Atopic Dermatitis: A Patient and Dermatologist's Perspective

This article has been co-authored by a patient with atopic dermatitis (AD) and her consulting dermatologist who is based at the University Hospital in Angers, France. Here they discuss the patient's experiences and difficulties with AD, as well as strategies that can help a patient in this situation. The patient describes the history of her illness and the difficulties encountered, particularly in terms of quality of life. She describes the various treatments she has received, mainly based on topical corticosteroids, and tells of her satisfaction at being treated today at the University Hospital. The healthcare team there is supportive and reassuring and she is receiving a systemic medication that has successfully reduced and controlled her AD symptoms. The physician describes the main characteristics of AD, and then reviews this case of chronic eczema with topographical localisations on the hands, head and neck and diffuse flares. Rapid resolution of the flares on the patient's hands and face, which were having a strong impact on mood, was achieved by treatment with systemic ciclosporin and topical corticosteroids. In 6 months, treatment with dupilumab will be planned to avoid ciclosporin-induced adverse effects on kidney function. The pivotal roles of therapeutic education as an adjunct to conventional therapy, a good patient-physician relationship with consideration of the patient's personal preferences, and treatment objectives are highlighted in this perspective piece. Plain Language Summary This article has been co-authored by a French patient who has had atopic dermatitis (eczema, AD) since childhood and her dermatologist, a French healthcare professional based in a university hospital in Angers. AD is caused by a genetic variation that affects the skin's ability to protect against bacteria, irritants and allergens. In people with AD, environmental factors make the skin red and itchy. AD can occur at any age; it most often begins before 5 years of age and may persist into adolescence and adulthood. AD signs and symptoms vary widely, and the disease may be accompanied by asthma and allergies. AD is long lasting (chronic) and, even if treatment is successful, signs and symptoms may return (flare) periodically. The patient describes her personal experience, including how the discomfort from the AD on her face and hands affected her daily activities and sleep. She talks about having to try various treatments, including home remedies, over the years to control AD and relates her frustration when experiencing symptoms. Now she is being monitored by a healthcare team in a French university hospital that gives her full care and support. As a result, she is now receiving a systemic medication that reduces and controls the AD symptoms and she is very satisfied with her care. The dermatologist notes that this patient's experience is a common clinical picture of AD in adults, and discusses how the patient was treated and how the treatment will evolve over time. The dermatologist emphasises the importance of a good patient-physician relationship for successful AD management. This should be based on confidence and empathy, and consider the patient's expectations, personal preferences and treatment objectives. Therapeutic education (educational programs, video training and workshops) is pivotal as an adjunct to conventional therapy.