Drs. Brittany Craiglow and Brett King highlight their panel discussion on All Things Atopic on Thursday, November 9, 2023, at the 4th Annual Elevate-Derm PA/NP Conference in Coachella Valley, CA.

In this video

Dr. Craiglow explains how dupilumab — now approved down to six months — "totally revolutionized" pediatric AD care and made her realize she had been under-treating patients when the only alternatives were methotrexate and cyclosporine with "scary" box warnings. She reaches for systemic therapy earlier now, particularly for the "not severe, but never clear" child on an elaborate topical regimen whose disease disrupts sleep, school, and quality of life. Dr. King emphasizes that AD is "bigger than" asthma and atopy, with growing associations to HS, learning disabilities, depression, and suicidal ideation — which calls on providers to be more inquisitive about how patients are functioning at home and school.

Both push back on the idea that improvement is the finish line: because dupilumab worked so well for so long, King argues, clinicians "insisted that better is good enough," when the real goal is clear or almost clear and an IGA of zero, one, or two. Craiglow offers practical strategies for skeptical parents — meeting them where they are, framing the risk of not treating, and telling families "I'd never treat a child with something I wouldn't give my own kid." King closes by encouraging providers to challenge patients who've simply adapted to being itchy: "let's just try better."

  • Reach for systemic therapy earlier — an elaborate Monday/Wednesday/Friday-plus-wet-wraps topical regimen is a signal the disease warrants more, especially for "not severe, but never clear" kids.
  • Look beyond the skin: AD carries comorbidities including HS, learning disabilities, depression, and suicidal ideation, so ask how patients are functioning at home and at school.
  • "Better is not good enough" — with dupilumab, oral JAK inhibitors, tralokinumab, and more, strive for clear or almost clear and an IGA of zero, one, or two.
  • Manage AD like any chronic disease with defined targets, the way you would diabetes, hypertension, or hyperlipidemia.
  • With hesitant parents, meet them where they are, acknowledge concerns, frame the risk of not treating, and note you'd only treat their child the way you'd treat your own.