Unmet Needs in Atopic Dermatitis

Dr. Todd Schlesinger (00:07):

Hi, I'm Dr. Todd Schlesinger. I'm a board certified dermatologist and member of the American Academy of Dermatology. I practice in Charleston, South Carolina, and I founded the Clinical Research Center of the Carolinas. And I also work with Epiphany Dermatology as my practice location.

(00:24):

Unmet needs in atopic dermatitis is something that we think about day to day when our patients come in the office. Now, unmet need could be access, for example. Hey, we can't get the drug we want. We want to be able to write a drug and get it without barriers in that situation. But in today's healthcare environment, access is an issue. So we have to find creative ways to get patients the medications that we think they need.

(00:45):

But the other unmet need I think is very important with atopic dermatitis is comorbidities. So just thinking about the things that come along with it, whether it's asthma, whether it's urticaria, other histaminic or non-histaminic processes that our patients are experiencing. Underlying disease states that are there as well. Chronicity, I think is another one that we should think about, like atopic dermatitis patients who have had disease for a very long time and are now experiencing those chronic adverse events, lichenification, pigmentary changes of the skin. How do we deal with those?

(01:19):

In my case, I think about those comorbidities day in and day out as far as my patients that have asthma, other comorbidities, underlying diseases of the kidneys, of the liver, and just simple things like weight management, nutritional, I think that's a big one as well. How can we get our patients on the right nutritional plan to help them with their atopic dermatitis?

(01:41):

And then the other thing is exposure in the environment. So as we know, atopic dermatitis is triggered by external factors, antigens in the environment, which then correlate with the barrier functions of the skin, creating inflammation that becomes a chronic cycle. So just breaking that cycle is important.

(01:57):

So I think if I had to pick one thing that was the biggest unmet need in atopic dermatitis, it's understanding the relationship between atopic dermatitis and the underlying comorbidities of the patients.

(02:08):

When thinking about what we as dermatologists can do to understand the unmet needs in atopic dermatitis, and of course do something about those, you have to remember that we are underlyingly medical doctors, medical physicians that have to look at the patient as a whole. So I'm routinely looking at that as well. Of course, I'm not practicing, trying to practice primary care in my clinic, but I am looking at the patient as a whole, doing laboratory examinations, looking and seeing what might be going on. Just asking a lot of questions in some cases is what you might be going on with the patient besides their skin. And then asking also a lot of questions about the environment.

(02:45):

Of course, everybody's got complicated home environments and work environments and exposures to many things in their practice. And of course, family history. That's a big one. And genetics.

(02:54):

All those things play into it, and we, as dermatologists, we see the patients, of course, we've got the clinical information to be able to supply our depth of knowledge into the community about what we're seeing in the clinic, and then advise the folks we work with on the industry side, the research side, and how they can focus on meeting those needs with our patients, whether that be mechanism of actions that are new, or just understanding how our existing drugs play into those more complicated patients than are typically involved in the studies. Because the studies, patients, as you know, are oftentimes very clean, a little bit of an enriched population in some cases. So we want to understand how it works in the real world.

(03:35):

So that's the best thing I think we can offer to our patients in dermatology, is real world experience as well.