Casey Butrus, PharmD, leads a panel of experts in a discussion surrounding atopic dermatitis.
Casey Butrus, PharmD: Hello, and welcome to this AJMC® Peer Exchange program titled “The Evolving Treatment Landscape of Atopic Dermatitis and Other Dermatological Conditions.” I’m Casey Butrus, a senior pharmacist at Highmark in Pittsburgh, Pennsylvania. Joining me for this discussion are my colleagues Amy Brennan, a prior authorization coordinator at Skin Care Physicians in Lynnfield, Massachusetts; Dr Brian Keegan, a dermatologist from Princeton Dermatology Associates in Jamesburg, New Jersey; and Dr Michael Cameron, an assistant professor of dermatology at Icahn School of Medicine at Mount Sinai in New York, New York. Our panel of experts will explore the changing landscape of atopic dermatitis [AD] and targets for pharmacotherapy, as well as the payer considerations and best practices for supporting appropriate, cost-effective, and efficient utilization of dermatologic products. Thank you for joining us. Let’s begin.
Dr Cameron, give us a brief overview of atopic dermatitis, including common clinical features that help diagnose this disease.
Michael Cameron, MD, FAAD: Atopic dermatitis is a chronic relapsing/remitting disease. It’s an inflammatory skin disease, and it affects millions of Americans. It can be very debilitating. The hallmark symptom of atopic dermatitis is itch. Patients can be up all night scratching, even bleeding. There can be times in their lives when it’s completely quiescent and not affecting them at all, and there can be other times where it’s flaring and uncontrollable. They have to miss school and work. It can affect parents as well as caregivers.
Casey Butrus, PharmD: Do you notice certain ages or genders are more affected by this disease?
Michael Cameron, MD, FAAD: Some of the work my chair, Dr Emma Guttman, has done at Mount Sinai has shown that AD is probably multiple diseases. There are various endotypes, basically cytokine profiles that can describe different types of the disease. The East Asian ethnicity, for example, can present with papular eczema and things like that. Based on that, it can be present at different points of life. More recently, we’ve begun to identify adult-onset atopic dermatitis in patients who never experienced eczema as a child. I’m curious about what you have to say, Brian. It appears to be multiple diseases. It’s always on my mind when I’m evaluating a patient with a rash. Atopic dermatitis is 1 of the things I need to rule out.
Brian Keegan, MD, PhD: That point was really helpful. There’s sometimes a perception that this happens to only young children or adolescents and that they’ll just grow out of it. We’re definitely seeing a lot more adult-onset patients. Children who don’t outgrow it make up a substantial portion of the population because they continue to have atopic dermatitis for many years later. They still make up a substantial population we see in the office. It can be very itchy and uncomfortable and interfere with their quality of life, their effectiveness at work, and their interpersonal relationships. It can be a real challenge for patients.
Casey Butrus, PharmD: Dr Keegan, do you notice family history or genetics playing a role in atopic dermatitis?
Brian Keegan, MD, PhD: There’s definitely a family history component, and there seems to be more correlation regarding where you are within your birth order and where in the world you grew up. It seems to be a bit more prevalent in firstborn children than second or third and more prevalent in urban communities. With all these things, we’re trying to understand some of the physiology of what’s happening within the body that may contribute to why different subsets of populations have it.
Transcript edited for clarity.