Helping Kids Thrive: Addressing Eczema Early with Systemic Therapies

Announcer:
You’re listening to DermConsult on ReachMD. On this episode, we’ll hear from Dr. Peter Lio, who’s a Clinical Assistant Professor of Dermatology and Pediatrics at Northwestern University Feinberg School of Medicine and a dermatologist at Medical Dermatology Associates of Chicago. He’ll be discussing the importance of proactively treating atopic dermatitis in our pediatric patients. Let’s hear from Dr. Lio now.

Dr. Lio:
When I have a patient who’s not doing great with topicals and telling me they’re having sleep issues or they’re having trouble with school, then I say, “Listen, maybe can we start talking about some of these systemic agents?” I don’t ever push them. I’m not in the business of telling people what to do, but I say, “This might be an option. I’d like you to consider it.” And I’m doing that much earlier than I used to. And what’s really nice is I think families appreciate that because I’m not putting pressure on them. It’s like, “This is just an option.” Some families say, “You know, we’re not ready for that. Can we keep going with our topicals?” Absolutely. But then sometimes they’ll say even at that visit or the next visit, “Okay, I think we’re ready. Can we talk a little bit more about that systemic?” And that’s really exciting because we can use these things a little bit sooner than something that has a much higher rate of trouble, like an immunosuppressant. Many clinicians are still quite concerned about using systemic agents in kids, as they should be. I think we should treat it with respect, and we should be careful because we don’t know all the answers. We are very, very new at all of this.

But that being said, I think we can look at these patients and we try to explain that, yes, there are safety and tolerability issues, but there are real risks to not treating diseases as well. And by not treating atopic dermatitis, there are some major risks. We know, of course, patients are miserable. It affects their mental well-being. It affects their physical well-being. It affects their development. It affects their sleep. Can you imagine? We have a culture where everyone’s obsessed with sleep. We have sleep trackers, apps, watches, and beds that cool you down and heat you up and all this stuff. These guys, sometimes they don’t sleep properly for years. They don’t have years of sleep because their skin is miserable. They have a risk of infection. So just saying, “Well, maybe it’ll go away, and let’s just let time do it,” people do that. Trust me, I have examples of families and patients who said, “We don’t want any treatment.” I have watched them with a broken heart suffer and be miserable, and I really do worry that some of these patients—and we know this is true—will have permanent scars—not just physical, but mental, psychological, and developmental. You’re only four years old once. You don’t get to go through that again. So if your three, four, and five years of age were miserable—wet wraps, open skin, infections, oozing, bleeding, scratching all night long, and not sleeping—what do you think that means for the next five years? What do you think that means for this child’s development?

And, of course, our tools are imperfect, as they have always been. In the history of medicine, we’ve never had perfect tools. But I’m happy to say we do help people, and I’m so lucky. I feel like I have so many patients who have done much better and are sleeping now and going back to school, and hundreds of times, parents and families tell me, “He’s like a new kid.” “She’s like a new person. It’s amazing. She’s so much happier. We’re seeing her play again. We’re seeing her take interest in the world again. She’s able to do this again. She’s able to live.” And that means something. That is why we’re in the game. That’s the whole point.

Announcer:
That was Dr. Peter Lio talking about why it’s so important to proactively treat our pediatric patients with atopic dermatitis. the evolving treatment landscape for pediatric eczema. To access this and other episodes in our series, visit DermConsult on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!