Learn from Dr. Melinda Gooderham about atopic dermatitis (AD), here is a summary from her session:
Don’t feel like reading, listen to the podcast:
Atopic dermatitis (AD) is far more than “just a rash.” In her recent Virtual Hallway lecture, dermatologist Dr. Melinda Gooderham illuminated how this chronic skin condition profoundly affects patients’ lives—from relentless itching and sleep disruption to mental health struggles and missed life events. Here’s a look at the essential takeaways from her expert session and why you might want to watch the full lecture.
The Unseen Burden of Mild to Moderate AD
Up to 80% of patients have mild to moderate disease, yet even these cases can wreak havoc. Nearly 80% of Canadian patients report sleep loss, and many resort to trialing over 10 treatments, often with limited success. The disease can impair physical activity, cost patients days of work, and carry a significant emotional toll, particularly due to stigma and visible skin changes.
Diagnosis Isn’t Always Straightforward
Dr. Gooderham illustrated the complexity of diagnosing AD across age groups, skin tones, and phenotypes. Infants typically show symptoms on extensor surfaces, while adults tend to experience flexural involvement. In patients with skin of color, typical erythema might not be visible, and post-inflammatory pigmentation changes are often more distressing than the eczema itself.
Through visual case studies, Dr. Gooderham also highlighted how easily AD can be confused with seborrheic dermatitis, psoriasis, contact dermatitis, or even scabies. Diagnostic precision is important, including low-cost tools like fungal scrapes.
Topicals: Steroid-Free Options Are Expanding
For years, corticosteroids dominated treatment, but concerns about long-term use—including skin atrophy, striae, and even osteoporosis—have driven the field toward steroid-sparing therapies.
Here’s a snapshot of what’s now available:
- Calcineurin inhibitors (tacrolimus, pimecrolimus): Useful but can sting.
- PDE4 inhibitors (crisaborole): Effective but limited by tolerability.
- JAK inhibitors (ruxolitinib): Powerful and fast-acting, but costly and come with boxed warnings.
- Newest arrival—Roflumilast: A once-daily topical PDE4 inhibitor showing promise for tolerability and convenience, available for patients aged six and up.
Practical Pearls for Clinical Use
- Don’t default to steroids—they’re best for acute flares, not maintenance.
- Moisturizers matter—prefer ceramide-rich options; Vaseline is underrated.
- Use steroid-sparing agents for chronic management, especially in cosmetically sensitive areas or widespread disease.
- Be alert to real-world challenges like burning on application and out-of-pocket costs.
The Takeaway
Topical treatment for atopic dermatitis is evolving. With newer agents offering steroid-free control and better tolerability, it’s time to rethink how we manage this lifelong condition. Dr. Gooderham’s session provides a deep, practical look at how to navigate these options to improve patient quality of life.
Watch the Full Lecture
Want to dive deeper? Catch Dr. Gooderham’s full session on Virtual Hallway, where you can:
- Watch on-demand at your convenience
- Earn MainPro+ credits
- Sign up for free at virtualhallway.ca
Stay ahead in your dermatology practice. Log in, watch, learn—and help your patients feel better, faster.