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Dr Robert Sidbury on Psychosocial, Behavioral Issues Linked With Atopic Dermatitis


Robert Sidbury, MD, MPH, chief, Division of Dermatology, Seattle Children's Hospital, discussed the psychosocial and behavioral issues faced by patients with atopic dermatitis, particularly those with severe disease.

For patients with a severe course of atopic dermatitis, emerging research has identified significant psychosocial and behavioral comorbidities in these patient populations, said Robert Sidbury, MD, MPH, chief, Division of Dermatology, Seattle Children's Hospital.

Sidbury recently served as co-author 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."


Psychosocial distress and behavioral problems have been identified in patients with atopic dermatitis. Can you discuss this association and recommendations for intervention?

For sure, it's been the last few years where some really important publications have come out highlighting this. Something that I think those of us who've treated patients with this condition, or at least patients on the more severe end of the spectrum with this condition, for years have known about, just because it's so impactful. And it's tricky because eczema—I'm a pediatric dermatologist so I just see kids.

I've obviously been involved in the guideline committee for the American Academy of Dermatology for adults as well, and that's the nature of the publication that we're talking about right now, but we've known that this is a condition that itches 24/7. Certainly, before biologics and the more recent therapies, we've not had great treatments, we've had good treatments, but not great treatments for it. And so it's always tough for me, because I hear the phrase: just eczema—oh, it's just eczema.

For kids who use a little vaseline it goes away, doesn't really keep them up at night—yeah, it is just eczema. But for the more severe end of the spectrum, it's just a different animal entirely. And for those kids, if you kind of imagine yourself having an itchy rash or a bug bite or something, it can be incredibly distracting, and even painful for the relatively short duration that you deal with it.

These are kids who deal with this or adults who deal with this 24/7. And so you might imagine in such a circumstance, particularly when your provider can't say: okay, well, I'm going to give you medicine, it'll be done in 2 weeks. No, this is a condition that's chronic, we've not had a cure, still don't have a cure, we just have better treatments. And so that context of a constantly itchy condition for which there's no clear end point, think about the psychological stress that would impose upon someone.

So, we've known about that. Now, some papers in the last few years have fleshed that out, and this paper that we've talked about—the comorbidity paper that was just published in the Journal of the American Academy of Dermatology, the JADD, it did show that atopic dermatitis is associated with depression, is associated with anxiety, some less certain associations with other things such as substance abuse, alcohol, cigarettes, but these are important things to be aware of.

At the very least, to discuss how effectively patients are being treated to try and mitigate the impacts on other aspects of their life and even to in cases pointedly question, how are our patients doing? Psychologically, how are they coping? What are the impacts of these diseases psychosocially? Because a lot of times if we don't ask, we won't know. And this literature is suggesting that in many, many patients we very much should ask.

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