Dermatologists need to consider modifying the appointment system to improve access to care for patients with atopic dermatitis flares, suggests researcher Jonathan Silverberg, of the Department of Dermatology, Preventive Medicine and Medical Social Sciences, at Feinberg School of Medicine, Northwestern University.
In a recent analysis of patient consults, published in The Journal of the American Academy of Dermatology, Dr. Silverberg and colleagues found that outpatient healthcare visits in U.S. children and adults with atopic dermatitis or eczema were increasing over time.
Atopic dermatitis is very common in the United States, affecting approximately 13% of children and 7% of adults. Many if not most patients with mild and intermittent atopic dermatitis can be managed in the primary care setting. Patients experiencing a flare will probably have an easier time getting into their primary care provider during a flare. Most primary care providers can provide basic skincare recommendations and short-term treatment approaches for flares,” he said.
“However, patients with chronic atopic dermatitis, moderate to severe atopic dermatitis, refractory atopic dermatitis, and atopic dermatitis complicated by comorbid infections or contact dermatitis require customized treatment approaches that are best suited for the dermatology setting.”
Many flaring patients will have chronic disease and it is important to assess the chronicity and longitudinal course of atopic dermatitis to properly tailor treatment, and that this is often best done in dermatology, Dr. Silverberg stressed.
But the problem with most dermatology practices is that they are typically not set up to allow timely follow up and or allow enough time for thorough discussion regarding the tremendous facets of one’s atopic dermatitis. Chronic, severe eczema can not be effectively managed in a 5 minute in office dermatology visit. A different approach and treatment platform is needed to address the special needs of those with chronic severe eczema.
Given that this condition is a chronic problem for most with moderate to severe disease, a treatment model that allows for timely follow up and allows for sufficient interaction between the patient and the provider is key for any long term success to occur.
“Atopic dermatitis patients are typically given a prescription for an undersized tube of topical corticosteroids and told to use it for a few weeks,” Dr. Silverberg said. “Patients with chronic atopic dermatitis require long-term treatment approaches, such as steroid-sparing agents and use of proactive therapy for flare prevention.”
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