Addressing the Psychologic Impact of Atopic Dermatitis on Pediatric Patients

Elizabeth Lippner:

My name is Elizabeth Lippner. I'm a pediatric allergy and immunology physician. I practice out of Ann & Robert H. Lurie Children's Hospital here in Chicago. I see pretty much all children with an emphasis on food allergy and allergic diseases, as well as immune deficiency diseases.

Thinking about psychiatric and mental health concerns that can complicate and can affect our patients' lives specifically in pediatrics, I think the difficult sensation of itch and then also sometimes the stinging sort of sensation that occurs just because of necessary treatment for atopic dermatitis can really cause a lot of challenges for both the children, and the parents and the caregivers. So we do see much higher rates of anxiety, anxiety in relation to things like certain clothing, certainly, to the medications and the moisturizers themselves and then, of course, for things like healthcare-associated visits.

There's also a slightly higher risk of ADHD that seems to be found in those with atopic dermatitis. And we're starting to learn more and more just about the role that the sensation of itch has on even things like sleep disturbance and the circadian rhythm.

Sometimes, it's really quite difficult to get to a place where we feel like we're adequately treating these mental health comorbidities, so, if it has a lot to do with anxiety, we sometimes will spend time talking about what these medicines do for the kids. And we certainly look for tips and tricks to try and make that experience less stressful for families, so something as simple as pairing it with part of your routine that is much more enjoyable for them, doing it as part of a routine for the family. So, if they have siblings, sometimes, if the challenge arises from not wanting to be different from their siblings, we'll just say that everybody needs to put some moisturizer on.

On the opposite side of the spectrum, if they want to be extra special and they want all of the attention, then we'll try to encourage them to have a special jar or a special container for their moisturizer or for their medicine so they know, "Oh, it's time to put your creams on, Sally. Go get your special unicorn jar," to make it a little bit more enjoyable.