From Environmental Triggers to Emotional Toll 

In this episode of Topical Conversations, Michelle Tarbox, MD, and Peter Lio, MD, take a comprehensive look at the evolving landscape of atopic dermatitis (AD), a condition that continues to challenge patients, families, and clinicians alike. They explore the environmental and emotional toll of AD, including how weather, wildfire smoke, and treatment fatigue complicate care. 

Cold Weather, Wildfire Smoke, and the Skin Barrier 

Dr Lio notes that winter often triggers AD flares due to dryness and disrupted skin barrier function. He highlights emerging research identifying isocyanates—components of wildfire smoke—as potential microbiome disruptors that may directly worsen AD. Dr Tarbox references data linking increased AD clinic visits and hospitalizations to wildfire exposure, reinforcing the importance of climate-related awareness in dermatology. 

When Topicals Aren’t Enough 

While mild AD can often be managed with topical therapies and gentle skincare, more severe cases require a different approach. They discuss treatment challenges such as poor adherence in children, fear of stinging medications, and the physical and emotional strain on families. Dr Lio breaks down why topicals sometimes fail and advocates for timely escalation to systemic therapy when appropriate. The Family Burden and the Path Forward The impact of AD extends beyond the skin. Dr Tarbox describes how the condition can dominate daily routines, strain marriages, and even disrupt childhood growth due to chronic inflammation and sleep loss. Both physicians emphasize the importance of moving from the vicious cycle of uncontrolled disease to a virtuous cycle of healing, and how newer biologic and oral treatments are making this more achievable than ever before. 

Biologics and the “Renaissance” in AD Treatment 

With multiple systemic therapies now available, including biologics for children as young as 6 months, patients and providers are entering a long-awaited “renaissance” in AD care. Dr Tarbox draws comparisons to the revolution seen in psoriasis treatment, noting how gratifying it is to now have effective tools for patients with eczema. Dr Lio adds that some newer therapies may even allow for reduced dosing over time, a hopeful sign for long-term disease control. 

Shared Decision-Making and Long-Term Trust 

Treating AD means building relationships. Both physicians advocate for shared decision-making and patience when introducing systemic options, especially in pediatric cases. Dr Lio shares a helpful tool: the Atopic Dermatitis Control Tool (ADCT), which helps patients recognize how deeply AD affects their lives. They close by emphasizing the value of listening, following up, and guiding families toward relief without pressure, but with compassion and clear options. 

Key Takeaways 

• Environmental triggers like cold weather and wildfire smoke can worsen AD and damage the skin barrier.
• AD affects the entire family and can impact child development, sleep, and quality of life.
• Topical therapies are not always enough; systemic options, including biologics, are now available for severe cases.
• Timely treatment can prevent disease “hardening” and improve long-term outcomes.
• Shared decision-making and regular follow-up help patients feel empowered and supported.