Ruchi Gupta, MD, MPH: Challenges and Opportunities in Managing AD in College

What are some of the unique clinical challenges and opportunities when supporting young patients with atopic dermatitis who are heading to college? Dermatology Times asked Ruchi Gupta, MD, MPH, professor of pediatrics and medicine at Northwestern Feinberg School of Medicine and Lurie Children's Hospital and I am the director of the Center for Food Allergy and Asthma Research, to share her experiences and experiences, including cautionary and supportive clinical pearls.

Dermatology Times: What are some of the unique challenges associated with treating atopic dermatitis in youth who are transitioning to college?

Ruchi Gupta, MD, MPH: I think that as you transition from home to college and become very independent it is challenging, and treatments have to be designed for patients’ new lifestyle, you know, busy running around and socializing. Atopic dermatitis is really big because it is something that anyone can become very conscious of—but especially when you're in college you. So how do we help support them best? Topical treatments are, I think, the mainstay in general, but are these patients able to follow a regimen if they're moving to a new place? And the environment—are there are new flares that may come out? Where is their dermatologist? Is the clinician back home or is it in their new location?

And then, of course, there's newer treatment s that may be beneficial.

So I think it's a real conversation with this young adult. Is there a biologic that would be better for them, versus a topical; and how do we have those conversations and do shared decision making?

This is so important because atopic derm also often goes along with allergies and food allergies and asthma. So many of these kids with eczema significant and atopic dermatitis—a significant portion, at least a third—may also have allergies and asthma. So, very, very important to manage the whole a topic spectrum of conditions for them, as they move on to being independent.

A lot of times when they're home, they have the support of their parents and the safety of their home and their doctors locally. And so once they move into college, the big issue is how do we manage all these conditions and let you live this independent, full life? There are lots of activities that you want them to do, whether it is sports, the social activities and clubs, and trips and stress that may come along with intense classes and how that all impacts a lot of these atopic conditions.

One big recommendation is for their general physician their dermatologist, and maybe their allergist, you have meetings with them before they go to college. And really discuss what their lifestyle is going to look like, what will change, and how do we manage all their conditions with the right medications that will serve them and well. Then have that open dialogue where if it's not working for them, or if they're flaring or if they're not able to manage the regimen, how do we quickly pivot and switch to something else that works for them? Because the hardest thing is quality of life. I mean, we see so many of these kids go to college, and they are embarrassed, oftentimes of their atopic dermatitis conditions.

And then, of course, food allergies. How do they get support when they don't know what maybe the foods they are eating at parties or club activities, etc. To their asthma, just making sure as they are playing sports that they have their meds up to date and have inhalers.

So all of these conditions are so critical to focus in, make a complete care plan with these young adults, and then execute on them. But then quickly be able to pivot if they are not working.

Dermatology Times: What about counseling young adults about their new found freedom at college and away from home?

Ruchi Gupta, MD, MPH: Very, very important for the physician, whether it be the dermatologists allergists, primary care physician, to really have that open conversation like that. When you talk about food and food allergies, a lot of times you don't know what are in a lot of drinks and foods. We talked about that they are trying new things at parties, or there will be a lot of food lying around, and it's hard for them always to ask like, “Oh, does anyone have a label or know if there's nuts in this mix that's sitting on the table?”

Those kinds of bad decisions sometimes happen, and it's very understandable. I mean, there is a lot of peer pressure at this age. There is a lot of wanting to fit in, and then there's that whole frontal lobe thing—decision making isn't fully developed.

What we see is that often these students, some of them, go full in and some are really careful. And some end up being isolated because of their fears of any reactions or anything happening. So they end up isolating themselves and not attending a lot of the activities that we would like them to enjoy in college, whether that be clubs, sports, parties.

So how do we empower students? I think that is the absolute key: how do we empower them with the tools that are needed to be able to be safe in those environments and enjoy the experience?

Dermatology Times: What about resources for patients heading off to college? What should clinicians recommend?

Ruchi Gupta, MD, MPH: So I would definitely recommend when they get to college to figure out their health center and really get connected there.

If they have food allergies, get in touch with the nutritionist. Most colleges are becoming way more aware of all the food conditions, not only food allergies, like celiac and intolerance. There's a lot of youth with these issues now; about 10% of kids going to college have a food allergy, and then an additional amount have a lot of these other issues. I'd say about 20% are avoiding food when they get to college. So make sure they get in touch with a nutritionist. Talk to their dining hall.

Tell them to really look into these things when they are choosing a college, and get those resources and those people on the college campus part of their world so they can turn to them.

A couple of things that we found is that one of the biggest indicators of success is having a very strong support group and most of that is your social group and your peers. So really finding people in their college who understand and support There are groups and colleges now developing local support chapters. I know at Northwestern we have a group of students who have started a club called Café. It is for kids with allergies, but also a whole spectrum of conditions. So joining a club like that, having like-minded peers, people to support is really critical. I would really advocate for that.

I'm in this position. My daughter is 17, and she is a senior in high school, and she has terrible atopic dermatitis and food and environmental allergies. So I am speaking from very personal firsthand knowledge so as I give advice on how to navigate. I am also trying to do it myself. It makes you really nervous when they want to go far away. But we have to encourage them, and let them fly.

My son is a senior in college and when he went to school with allergies, he got his allergy shots in college through the health center. We navigated all that, and it worked out really well.

So physicians are talking to the whole family during this transition. Definitely check in, make sure they are safe and make sure they have support where they are moving. Have them find a local doctor, whether it is at the college health center, if they need, an in town allergist so that they are hooked up. Then, if something happens, they are not having to figure it out. That often can be very challenging.

For dermatologists, we have many resources in terms of new medications and better treatments. So just really understand each situation: is it best to have a topical, is it best to have one of the biologics? Understand their lifestyles and work with them to make sure we can get them the treatments they need. And work with whatever college they are going to, because a lot of the health centers can administer medication. So if they can get that set up with you, if they have a biologic, for example, and they need it administered monthly at their college, that is a possibility. It may be easier on this young adult to have that done versus daily topicals with their lifestyle. Just take all of that into consideration.

Transcript edited for style and length.

Have you assisted patients transitioning to college or during a move? Share your challenges and triumphs with your colleagues via DTEditor@mmhgroup.com.