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Dr Robert Sidbury on Mental Health Implications of Atopic Dermatitis


Robert Sidbury, MD, MPH, chief, Division of Dermatology, Seattle Children's Hospital, spoke on the mental health comorbidity risk linked with atopic dermatitis and how dermatologists can play a role in managing behavioral care needs of at-risk patients.

Although dermatologists cannot directly provide care for mental health needs of patients with atopic dermatitis (AD), consultations on disease burden can open opportunities to spotlight potential behavioral health care gaps in at-risk patients, said Robert Sidbury, MD, MPH, chief, Division of Dermatology, Seattle Children's Hospital.

Sidbury recently served as coauthor of a study published in the Journal of the American Academy of Dermatology, titled “AAD Guidelines: Awareness of Comorbidities Associated With Atopic Dermatitis in Adults.” He also participated in a panel discussion at the 2022 American Academy of Dermatology (AAD) Annual Meeting, titled “Translating Evidence into Practice: Atopic Dermatitis Guidelines.”


Can you speak on the behavioral health implications cited in the recently updated AAD guidelines on comorbidity risk in patients with AD?

Yeah, that's a great question. It's a really important question—maybe the most important question that comes out of these guidelines. And I will say to be very clear that these guidelines do not recommend any specific form of screening. I think that's really important to say, because we didn't have the evidence to do that. That was not what the nature of our literature search did and what was within our purview.

That said, we have this document that tells our community of providers that AD is associated with depression and anxiety. As a provider, as myself, totally independent of my role with these guidelines, I hear that and I hear this document saying: OK, we're not saying you must screen or you must do this or that. But I'm also saying: OK, well, now I know that this is an issue for my patients.

I know I'm not a psychiatrist. I can't manage this. I can't prescribe SSRIs [selective serotonin reuptake inhibitors]. I can't primarily deal with this, but what I can do is ask the question: Are you losing sleep every night? How does that affect you? How does this make you feel? Does it have impacts beyond just itchy skin? And oftentimes, the answer is yes. And oftentimes, the answer is profoundly yes. And that's when we start to get into these patients who truly do have other psychiatric diagnoses, such as depression or anxiety.

And then if we know that, it doesn't mean it's then all on us to fix. Of course not, but it does mean we have the awareness to allow our patients to be supported in the way that they should be supported. Maybe that's calling, in my world—I'm a pediatric dermatologist—maybe that's calling their pediatrician, and saying: Hey, maybe this didn't ever come up in your conversations about other things, but it's come up today; please help this patient the way they need to be helped.

In the adult population, maybe it's having that patient say, hey, what sorts of resources do you have that might be able to help you with this, let me make a referral for you or let me link you into some resources that you may not know about. So, it may take us in a little bit different direction than we're used to as dermatologists, but it is so worth it.

What role can dermatologists have in managing adverse mental health risks in teens?

Yeah, thanks for asking that, because I do think it's important. A 3-year-old, a 4-year-old, a 5-year-old, they're going to go to their doctor's visits, because their parents are going to take them there. They're going to probably say: If I have an itchy rash, I have an itchy rash, or something's bothering me on my skin, I'm going to tell that doctor, or if I'm bothered about something, I'm going to tell my parents, I'm going to tell that doctor.

That's not the case with tweens, that's not the case with teens, they may be reticent to speak about those things. And so we may be the only doctors they're seeing on a regular basis. My 16-year-old daughter does not go to her pediatrician anymore every year just to go and have a well-child care checkup. So, if she's got something going on that she's not willing to tell me about, she's not going to her doctor, so who she's going to tell?

So, I think we as dermatologists have this window of opportunity. Since tweens and teens are worried about their acne, they are coming to us to see us for their skin, and so we have this opportunity maybe to take advantage of the fact that they're coming to us in this context for their eczema and sort of ask the questions that might be related to the eczema, but not particularly a symptom of the disease itself.

And so I think it's so important to leverage that opportunity to ask the patients about these things. The example I use that was not psychiatric in nature in our talk was with regard to hidradenitis suppurativa—a really impactful disease that some people call acne inversa, because it's almost like acne lesions in strange spots, the axilla and the groin, but it's not acne. It's intense inflammation in those locations that sometimes because they're in the groin, because they're in the axilla, kids don't want to mention it. They're too embarrassed and haven't even told their parents, they may not have told their best friends.

So they come in for their acne, and we can use that opportunity to say: Hey, do you get acne in these locations? It's not acne, but it gives them the opportunity to say: Oh, wow, yeah, I do. And then you might have a window into helping them that you didn't have before.

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