Approaches to Treating Mild, Moderate, and Severe Cases of Atopic Dermatitis

Dr. Peter Lio (00:07):

Hi, I am Dr. Peter Lio. I'm a clinical assistant professor of dermatology and pediatrics at Northwestern University, Feinberg School of Medicine here in Chicago, Illinois.

(00:15):

It's fascinating when we look at the landscape of therapeutic options, we often see these splits into mild, moderate, and severe. And while in some ways that is a helpful rubric to think about, it also to me is a little bit counterintuitive as a clinician, because we start at the same place for everybody. We want to start out with excellent topical care and topical approaches. So we're going to do gentle bathing, we're going to do good moisturization. And then of course, we're going to use our topical therapeutics.

(00:40):

And it's remarkable because sometimes a patient will come in looking pretty severe, but especially in kids, they can be covered in atopic dermatitis. And then literally, a week later of just a good topical regimen, they've turned around and they're clear.

(00:53):

On the other hand, you might have an adult, or again, maybe an adolescent who has more focal disease that might be just, you might qualify it as mild or moderate, depending on where it is, but it's super refractory. Maybe you're using high potency topical steroids. Maybe they're even on a systemic agent already. And this is refractory disease that's still there, even though it might only be called moderate on an IGA scale.

(01:14):

So to some degree, I approach everybody the same. I'm thinking about this stepwise therapy. And I really am trying to use as little as possible to get them better. But I also want to make sure we have really good control. So I'm not going to settle for, "I'm a bit better," or, "I'm hanging in there," and then I will escalate my therapeutics until I get that point where I feel like the patient is doing great and they're happy, and all of the metrics are in alignment.