Dr Jason Ezra Hawkes: Education on Chronic Nature, Subtypes of AD Key in Managing Diverse Patients


Jason Ezra Hawkes, MD, MS, FAAD, board-certified dermatologist and associate professor of dermatology at the University of California Davis in Sacramento, discussed why it is important for dermatologists to educate patients on atopic dermatitis (AD) and keep an open mind on variations in disease presentation by skin color.

It is critical for dermatologists to educate patients on the disease course of atopic dermatitis (AD) and understand how disease presentation may vary by skin color, said Jason Ezra Hawkes, MD, MS, FAAD, board-certified dermatologist and associate professor of dermatology at the University of California Davis in Sacramento.


What considerations should be top of mind for dermatologists managing the care of diverse patients with AD, both in the pediatric and adult setting?

One need that we need to focus on is really centering our conversations on education about what the disease is and what the disease isn’t. So, especially with AD, it's highlighting this idea that they're dealing with a chronic condition in most cases, and that it goes through this very typical atopic march where we might see the development of other conditions. So, allergies, food allergies, sensitivity to latex or adhesives.

So, we start to see the disease change. They might have flexural disease when they're younger, and it sort of starts to evolve and presents differently in adulthood. So, I think education about the disease course and what to expect is really critical and we need to be driving that discussion. So, if there's expectations as to what this disease might look like over time, it's important to talk about how this condition impacts quality of life. For kids, for example, this is a huge sleep problem. It can also be an issue with school and how they interact socially. So, there can be a lot of stigma associated with these chronic conditions, eczema and both psoriasis and other skin conditions. So, we need to be considering that.

Having this conversation with patients that have seen multiple dermatologists or other providers, for example, it's shocking to me how many patients have not been told or don't understand the fact that they have a chronic skin condition. So, I think those are important points to kind of hit with patients.

And I think the other aspect I think about with managing conditions like eczema is that when treatments aren't working, sometimes we have to back up and rethink the diagnosis because there's a lot of mimics of eczema, for example. So, we need to be open to that. And the last point I'll make is about being maybe more open or less tied to particular therapies or conditions in skin of color, where presentations may be atypical.

This is true for AD where we can certainly see flexural disease, but sometimes for skin to color, we don't see the scale as well, we don't see the erythema. Sometimes there's a papular subtype of eczema that looks different from the typical plaques that we can see. And so we need to really kind of be open to some of these different subtypes and be a little more vigilant in diagnosing these conditions in skin of color.

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