Heterogeneity

This issue of The Dermatologist leads with a detailed description of the heterogeneity of atopic dermatitis. Atopic dermatitis is a common reason for patients to see a dermatologist. It can be a devastating condition when severe. Fortunately, revolutionary treatments for atopic dermatitis have been developed with more on the way. These treatments will address atopic dermatitis’ manifold presentations, varying in pathogenesis, locations affected, extent of disease, and quality of life impact (not to mention, of course, how adherent to treatment patients are). The heterogeneity of atopic dermatitis complicates its treatment.

One of the greatest sources of heterogeneity in atopic dermatitis (and among our dermatology patients more generally) is the personality of our patients. For someone like me—someone with a bench chemistry research background who does very well on standardized tests—the interpersonal issues involved in the management of chronic skin diseases can be one of the most daunting challenges.

Patients who just want a diagnosis and an effective treatment are the easy ones. The ones who need validation, support, and hand holding are, for me, more challenging. Human need for this kind of support can be seen on an acutely magnified basis when patients are dying from cancer—when there is no quick fix. In his book Faith Unravels, Rabbi Daniel Greyber portrays an intimate view of this profound human need. Many of our patients with atopic dermatitis hunger for such support.

In her recent book How to Improve Doctor-Patient Connection, dermatologist Christine Ko describes her own moving tale of a family medical (mis)adventure and the profound value of a supportive physician. Ko gives practical advice on how people like me can learn to give patients the support they need. Ever the academic, she even gives homework assignments to help build the emotional intelligence and other skills needed to identify and better fulfill patients’ needs.

That said, I hope the new atopic dermatitis treatments provide us the opportunity to give all patients with atopic dermatitis such a quick fix that I will not be pushed too far outside my comfort zone.

Greyber D. Faith Unravels: A Rabbi’s Struggle with Grief and God. Resource Publications; 2012.

Ko CJ. How to Improve Doctor-Patient Connection: Using Psychology to Optimize Healthcare Interactions. Routledge; 2021.