Evan Rieder, MD: Immersion in the Eczema Patient Experience

AbbVie Inc recently presented a clinically-focused, immersive event in New York City, "The Eczema Experience: Stories Itching to Be Told," to recognize National Eczema Awareness Month and provide attendees with a comprehensive exploration of the physical and psychosocial challenges faced by individuals with eczema.

Through a structured presentation that incorporated personal narratives and expert-led insights, the event featured narration by eczema advocate Tia Mowry and clinically-relevant insights from Evan Rieder, MD, one of three clinicians in the US to be board-certified in dermatology and psychiatry. The multisensory design of the experience allowed participants to engage with the symptomatology of eczema, including its impact on skin barrier dysfunction, inflammation, and emotional health, while directing attendees to EczemaHQ.com for more information.

Dermatology Times recently spoke with Rieder, the founder of 36 North Moore Dermatology in Manhattan, New York, and a member of clinical faculty at Mount Sinai School of Medicine, to discuss the intersection between mental health and eczema, addressing burden of disease, and the role of an immersive experience in shedding light on the patient experience.

Evan Rieder, MD | Image Credit: © Massachusetts Academy of Dermatology

Q&A

Q: How do you approach the management of patients with eczema who also exhibit psychological distress or mental health symptoms related to their condition?

A: It's a really good question, and I think that we have to be honest with ourselves as dermatologists. We do not always have the luxury of time to be able to get into the weeds, and many of us do not have the the training necessary to [do so]. We do a full, in-depth psychological evaluation, but I think a couple things that I would say is, 1.) Pick up on the nonverbal cues that people may be showing of depression, like [limited] eye contact, impoverished speech, giving one word answers, feeling depressed, moving very slowly. I think understanding those nonverbal cues is really important, and then really aggressively treating the eczema first. A lot of the times, what we see in people who are living with eczema is the mood disturbances or the anxiety or the social withdrawal, are directly related to their skin condition. If you get to the point where your skin is clear, people are still showing those symptoms, or their symptoms are completely apart and separate from their eczema symptoms, then we have to be thinking about keeping lines of communication open between ourselves and the patient, but also incorporating a more comprehensive care team with a colleague in the mental health profession. It's easier said than done.

Q: With the increasing intersection between skin and mental health, how would you recommend dermatologists approach patient care in a way that integrates mental and emotional wellness?

A: I think it's really hard to do, and I think that it's much easier to do if you're in an academic setting or you have a specialty care setting for the treatment of eczema, or, say, psoriasis, where you know you're going to be seeing a lot of people who have a lot of psychological comorbidity, and you may have the systems in place, but again, picking up on those nonverbal cues, asking a couple of screening questions, can sometimes be helpful as well--about mood, about [whether] people are able to enjoy things in life. If they're not, then it's really incumbent upon us as dermatologists, when people go canvas the area, when they open up a new practice, and they get PCPs to send them patients, you probably want to have a couple mental health professionals in your Rolodex, as well.

Q: The Eczema Experience pop-up in NYC presents a way to raise awareness of the emotional, social, and physical burdens of eczema. What do you hope attendees take away from this event?

A: I have seen patient stories in my own practice and in similar events before. I hope that there's the human quality and the human experience of living with eczema. I hope that comes through, and I'm imagining that it will. I think the general public probably just sees eczema, and they don't know what they're looking at. Sometimes people see it, and they think it's an infectious condition, and most people think it's just the condition of the skin. But I think a lot of people don't realize that it's more comprehensive than that, as much as it's skin, it's a lot of mental health comorbidity that goes along with it.

Q: How do you envision this type of immersive experience enhancing conversations between patients and health care providers about the impact of eczema beyond its physical symptoms?

A: I think that health care providers are aware of this overlap, I think especially those also in dermatology have even people who don't have a true psycho-dermatology curriculum in their residency, people are aware of the comorbidities between inflammatory conditions in skin, like eczema and mental health comorbidity. However, I think this will hopefully give people who don't have community, to allow people to know that they are not alone in living with eczema, and it will allow them to hopefully ask more questions in their health care encounters, and hopefully be more open to the possibility of getting more comprehensive care. That may not necessarily be coming to the dermatologist. That may be the dermatologist being the conduit for patients to get to the mental health professionals.

Q: What is the role of patient education in managing eczema and reducing the stigma around chronic skin conditions? How important is the patient's understanding of their treatment plan in managing both the physical and psychological aspects of eczema?

A: I think it's really important, and I think that we have to be realistic again about what we can do as dermatologists. I think, sure, we could all screen for mental health comorbidities and be able to provide psychological 360 degree services, but in reality, we don't have the bandwidth for that. I think that educational programs like this can be profoundly helpful for patients, because they can give them resources, and we as dermatologists can point them in the direction of those resources so they can understand that their experience is normalized. Then there's community that they can tap into, and then there are resources outside of the dermatologist's office, in the purview of the dermatologist's practice, that could be made available to them very readily. I think a lot of people, with the advent of social media, have found these communities, but not everybody has, and not everybody has access to good quality information. Bringing that to the forefront, I think, can be profoundly helpful for people who are living with, struggling with, and looking for additional resources to live a full and healthy life with eczema.

Q: Is there anything else that you feel is important for dermatology clinicians to know or consider?

A: I get this question all the time: What do we do in these situations? We all know that people living with eczema have increased rates of depression, anxiety, and decreased quality of life. What do we do? I think that what I would say is: Look at the nonverbal cues. Treat people's eczema aggressively, but if you get to the point where their eczema is clear and there's still these symptoms of depression and psychological comorbidity, that's when you really need to be tapping into your network. Understand that you've reached your limit on what you can do. Keep the dermatologist-patient relationship intact, but then sort of transition them to a point where your relationship with the patient becomes secondary, and the relationship between the primary, the mental health professional, and patient, becomes primary. It's much more difficult to do than it is to for me to articulate, but that's ultimately the goal.