Multidisciplinary Atopic Dermatitis Program (MADP)
The Multidisciplinary Atopic Dermatitis Program (MADP) clinic is a specialized clinic to evaluate patients with severe atopic dermatitis who may benefit from comprehensive evaluation, therapy and education. This is a collaborative program of the Rady Children’s Hospital and UC San Diego Health Division of Dermatology (led by Lawrence Eichenfield, M.D.) and Division of Allergy & Immunology (led by Bob Geng, M.D.).
Clinics are held monthly and involve evaluations by dermatologists, allergists, clinical pharmacists, physician assistants, research associates and patient educators. Evaluations include an assessment of the history of eczema and allergies, an assessment of prior therapies and clinical response, a review of patient and family perspectives on their disease, physical examination, and an assessment of disease severity and impact on the quality of life.
Approaches to evaluation and management are discussed both by the team and the patient and family to determine the most appropriate diagnostic and therapeutic options.
How to Get a Referral
Our MADP clinic is designed to help patients and families with severe/difficult-to-manage eczema AND allergic rhinitis, food allergies or asthma. In order to been seen in our clinic, you or your child must be referred by either a Rady Children’s dermatologist or allergist. Once we have received your referral, our clinic coordinator, Norma Villapando, PA-C, will contact you and help you schedule your appointment. If you believe you or your child would benefit from being seen at our clinic, please talk to your Rady Children’s dermatologist or allergist.
What to Expect
The MADP clinic visit is more comprehensive than a typical office visit and will take about two hours. You or your child will be asked to complete paperwork in advance regarding the history of eczema, allergies, other atopic conditions and the prior therapies used for these conditions. You or your child will also be asked to create an account on eczemawise.org, a website created by the National Eczema Association to help assess and track eczema symptoms.
The symptom tracking feature of the website allows us to incorporate patient-reported outcomes in our assessment of treatment efficacy. We ask that you complete the symptom tracking the morning of your visit and bring a printed copy to the visit if possible. During the clinic, you will fill out a few additional questionnaires to expand our understanding of the impact eczema has on your or your child’s life.
During the visit, you or your child will be evaluated by the dermatologist, allergist, clinical pharmacist and others who will assist with the assessment of eczema severity and provide family education about the disease. We ask that you come to the clinic open to discussing different treatment options, including topical and systemic therapies.
Understanding eczema is vital to successful treatment, and our team has worked together to create a variety of educational materials. During your visit, you will meet with a patient educator to review these materials and help answer any additional questions you might have regarding eczema. The frequency of your visits will be determined by the clinic team during your visit but typically range from once every one to three months.
The MADP clinic uses a standardized set of evaluation tools in order to consistently compare the extent and severity of eczema between visits. These include:
- Eczema Area and Severity Index (EASI)
- Patient-Oriented Eczema Measure (POEM)
- Validated Investigator Global Assessment (vIGA)
- Body Surface Area (BSA): Extent of body that has eczema involvement on a scale of 0-100%
- Pruritus (itch) Rating
Many eczema patients also experience problems with allergies. If you or your child is experiencing troubling symptoms due to allergies the allergist can order different testing to assess the cause(s) and evaluate the impact on eczema. Testing includes, but is not limited to:
- Skin prick testing
- Blood (serum) testing
- Patch testing
Additional blood tests may be ordered to evaluate the immune system, multiple organ systems, screening prior to initiation of certain medications, and any other specific tests based on your or your child’s needs and conditions. For more information regarding the relationship between atopic dermatitis and allergies and the evaluations listed here, please see “Atopic Dermatitis and Allergies” under the “Education” section below.
Our clinic also uses questionnaires to gain a broader understanding of the effect eczema plays in the patient’s life. These include:
There are many different therapies available for the treatment of eczema, including a variety of topical and systemic therapies. During your visits, the physicians will be able to discuss what therapeutic options are best for your specific treatment. For more information about the therapies available, please refer to “Atopic Dermatitis Topical Therapies” and “Atopic Dermatitis Systemic Therapies” under the “Education” section below.
Shared-decision making involves physicians and other health care professionals discussing options for evaluation and treatment with the patient and family in order to incorporate their perspectives in determining the best course of action. Incorporating the patient and family in the decision-making can improve the comfort level in undergoing evaluation and treatment as well as increase the likelihood of successful disease management.
We use the National Eczema Association’s website, eczemawise.org, to help the patient and family gain more insight into the role eczema plays in their lives. We encourage you to complete the tracking before your clinic visit in order to more efficiently utilize your clinic time. While we only require use of the website before clinic visits, we highly suggest taking advantage of the website to track symptoms from day to day (or week or to week) to create a database to track the progression of your or your child’s eczema.
Dr. Lawrence Eichenfield is a codirector of the MADP clinic, chief of Pediatric and Adolescent Dermatology at Rady Children’s, professor of dermatology and pediatrics at UC San Diego School of Medicine and vice chair of the Department of Dermatology at UC San Diego. Dr. Eichenfield coordinates dermatologic evaluations and comprehensive atopic dermatitis management.
Dr. Bob Geng is a codirector of the MADP clinic and an assistant professor of pediatrics and medicine in the Divisions of Adult and Pediatric Allergy and Immunology at UC San Diego. Dr. Geng coordinates allergic and immunologic evaluation and comprehensive atopic dermatitis management.
Alyssa Hobby is a board-certified pediatric pharmacist who has spent her career at Rady Children’s Hospital. She ensures that patients are compliant by verifying medication refills with their outpatient pharmacy. During clinic, she performs interviews with the patients and families and administers subcutaneous medications as needed.
Norma Villapando, a certified physician assistant who has been trained in both pediatric dermatology and allergy, is the MADP clinic coordinator. Norma helps coordinate care before, during and after appointments. During the clinic, she assists both Dr. Eichenfield and Dr. Geng with patient evaluations and treatment plans.
Alexis Tracy is a current combined Pediatric Dermatology and Allergy and Immunology Clinical Research Fellow at Rady Children’s Hospital who completed her preliminary medicine training at UC San Diego. Her role in the MADP clinic includes creating education materials, participating in patient interviews, performing disease activity assessments and providing team decision-making for management.
Safiyyah Bhatti is a combined Pediatric Dermatology and Allergy and Immunology Clinical Research Fellow at Rady Children’s Hospital. She completed her internal medicine residency at Hahnemann University, Drexel University College of Medicine. Her role in the MADP clinic includes creating education materials, participating in patient interviews, performing disease activity assessments and providing team decision-making for management.
Hyunchang Ko is a visiting scholar of Pediatric and Adolescent Dermatology at Rady Children’s Hospital as well as an associate professor in the Department of Dermatology at Pusan National University, South Korea. Dr. Ko observes and helps Dr. Eichenfield and Dr. Geng with patient evaluations and disease management.
Lauren Loop is a coordinator in the Department of Allergy & Immunology and the patient educator for the MADP clinic. She meets with patients to review the questionnaires and education materials provided in the clinic and assists with setting up the eczemawise.org account to track signs and symptoms of eczema.
The divisions of Dermatology and Allergy & Immunology support a variety of clinical research projects, some of which might be relevant to your condition(s). Below are links to the ongoing studies supported by Rady Children’s Hospital. If you are interested in any of these studies, you can either contact the study coordinator listed below or discuss potential involvement with the clinic team at your next visit.
Atopic dermatitis studies