Guidance on Guidelines: Managing Atopic Dermatitis with a "New York State of Mind"

In this episode of Derms and Conditions, host James Q Del Rosso, DO, is joined by Alexandra Golant, MD, to discuss taking a holistic approach to diagnosing and managing atopic dermatitis beyond the AAD guidelines, exploring the importance of looking beyond treatment rankings and considering comprehensive patient information. They begin by discussing the significance of patient history, emphasizing the importance of context clues like family history, seasonal variations in symptoms, and quality of life impacts in forming a comprehensive understanding of the individual. They also address navigating the challenges of gathering family histories, noting that despite challenges in obtaining accurate details, it's crucial to maintain a broad perspective while making diagnoses, focusing on key features while not losing sight of supportive aspects. Next, they highlight diagnostic challenges, emphasizing the need to consider atypical presentations and always keep a range of differentials in mind. Dr Golant discusses using therapeutics as both a treatment and diagnostic tool, with an emphasis on reassessment if treatment expectations are not met. Trigger factors are also explored, with both doctors sharing anecdotes that illustrate the impact of environmental triggers on symptoms. The pair also discusses their differing approaches to making skin care recommendations to their patients, highlighting that this varies among practitioners with some providing liberal suggestions and others providing more specific guidance. They then move on to discuss how they select treatments for their patients, noting that the integration of topical therapy is patient-dependent, with newer agents gaining traction due to improved tolerability. Systemic therapies, including monoclonal antibodies and JAK inhibitors, offer promising options, with treatment selection tailored to individual patient factors. Looking ahead, they note that advancements in monoclonal antibodies and targeted therapies hold promise for improving AD management. They conclude their discussion by highlighting evolving guidelines and a shift away from corticosteroids towards more targeted therapies, signaling progress in the field. Tune in to the full episode to hear more about using guidelines to inform a holistic approach to the management of atopic dermatitis!