In this episode of Topical Conversations, Nicholas Brownstone, MD, sits down with Dawn Merritt, DO, to discuss the often-overlooked impact of atopic dermatitis (AD). While dermatologists may see a rash that appears mild, for many patients the disease affects far more than the skin, touching sleep, mental health, cognitive function, and overall quality of life across all age groups.
Pediatric burden
Dr Merritt emphasizes that pediatric patients and their families face a unique set of challenges. Children with AD often require multiple prescriptions per year, and caregivers may spend more than 10 hours weekly managing symptoms. This burden extends beyond the patient, commonly affecting parents’ time, energy, and mental health.
The itch burden and mental health
Pruritus is central to the disease burden in AD. Studies show patients with itch experience worse quality of life than those with chronic conditions like heart failure or stroke. Sleep disruption from itch can contribute to depression, anxiety, and even suicidal ideation. Dr Merritt notes that over 85% of patients with moderate-to-severe AD report at least itch or sleep disturbance as a symptom.
Impact on school performance
Children with AD may miss school due to rash, infection, or poor sleep. Even when present, they often struggle to concentrate (presenteeism), which can affect academic performance and self-confidence.
Asking the right questions
Both speakers stress the importance of asking beyond “How are you doing?” to uncover a patient’s full burden of AD. Specific questions about sleep, school, itch severity, and mental health allow patients and families to share concerns not visible on exam. Simple tools such as the Atopic Dermatitis Control Test or the PHQ-2 depression screen can help integrate formalized assessments into a busy clinic.
Systemic therapies and emerging data
For patients with significant quality-of-life impairment, Dr Brownstone recommends considering systemic therapy and referral to mental health support. Emerging data highlight that systemic biologics, such as dupilumab, may not only control skin symptoms but may also potentially improve growth outcomes and reduce ADHD medication needs in pediatric patients.
A new therapeutic landscape for pediatric patients
Systemic options for AD have been expanding rapidly. Dupilumab is approved for patients as young as 6 months, while biologics such as lebrikizumab, nemolizumab, and tralokinumab are available for patients aged 12 and older. Compared to the limited options of the past, Dr Brownstone describes this as a “golden age” for pediatric AD management.
Addressing comorbidities and empowering families
Drs Brownstone and Merritt conclude their discussion by emphasizing that effective care includes addressing comorbidities such as sleep disturbance and depression. Dr Merritt also uses simple, relatable tools, like asking children to grade their AD with a letter grade, which helps track disease burden across visits. Both recommend connecting families to resources such as the National Eczema Association to provide education and empowerment.
Key takeaways
In this 45-minute symposium, expert faculty cover the latest updates for JAK inhibitors, including head-to-head efficacy and safety data for JAK inhibitors and biologics, and share clinical pearls for using JAK inhibitors in dermatology practice for atopic dermatitis."I can say that in my clinic, I am reaching for those high bars. You have toput yourself in the position of the patient or imagine that patient is your family member. Would you want mediocre treatment for them or average treatment or moderate treatment? You’d want them to get the best possible treatment. In my practice I’m now counseling patients 'yes we want clear skin. Yes, we want minimal itch. Yes we want your skin pain gone and for you to sleep better.'”- David Cotter, MD, PhDFC25: Charting the Course to Higher Targets With JAK Inhibition in Atopic Dermatitis: An Online ActivityThis activity is supported by an educational grant from AbbVie.
Don’t miss this Satellite Symposium from the 2025 Fall Clinical Dermatology Conference®, as Dr. Alexandra Golant, Dr. Mona Shahriari, and Dr. G. Michael Lewitt discuss IL-13 targeting biologics in the treatment of atopic dermatitis as well as strategies for optimizing their use.“To me, coming into an exam room in 2025, when we have so many different treatment options for these patients, it's a unique opportunity to use what we know about the data of these therapeutics and walk patients though their options and how to understand their disease state, and how to best choose the therapy that feels right for them.” – Alexandra Golant, MD FC25: Illuminate the Role of IL-13 Inhibitors for the Management of Atopic DermatitisThis activity is supported by an educational grant from Lilly.
“Of course we’re always starting with our basics: we’re using our gentle cleansers, our moisturization, our avoidance of known allergens or triggers, and then we're doing our topicals. But it can be very difficult if you have heavy stuff on your face or you’re required to put it on over and over. It can be really tough. So this paves the way really nicely to say it is time to move up, it is time to think about the next level, and typically the next step up is going to be a biologic agent.” - Peter Lio, MDA ‘HowTo’ activity delivers a short burst of engaging and compact content for learners to study at their own convenience. This microlearning activity is intended to provide practical insights from two experts on ‘HowTo’ improve care in head and neck atopic dermatitis in 10 minutes.This activity is supported by an educational grant from LEO Pharma.
This 30-minute symposium from the 2025 Pediatrics360 Virtual Conference takes a closer look at biologic therapies that can address the immune pathophysiology, associated comorbidities, and progression of moderate-to-severe atopic dermatitis in pediatric patients.“A lot of them (children with atopic dermatitis) do have tactile sensitivities and don’t like the way any creams, ointments, anything, feel on their skin. Thinking about a shot, even though it hurts, doing a shot once or twice a month can actually often be so much easier than having the parents have to argue with the kid two to three times a day to get the topicals on. So, I actually think of injections very quickly for patients with tactile sensitivities.” – Dr. Elizabeth SwansonPEDS25: Controlling the Wolf in Sheep’s Clothing: Managing Pediatric Atopic Dermatitis with Biologic Therapies: An Online ActivityThis activity is supported by an educational grant from Sanofi and Regeneron Pharmaceuticals, Inc.