Panelist discusses how referral to dermatology should occur when patients fail to reach treatment goals despite proper skincare, appropriate topical steroid and nonsteroid use, and proactive treatment, emphasizing the importance of maintaining open dialogue about systemic therapy options rather than dismissing them as “last resort” treatments.
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Determining appropriate timing for dermatology referral in atopic dermatitis management depends on treatment response despite optimal topical therapy implementation. Patients should be referred when persistent symptoms continue after proper skincare practices, appropriate topical corticosteroid and nonsteroidal use, and proactive maintenance treatment. Key referral indicators include ongoing pruritus, significant quality of life impacts, and need for systemic therapy discussions beyond primary care comfort levels.
Primary care providers play crucial roles in initial atopic dermatitis management, often representing patients’ first health care contact. Most mild to moderate cases can be effectively managed in primary care settings through comprehensive patient education about proper skincare, irritant avoidance, and proactive treatment strategies. Success requires understanding quality of life impacts beyond cosmetic concerns, as untreated atopic dermatitis leads to significant atopic and nonatopic comorbidities affecting sleep, mental health, and overall well-being.
Advanced therapeutic options available through dermatology consultation include biologics, JAK inhibitors, traditional immunosuppressants, and phototherapy. Biologics offer targeted cytokine blockade with excellent safety profiles, while JAK inhibitors provide broader intracellular signaling interference with superior efficacy but require careful patient selection due to FDA box warnings. Phototherapy, specifically UV-B treatment, remains underutilized despite effectiveness for both in-office and home-based treatment protocols.