” Dr. Oza said. “What role does food play in AD? What are [their] concerns about the safety of topical steroids, and the origins of AD? When will it go away? What assistance do they need to navigate the many products that they may need to use on their infant’s skin?”

Dr. Oza told attendees that topical therapies are still the main approach for moderate-to-severe infantile atopic dermatitis and discussed promising new developments on that front.

“We have extensive experience using certain topical therapies such as pimecrolimus in infants, even though it is off label,” he said. “We are excited that efficacy and safety data are strong for dupilumab even down to six months, and we will have to navigate with our families how best to deploy these new therapeutic options.”

Family’s role crucial

Parental decisions play a key role in that navigation. Dr. Oza said that the management of atopic dermatitis is “a lesson in shared decision making.” Often, parents can be afraid of the treatments a physician may prescribe for their child. The key to managing that fear is communication.

“We have to establish the goals that families have, and we have to address their fears if we hope for there to be compliance with our plans,” he said. “Topical corticosteroid phobia is prevalent independent of socioeconomic or cultural background, and this can greatly influence a child’s success with treatment.”

Safe and effective treatments

Dr. Chernoff said that one of the keys to helping ease the fears of families is teaching them how to use topical steroids safely and effectively.

“Dermatologists need to address the question of ‘when do we need to worry about systemic effects or long-term, cutaneous adverse effects?’” she said. “Parents and physicians often worry about these effects in young children.”

Another concern families may have is: What happens when topical steroids aren’t working as expected? In this case, Dr. Chernoff said she might turn to alternative topical therapies, such as calcineurin inhibitors, crisaborole ointment, and dupilumab.

Families may also wonder if allergies are playing a role in their child’s eczema. Dr. Oza said this is another area in which the dermatologist can work closely with families to ease their fears and determine the best course of action. 

Diversified diet

“We often spend a lot of time with families to help them recognize a paradigm shift in how they think about AD and diet,” he said. “Many families are concerned that certain foods are causative or highly contributory to their infant or child’s eczema. We spend a lot of time discussing the importance of maintaining a diversified diet in infancy in the hopes of building immunologic tolerance and reducing the rate of true food allergy. Therefore, elimination diets can actually cause more harm than good.”

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