Transcript
Lisa Swanson:Hello everybody and welcome to another Type 2 Inflammation Journal Club with Practical Dermatology. I'm Lisa Swanson and I'm here with one of my favorite people, Michelle Tarbox. Michelle, tell everybody a little bit about yourself.
Michelle Tarbox:Well, I am one of the luckiest dermatologists in the world, I think, because I get to be friends with you.
Lisa Swanson:Aw.
Michelle Tarbox:I get to talk about cool things like type 2 inflammation. And I get to be chair and program director of a wonderful residency program at Texas Tech University Health Sciences Center in beautiful, sunny Lubbock, Texas, and I get to co-host the Dermasphere podcast. And Ithink you have a podcast also.
Lisa Swanson:I do have a podcast and Practical Dermatology has a podcast. Everybody has a podcast. Everybody should get a podcast. Everybody should do it. I figured that I would give podcasting a good 10 years of existence before I jumped in. Make sure it was a real thing.
Michelle Tarbox:Oh, yeah. Make sure it's legit.
Lisa Swanson:Yeah.
Michelle Tarbox:Feel it out.
Lisa Swanson:But today we're going to talk about something that's very exciting to me, near and dear to my heart and my patients. We're going to talk about an article that was published in Dermatology Practical & Conceptual, entitled The Effect of Dupilumab on Growth Parameters inPediatric Atopic Dermatitis Patients. The lead author was Dr. Piccolo. And this was so exciting. It was a case report of a patient they had treated with atopic dermatitis with dupilumab and saw the child grow, ready, set, grow with dupi. And I have witnessed this inmy clinic. So not only do I appreciate the publication, but it also just cements what I've observed day to day. Tell the audience your perspective.
Michelle Tarbox:Well, I loved this article and also I've personally experienced this from my patients as well. We had the sweetest little baby. She was failing to thrive. She was actually admitted to the NICU. She was five months old, but she only weighed 10 pounds. So she was 0.22% of herprojected body mass index. And this poor little baby had no hair. This was an African American baby with no pigment. And she had hypernatremic dehydration because she was losing so much fluid through her skin. So she was in the ICU on IV fluids. They weretrying to do tube feeds. They could not get her to eat because of the lethargy and the severe dehydration she was experiencing. Her sodium was 169.
Lisa Swanson:Oh my gosh.
Michelle Tarbox:So she was very, very sick and teeny, teeny, tiny, like little itty bitty pipe cleaner legs. And we were looking at all of our options and we were like, "Well, either we're going to get this baby's atopic dermatitis under control or she is not going to continue to be here on thisearth." And so I took our syringes of dupilumab into the NICU and with a little bit of putting your big girl pants on, which you have to do sometimes.
Lisa Swanson:Use your big girl bark.
Michelle Tarbox:Exactly. I had to give those little shots in those little tiny pipe cleaner legs and that sweet baby started to grow like crazy. She went from 0.22% of her BMI projected to 86th percentile. She comes from a tall family and she started to look like her family again. She lookedlike her big sister. Her pigment came back, her hair came back. She was so sick. We had to rule out Netherton syndrome and Omenn syndrome. She didn't have anything besides severe, severe atopic dermatitis. But the medication was life changing for her andshe's the cutest little chubby three-year-old now running around causing trouble asking for stickers. It's adorable. I love it.
Lisa Swanson:Yes. I mean, it's so wonderful to watch these patients go through it. And your patient was like sick with eczema, like ill with eczema.
Michelle Tarbox:Systemically.
Lisa Swanson:Systemically. And that, I mean, dupi is truly a lifesaver in those situations.
Michelle Tarbox:Oh yeah, absolutely.
Lisa Swanson:And then we also have some kids who are like six to 11 years old and maybe not doing great on the growth curve and they struggle with atopic dermatitis. And we know that this is linked, this is associated. Kids with bad AD tend to be small. And I have found that that issueresonates so profoundly with parents who might be on the fence about treatment or on the fence about taking the leap towards dupi. When I talk to them about growth disturbance, their ears are wide open. They're like, "Oh wait, what now? Like this will makemy child short?" And they pay attention.
Michelle Tarbox:Yeah, it makes a difference.
Lisa Swanson:Have you discovered that as well?
Michelle Tarbox:Oh, yes. And you and I are both travel size. So I think I'm maybe an inch taller than you are, but we both have to, let's be honest, we both have to climb on things at the grocery store all the time.
Lisa Swanson:Oh, yes. Yes. I was just at a conference and I was sitting in a chair on the stage and my feet didn't touch.
Michelle Tarbox:Never. I can never see over the podium either. I'm on my tiptoes every single time.
Lisa Swanson:That was so hard. That was so hard. Sometimes I can't see the timer because it's like, yes. Oh my gosh. The life of being short, vertically challenged. And so I make that joke that like it has become quite clear to me that nobody wants a short child, which I try not to takeoffense to as I stand here proudly at five foot, one and a half. But we have this window of opportunity with these kids to intervene and affect their growth trajectory. While this article was just one case, we have a lot of data showing that introduction of dupi foratopic dermatitis helps the kids grow.
Michelle Tarbox:Absolutely.
Lisa Swanson:Absolutely. What do you think is the... I have my theory about the origin of the growth disturbance. Do you have a theory?
Michelle Tarbox:I think that there's so many different ways that severe AD impacts children's wellness. Certainly it is a systemic inflammatory disease and some of these kids are downright cachectic. They can't gain weight. They're not growing. They can't grow their normal tissues. Theirhair and their nails are brittle. Of course, you and I both know that it also can impact things like appetite, it can impact, of course, growth velocity, and I think the real key issue is sleep.
Lisa Swanson:Yes. Sleep is the biggie. I read an article a couple of years ago, two, three years ago that there are multiple factors that lead to the growth disturbance in atopic dermatitis. But the biggie is sleep, that when kids with eczema sleep, they don't sleep as well and they don't enterREM as long or as often. And it's during REM sleep that growth hormone is secreted. So physiologically they're low on growth hormone. And that also contributes to bone strength and development, which helps explain the increased risk of osteoporosis, osteopenia, even fractures. So this is a real thing, but the good news is we can fix it.
Michelle Tarbox:Yeah. It's amazing. It's like having a magic wand.
Lisa Swanson:I know, right? I think that's a great point to end on. A magic wand, help our kids grow, ready, set, grow with dupi. Treat your patients with bad atopic dermatitis, make them better and you'll see them grow. Thanks, guys.
