Closing Thoughts With Patient Cases: Choosing the Right Topical Treatment for Patients With Atopic Dermatitis

EP: 1.Recognizing Atopic Dermatitis in Practice and Differentiating from Other Skin Conditions

EP: 2.Differences in Atopic Dermatitis Presentation Across Age Groups and Skin Types

EP: 3.Determining Atopic Dermatitis Severity in Clinical Practice

EP: 4.Addressing Current Topical Management of Atopic Dermatitis in Primary Care

EP: 5.Navigating Appropriate Use of Topical Corticosteroids in Atopic Dermatitis Treatment

EP: 6.Risks and Adverse Effects of Long-Term Topical Corticosteroid Use

EP: 7.Exploring Newer Nonsteroidal Topical Treatments for Atopic Dermatitis: PDE4 Inhibitors

EP: 8.Newer Nonsteroidal Topical Treatments for Atopic Dermatitis: JAK Inhibitors and AhR Agonists

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EP: 9.Closing Thoughts With Patient Cases: Choosing the Right Topical Treatment for Patients With Atopic Dermatitis

The speaker emphasizes the importance of simplifying treatment regimens for patients, especially when using topical steroids. The issue arises when patients are prescribed different potencies for different body parts—low potency for the face, mid potency for the body, and super potent for hands—without fully understanding the regimen, making it difficult to follow. The speaker advocates for nonsteroidal treatments, which offer an advantage by simplifying the process and avoiding concerns about steroid adverse effects, offering a more straightforward approach. Clear written instructions and regular follow-ups are crucial for patient success, as many patients stop their treatments too soon, thinking it didn’t work, when in fact the drug worked but they didn’t follow through as instructed.

When it comes to referrals, the speaker suggests a thoughtful approach. It’s recommended to first try a topical therapy and then assess if it’s working. If the therapy doesn’t work after a reasonable trial, it may be time to consider a referral. The speaker points out that some primary care physicians are overly cautious about referring, and patients can end up struggling unnecessarily. However, collaboration with dermatologists is essential for getting patients the help they need, particularly when specialized care is required. Building relationships with dermatologists who take insurance and can see patients sooner is critical. The speaker also discusses the need for more crosstalk between primary care and dermatology, particularly for complicated patients.

The speaker concludes by discussing the advancement of treatments, particularly systemic therapies and biologics. There’s a case for moving to systemic treatments or biologics after 1 failed topical therapy, although some might prefer to try additional topicals. Biologics like dupilumab, tralokinumab, and lebrikizumab work similarly, with nemolizumab having a novel mechanism and better effects on both itching and lesions. Janus kinase inhibitors, though effective, come with significant safety concerns, including boxed warnings for potential mortality risks. The speaker highlights that, with increasing innovation in the systemic space, there are now more options than ever, but safety and patient characteristics should be carefully considered when progressing to these therapies.