Understanding Atopic Dermatitis in Teens: A New Perspective
A few weeks ago we were approached by The Understand AD Squad, a program dedicated to raising awareness and understanding atopic dermatitis in teens.
The program currently documents the experience of 17-year-old AD patient Isaiah as he gains valuable insight from a group of experts on managing his disease on his own as he transitions into adulthood.
The campaign brings together the knowledge and expertise of a pediatric dermatologist, psychotherapist and an adult peer who has lived with atopic dermatitis since he was a child, to help raise awareness and inspire kindness and empathy for teens battling atopic dermatitis.
We had the chance to interview pediatric dermatologist Dr. Mercedes E. Gonzalez and psychotherapist Christine Triano on teen atopic dermatitis. Check out our Q&A below!
Dr. Mercedes E. Gonzalez (see bio below)
Q: How common is it for children to continue to experience eczema from childhood into adolescent years (not “grow out of it”)?
About a third of kids do not outgrow [eczema]. It’s a very common misconception [that kids may outgrow atopic dermatitis or eczema], not only in the general public but among pediatricians and general practitioners in the medical community as well.
Q: In existing eczema cases, is it common to see eczema change when a child hits puberty? Can you explain?
Some patients do improve when the hormonal changes of puberty happen. This is true in many skin conditions and chronic diseases in general – arthritis, for example. Kids that get arthritis when they’re really young, often no longer experience symptoms after puberty.
Any time when there’s a hormonal shift, it could make [the condition] worse or better. I’ve seen both situations – I’ve definitely seen [instances] where very severe eczema clears up and gets a lot better with puberty, or just gets worse. [Approximately] 30% [of patients] will have a persisting condition, and if you have it into older childhood and adolescence, about 50% will get better with puberty.
Q: Discuss the impact eczema has during teenage-years and why it’s particularly challenging as a teen.
[In the Understand AD Squad initiative], this is a lot of what Isaiah talked about. [Teens with moderate-to-severe atopic dermatitis] have to start choosing activities based on how they’re skin is going to react and avoid participating in certain things, like sports, where they get very sweaty.
They also have to choose their clothing carefully, and even wake up an extra hour early, to care for their skin. The daily care routine required by these adolescents can be burdensome and impact their ability to do other things.
Then, there’s the fact that [the disease] is very highly visible. The skin looks different and can effect interactions with peers and impact how teens feel about themselves.
Q: What other factors can affect eczema at this age? What would cause eczema for the first time?
We don’t know exactly what causes eczema but we do know that there’s a hereditary component. I think of …four main factors that contribute to eczema development:
- Genetics – a hereditary predisposition
- Defects in epidermal, or skin, barrier where the skin is not formed properly and there are a lot of leaks or holes between the skin cells that allow for easy penetration of allergens and antigens to enter
- Problems with hypersensitivity of the skin, and makes it reactive to certain types of inflammation
- Environment – environmental factors that serve as triggers for flare-ups
Q: At this age, is it more common to see eczema on certain parts of the body than others?
Yes, there is an age-specific pattern of distribution to the lesions in atopic dermatitis.
The eczematous lesions are typically present on the face and extensor surfaces of the extremities when in infancy. Once you’re in childhood – and into adolescence, especially – it’s the flexural surfaces (elbow and knee creases) that are typically affected. In mid-adolescence, in addition to the flexural surfaces, the neck, and the skin around the eyes on the face are often also problematic.
Q: Acne often appears for teens around this age – what are the causes for acne vs eczema? Do they ever appear at the same time in the same location on the body? What else should we know about acne vs eczema or their connection to one another?
No, there’s not a connection. They are two separate diseases. Acne tends to happen around puberty because of the hormonal changes and the resulting increase of oil production in the oil glands, and that leads to clogging of the hair follicle which [causes] the development of the acne pimple or lesion.
The two diseases can occur in the same location on the body, such as the face, and that gets tricky because the treatment of the eczema can cause acne or make acne worse and vice versa – treatments for acne can, sometimes, make eczema worse. I’ve seen this happen in many of my patients.
Q: What are your top tips for teens who have been newly diagnosed with eczema? And top tips for their parents?
[Ensure] your skin care routine includes products that are specifically made for sensitive, dry skin, such as fragrance-free products, gentle skin cleansers and moisturizers. Make sure you’re working closely with a dermatologist who has an expertise in eczema to give you the proper treatment as soon as possible. The sooner you treat a flare-up, the quicker it will go away. The longer that you let a flare-up go untreated, the thicker it will get and the more likely it is to get infected. It’s also important to have a skin care routine in place and to stick to it as much as possible.
For parents, make sure you have someone with an expertise in eczema who you can trust to guide you through the proper treatment options. Get to know what your child’s triggers may be and try to avoid them.
Q: How do you use the Understand AD videos/content as a resource in practice and what does it offer beyond the doctor-patient visit?
The Understand AD videos and content provide a level of connectedness, reality and empathy that goes above what can be conveyed in the exam room. Parents with a child or adolescent with moderate to severe AD will instantly identify with the Dixon family and their struggles. I encourage patients and families to watch the videos and view the content so that they can see that they are not alone. By viewing how Isaiah and his family have been able to live with and overcome many of the challenges associated with moderate-to-severe AD they may be inspired to assemble their own Squad to do the same.
Christine Triano (see bio below)
Q: What are your top tips for teens who have been newly diagnosed with eczema? Any advice for parents?
For teens, this is an age and stage when it’s really important to take some agency and ownership over their own care – whether it’s mental, emotional, or physical. It’s important to connect with resources and learn as much as you can, having open discussions with family about what it’s like and what the plans are going to be, because a new diagnosis is really overwhelming. So, slowly acknowledging [the diagnosis] and honoring those feelings and then moving into the stage of getting armed with information, resources and plans.
For parents, make sure you’re taking care of yourself. Nobody wants to hear that their child has been diagnosed with a disease, especially one that is chronic. So make sure you’re taking care of yourself so that you can show up and be as supportive, connected and calm as you can be for your kid. Involve [your teen] in what the treatment plan is, who the doctors are and what the resources are that you need. Making sure that they feel included is super important.
As parents, we want to charge ahead and take over – especially when we’re feeling that anxiety ourselves, “oh no, something is wrong with my kid!” It’s important to slow down, be explicit and communicate through all of the steps.
Q: Discuss the social impact of a chronic illness diagnosis on teens.
A chronic disease diagnosis may mean that your teenager is not going to get to do some of the things that they hope to, like play a sport or go on vacation. The family needs to take all of those things into consideration and figure out new ways to be connected, find shared joy and keep creating positive memories.
Q: Can you provide any tips for promoting a sense of empathy and kindness to children, as well as advice for addressing your child’s diagnosis with their siblings?
Family communication becomes very important when there are multiple siblings, surrounding a new diagnosis. As parents, work with your teenager to figure out how [they] want to share that information. Maybe it’s a family meeting on a Sunday or it’s a conversation around an activity that everyone enjoys. Let your teenager have a part in how he or she wants to share the news with their siblings, and what would be supportive for them.
Also hear from the siblings – ask them what that’s like to learn and what their questions, concerns or fears are, without judgement. A younger sibling may be resentful – “we can’t go on our beach vacation?” – and really build empathy around that. Respond with, “yes, that stinks! But this is what we do as a family – we stick together and do this other activity instead.” Try to have them take part in the plan, so that they don’t only feel the loss of what [their sibling’s diagnosis] might mean for them.
For more information or to view these series, make sure to visit The Understand AD Squad.
MERCEDES E. GONZALEZ, MD
Dr. Gonzalez is a pediatric dermatologist treating patients with skin, hair and nail conditions. She serves as a Clinical Assistant Professor of Dermatology at the Florida International University Herbert Wertheim College of Medicine and at the University of Miami Miller School of Medicine, where she serves as faculty advisor for the dermatology interest group. Dr. Gonzalez has published over 30 journal articles, contributed to dermatology textbooks and spoken at dermatology conferences. She joined the Understand AD Squad to give teens a chance to talk candidly with a dermatologist and provide patients and their families with important advice about AD management—starting with open conversations.
CHRISTINE TRIANO, MSW, LCSW
Christine is a licensed clinical social worker (LCSW) and psychotherapist specializing in the treatment of adolescents, adults, families and creative professionals. Her strengths-based approach ensures that counselling addresses not just what’s going wrong, but identifies and nurtures what is going right. She strives to help clients make new discoveries about themselves and identify ways to overcome the obstacles they face—which is why she joined the Understand AD Squad. By encouraging patients with chronic diseases to open up about their personal experiences, Christine can help them realize their condition does not define them.
FROM: Eczema