Guest: Dr. Doris Day
Presenter: Neal Howard
Guest Bio: Doris Day, MD, is a board certified dermatologist who specializes in laser, cosmetic and surgical dermatology on the Upper East Side in New York City. Her private practice includes national and international celebrities. Dr. Day is affiliated with Lenox Hill Hospital in New York City and is a clinical associate professor of dermatology at the New York University Langone Medical Centers where she was presented with the award for Dedication and Excellence in the Teaching of Dermatology.
Segment overview: Dr. Doris Day, MD, a board certified dermatologist discusses Atopic Dermatitis during October’s Eczema Awareness Month.
Health Professional Radio – Eczema Awareness Month
Neal Howard: Hello and welcome to the program. I’m your host Neal Howard here on Health Professional Radio, thank you for joining us today. October is Eczema Awareness Month and in studio with us today is Dr. Doris Day, she’s a board certified dermatologist and she’s here to talk with us about atopic dermatitis. Welcome to Health Professional Radio Dr. Day.
Dr. Doris Day: Great, thank you for having me.
N: Tell us a little bit about your background. How you got into dermatology, was that your focus from the very beginning of your medical career?
D: Actually I started out as the Medical Journalist and that was my first career and as I studied and worked as a journalist it was in the early, mid 80s and HIV was the relatively new disease and one of the early findings was something called Kaposi’s sarcoma which was a skin condition. So I covered a lot of dermatology meetings where we talked about and I learned more about the skin through learning about Kaposi’s sarcoma, so by the time I got to med school I already knew so much about dermatology when most of my colleagues just thought it’s like a couple of easy questions on the exam that they did not need to pay attention to. So my level of interest was already raised and I did internal medicine before I did dermatology, I understood that the skin really is a powerful reflection of your overall health and wellbeing and that I could tell so much about the patient beyond the skin by understanding the skin itself and that’s why it’s my passion. The skin is such an interesting organ and it is really a great way to help somebody stay as healthy as possible for as long as possible.
N: One of my daughters is 16 and I can remember her coming home from elementary school saying ‘Dad we learned that the skin is the largest organ that we have.’ And she was so excited and then when you think about it, I mean the skin encompasses everything that we are and when you’ve got a problem with the skin say October being Eczema Awareness Month, how involved did you become with eczema and not just the health of the skin but the diseases of the skin?
D: Yeah, you’re absolutely right, the skin is the largest organ, it has very important function, you can’t live without it, it’s important for water balance, temperature control, it has its own immune system that shields you from germs and the environment so it’s really important and the roles that it does and it protects the entire body. So when the skin isn’t healthy the rest of you is at risk and when you have a chronic condition it doesn’t just affect your skin’s overall health but it can affect your mental outlook as well and when we look at things like atopic dermatitis and other chronic conditions we also see association with depression and anxiety. So we really have to be very broad in how we take care of our patients and try to help them control it not just think of it ‘Oh it’s just another skin condition, it’s nothing important.’ It actually is really powerful and important and what I love about this survey that was done by Harris Paul is that in looking at adults with moderate to severe atopic dermatitis and this is looking at over 500 people that matched the general population we could really see on a psychosocial level how powerfully it negatively impacted their life and it tells us that we need to do more to help these patients.
N: For our listeners who may not be that intimately aware of atopic dermatitis, what is it? Is it a form of eczema or is it something that stands alone?
D: Atopic dermatitis is a chronic form of eczema, it can happen at any age and affect any part of your body. It’s what I call a rash, it’s an itch that rashes. So a lot of rashes start out as a rash and the rash may itch but in the case of eczema or atopic dermatitis what you feel first is a horrible itch that can also burn and there’s no resisting scratching it. Once you scratch it, the rash starts to come out, the skin can sting and burn and turn very red and thick and can even ooze and have crusting, it’s unsightly. It can happen on different parts of the body at different time,s we see different patterns in different ages. Not everyone, sometimes you outgrow it sometimes you grow into it. It can be worst at different times of year so people have their own personal triggers but there are specific patterns that we see as well that we see based on certain ages and immune patterns and the other thing is that this is an immune condition so we’re looking to understand the pathways that trigger it and looking at more important and helpful direct ways to help target it and control it with as few side effects as possible. And part of the problem is that our basic treatments have been immunal suppression meaning by turning off that pathway that leads to that itch, that leads to the scratch, that leads to the rash, we can try to get a head of it but we’re really just masking it and hoping for the best and everything has a side effect so a lot of times patients either don’t tolerate it or they give up because they don’t have adequate response and it makes it difficult for them to stay compliant.
N: Have you noticed any differences in these patterns that you speak of? We talked about many different aspects, age and I’m assuming maybe environment. What about gender, do you see an incidence more in men or women or maybe young boys and young girls?
D: No it happens in both men and women, it can happen in any ethnicity, in any age group so we see it broadly across populations but because there is a genetic component of it, we do see it tending to run in families as well.
N: So there are genetic markers. Are there things can be done to prevent the condition?
D: No, There’s nothing in that way, it’s just a matter of it if you don’t…family then you know that you may be more prone to it. It doesn’t just having it in the family it doesn’t guarantee you that you’ll have it and it isn’t something like a genetic marker where you would basically go through IVF, I mean there’s things that you really don’t want to have that baby because they’ll have deformities or whatever. This is something that you just have to be aware of that can run in the family and you need to try to be optimizing your overall health in order to try to minimize the triggers but there’s no other way at this point to avoid it or to genetically cure it.
N: What would you say to some health care providers that are listening when it comes to dealing with a patient who may be suffering from atopic dermatitis? We talked about some of the psychosocial aspects of it, is there a large stigma? Are there things that prevent a patient from being maybe honest or even going to seek help until it’s extremely affecting their lives?
D: Patients often give up on seeing doctors for it because they’ve tried lots of treatments in the past and feel that there isn’t anything that’s going to really help them and they resort to either homeopathic treatments or things that are otherwise destructive but make them feel better. I’ve seen patients put scolding hot water on it or just rip their skin apart because it feels so good to scratch, they just give into it and they know it’s making it worst but in the short run they feel better. So I think for health professionals and for doctors taking care of patients with atopic dermatitis, these are the adult patients with the moderate to severe uncontrolled atopic dermatitis. I think it’s really important to understand how powerfully it’s affecting their lives so we look at the survey, about 75% of people in the survey said they scratch three or more times a day, 82% said that they made lifestyle modifications -meaning they wouldn’t go on dates or wouldn’t even want to be in pictures and more than a quarter of those survived said that they had 10 or more sleep disturbances due to their atopic dermatitis over the past month. A quarter of them felt they had depression and just about a third said they felt more anxious. So these are really powerful numbers and what we have to do is understand those numbers are statistically across the range or that person sitting in our office, to them they have their own individual unique story and we need to listen to that story and try to help them directly by understanding what their triggers are and the best ways they can modify those in order to work on what they have control over. So they don’t have control over the fact that they have this condition, that’s not their choice. This is just something that happens but we can try to help them understand by thinking about what they tell us in that moment, what they choose to tell us what’s going on in their life or how would it affect them by listening carefully and listening kind of between the lines and between the words, we can often make a very big difference even just by being empathetic and guiding them in the best ways to manage their condition. And I think that’s what makes us true healers rather than just prescribers.
N: You’ve been listening to Health Professional Radio. I’m your host Neal Howard in studio with Dr. Doris Day, board certified dermatologist discussing atopic dermatitis during October which is Eczema Awareness Month. It’s been great having you here with us today doctor.
D: Great. Thank you so much for having me.
N: Thank you. Transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm and you can subscribe to this podcast on iTunes.