VIDEO: How age, treatment history may impact atopic dermatitis management

Editor’s note: This is an automatically generated transcript, which has been slightly edited for clarity. Please notify editor@healio.com if there are concerns regarding accuracy of the transcription.

When you have a very young child who comes in for the first time, I'm not going to leap into a systemic medication. I am going to see what they've been using before, try to get a sense about whether there was good adherence, or was it used correctly. Was it strong enough medication even prescribed to begin with, which is a common problem with children.

I will usually spend a few months at least treating in a way that I think is appropriate, engaging adherence and measuring the results. And then I'll make a decision about whether to go to something systemic. An adult or an adolescent often has had their disease for quite a while, and there may be a long list of what they've used. And it's really, I think, important not to spend too much time fooling around with topicals. If there's a good record of having used them and not getting there, the patient has suffered for so long, and then I might more briskly jump to a systemic agent.

I'm going to be very careful in anyone about what to choose, but I'm going to be particularly careful in a child, even more so in a young child about choosing a medication that may have side effects or may require laboratory monitoring because that in itself is a huge stressor for our younger patients. And then in terms of how long to use the medication, that's also going to make a difference. We don't have good data yet. Hopefully, in the next few years. But we have every reason to believe that younger children are going to be much more likely to be able to stop a systemic medication and have a more sustained period without the disease or with very limited disease than what we see in someone who has had it chronically for a decade or more.

So, for example, I've seen this with cyclosporine when I start very early on and really aggressively manage, that the child can come off of it and be clear sometimes for years, maybe have it come up again later in life. So, I think that how we think about trying to taper, trying to get off of systemic medications in those who are moderate to severe when doing well, is also going to be something that may depend somewhat on age. Of course, comorbidities, different ages, different comorbidities, different risks of comorbidities developing. That's something we also have to pay attention to.