Background

Atopic dermatitis (AD) is a chronic inflammatory skin disease that affects up to 20% of children worldwide and up to 10% of adults worldwide, with a subset experiencing severe disease that profoundly impacts quality of life.1,2 Patients with severe AD often face a complex interplay of dermatologic, allergic, and immunologic challenges that require coordinated care. To address this need, Dr. Bob Geng presented the Multidisciplinary Atopic Dermatitis Program (MADP) at Rady Children’s Hospital, San Diego, developed in collaboration with University of California San Diego Health’s Divisions of Dermatology and Allergy/Immunology.

The MADP provides specialized evaluation, therapy, and education for patients with severe AD and their families. By incorporating perspectives from dermatologists, allergists, pharmacists, and patient educators, the program emphasizes shared decision-making, by balancing clinical expertise with the lived experiences and preferences of patients and families. The program systematically collects clinician-reported severity measures, patient-reported outcomes, and satisfaction data to evaluate its impact on patient care, creating an extensive repository of data that they have leveraged to perform research.

Structure of Patient Visits

MADP clinics occur monthly and last 1–2 hours, reflecting the comprehensive scope of evaluation. Each visit also includes pre-visit paperwork and symptom tracking via patient reported outcomes. Each patient is independently assessed by a dermatologist, allergist, and pharmacist. Visits include:

• History and Clinical Evaluation: Eczema course, comorbid atopic conditions, prior therapeutic responses, and a review of patient and family perspectives.
• Standardized Severity Metrics: Eczema Area and Severity Index, Validated Investigator Global Assessment, and Body Surface Area.
• Patient-Reported Outcomes: Patient Oriented Eczema Measure, Pruritus Itch NRS, National Eczema Association questionnaire, Dermatology Quality of Life or Child Dermatology Quality of Life which all measure the impact of AD on quality of life.
• Allergy and Immunology Assessments: Skin prick and serum testing (environmental and food allergens), pulmonary function testing for concomitant asthma, immunologic evaluation (especially in suspected secondary immunodeficiency), and patch testing when indicated.

Furthermore, educational resources covering skin care, topical and systemic therapies, and allergy-eczema interactions are also provided. Due to the vast research that the MADP engages in, they also offer various clinical trials to patients that are appropriate. This entire model culminates in guiding families through evidence-based information, empowering them to participate in treatment decisions.

Eligibility and Referral Pathways

There are no direct referrals to the MADP as this collaborative effort is focused on a specific subset of patients. All patients are referred by dermatologists or allergists, unless they had significant conditions during a hospital visit. A clinical coordinator screens referrals to confirm eligibility, focusing on individuals with severe eczema or allergy-related complications. This process ensures clinic resources are directed toward patients most likely to benefit from multidisciplinary input.

Insights from Collected Data

MADP has demonstrated discordance between patient- and clinician-reported outcomes, an important reminder that disease severity is not fully captured by clinical scoring alone.3 Publications from the group highlight correlations among Eczema area and severity index (EASI), Validated Investigator Global Assessment for Atopic Dermatitis (vIGA), and Body surface area (BSA), helping refine the interpretation of these tools in severe AD.

By embedding research into routine practice, the program contributes to a broader understanding of how clinical and patient-reported outcomes align and diverge in atopic dermatitis.

Future Directions

Dr. Geng emphasized that MADP is not just a treatment model but a framework for expanding collaboration between dermatology and allergy/immunology. Current efforts focus on severe AD, but future goals include incorporating multidisciplinary care into related conditions such as:

• Drug allergy/severe cutaneous adverse reactions (e.g. Stevens-Johnson Syndrome)
• Chronic spontaneous urticaria
• Allergic contact dermatitis

Such an expansion would solidify MADP’s role as a comprehensive multidisciplinary hub for complex dermatologic and allergic conditions.

Conclusion

The Multidisciplinary Atopic Dermatitis Program at Rady Children’s Hospital represents a forward-thinking approach to managing severe atopic dermatitis. By combining objective clinical measures, patient-centered outcomes, and collaborative expertise, MADP serves as a model of care that bridges dermatology, allergy, and immunology. As this framework evolves, it has the potential to reshape not only how severe atopic dermatitis is treated, but also how multidisciplinary care can improve outcomes across a spectrum of interconnected skin and allergic diseases.