Beyond the Surface: How Skin Conditions Affect Daily Life

Peter Lio, MD, a clinical assistant professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine, emphasizes the profound impact that dermatological conditions can have on patients' lives. Contrary to common assumptions, skin disorders are not merely superficial but can impose a significant disease burden comparable to systemic illnesses such as diabetes.

"I think many healthcare practitioners assume that if it's just on your skin, then it can't have much burden of disease. But we understand that the skin affects every aspect of our life," Lio states. He elaborates that conditions like atopic dermatitis can cause pain, itching, open sores, cracks, and bleeding, which substantially affect patients' quality of life. Studies indicate that moderate to severe cases of atopic dermatitis can be as debilitating as, or even worse than, other chronic inflammatory diseases.

A key challenge in dermatologic care is the necessity of extensive coordination with schools, workplaces, and support services to ensure patients receive the accommodations they need. However, the healthcare system often does not compensate for these additional efforts, leaving physicians to navigate the complexities without dedicated time or resources. "There's nobody really paying you to do this. There's not really time allotted in clinic, but our job is to help make sure the patients get what they need, and that has to be our goal," Lio explains. This may involve tasks such as writing letters to justify medical accommodations or completing Family and Medical Leave Act paperwork for caregivers.

Lio underscores the importance of shared decision-making in dermatologic treatment. Rather than imposing a one-size-fits-all approach, he advocates for engaging patients in discussions about their options, considering factors such as efficacy, accessibility, safety, and tolerability. "The worst thing you can do is give them something they've already tried and failed," he acknowledges. "It's so important that they're on board and comfortable and understand it, because at the end of the day, it's for them, it's not for me."

To enhance treatment personalization, Lio utilizes decision-making frameworks such as "EAST" (efficacy, accessibility, safety, tolerability) and a newer adaptation, "ESTAR," which includes remission or remittive effects. By prioritizing patient preferences and experiences, he strives to ensure that treatments align with individual needs and expectations.

Ultimately, Lio’s approach reinforces the necessity of clinicians serving as patient advocates, working within—and often beyond—the constraints of the healthcare system to optimize care and improve quality of life.