Elena B. Hawryluk, MD, PhD: Managing Atopic Dermatitis in Pediatric Patients

Elena B. Hawryluk, MD, PhD, FAAD, FAAP

For pediatric populations, the onset of complications brought on by atopic disease could have dramatic social, emotional, and physical effects on their daily lives.

Luckily, health care professionals such as Elena B. Hawryluk, MD, PhD, FAAD, FAAP, Massachusetts General Hospital Dermatology, have been loyal in their efforts to manage conditions such as atopic dermatitis and acne in young patients.

In her session “Tips for Managing Atopic Dermatitis” which was presented at the 2021 American Academy of Pediatrics Virtual Conference, Hawryluk spoke of the complications of diagnosing pediatric patients with atopic diseases, and how caregivers and clinicians can better treat an affected child.

Hawryluk detailed some of the data found in her presentation in an interview with HCPLive.

HCPLive: What are the physical and psychological implications of atopic dermatitis on pediatric populations? What is the epidemiology of this disease, and how do the burdens associated with it affect young patients over time?

Elena B. Hawryluk, MD, PhD:Physically, atopic dermatitis causes itch, pain, soreness; it is physically disfiguring with ready appearance of disease.Psychologically, atopic dermatitis can be distracting, disfiguring, and uncomfortable; also in visible areas and stigmatizing.

HCPLive: What are some clinical features of atopic dermatitis in young patients? How do patients and caregivers recognize them?

Hawryluk, MD, PhD:Eczema has a very characteristic presentation in young patients, including itch, dry skin, and inflammation, with distribution in typical areas.Often a rash will appear in areas of itch, so called “the itch that rashes.”

HCPLive: In your session, you speak on some of the myths associated with atopic dermatitis management. What are some of the misconceptions and potential falsehoods of this disease, and how do they affect how young patients are treated? How do patients, parents, and clinicians stay informed on this disease?

Hawryluk, MD, PhD:I think one of the biggest challenges and myths associated with atopic dermatitis management is pressure to use products that are natural and organic, while these products may also be very irritating to patients with sensitive skin and atopic dermatitis.I find this challenging because I know that my patients’ parents are purchasing often expensive and carefully selected products to do their best for their child!However, many natural products are highly fragranced, which is a common trigger for atopic patients.

HCPLive: What are some ways in which patients and caregivers can establish a successful therapeutic regimen? What are some common goals, and how do patients maintain these regimens?

Hawryluk, MD, PhD: The treatment regimens for atopic dermatitis can be quite cumbersome and so I like to think about managing with a “flare plan” which is more intense for a brief duration, and a “maintenance plan” which is more manageable.It is vital to have a baseline expectation of emollient use because taking a pause from treatment can cause big setbacks in the skin.

HCPLive: How do you go about counseling families and affected patients about proper skin care? What do those conversations entail, and what are some acceptable products and methods for the management of atopic dermatitis?

Hawryluk, MD, PhD:One of the most important considerations is meeting each patient and family “in the middle” with a plan that incorporates their preferences.It is actually one of the most interesting parts of eczema management and adds variety to my day.In general I recommend routine skin care with regular bathing, gentle and fragrance free products, and frequent emollient use.

HCPLive: What changes need to occur to allow for more inclusive and informative discussions to be had about the management of atopic dermatitis? What improvement would you like to see in this field/ what needs to be done?

Hawryluk, MD, PhD:I think the most important factor for inclusive and informative discussions in atopic dermatitis care is listening.I introduce a lot of the concepts we use as “let’s try this for a bit and see” because eczema care is not “one size fits all” and the disease is expect to wax and wane over time.It is very important to equip our patients with a number of strategies and tools to help, while also incorporating a patient/family’s input on their preferences to align treatment strategies.