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Coordinating eczema care at a multidisciplinary clinic

Dr. Attarian's story

Hrayr Attarian
Hrayr Attarian, MD, Sleep Neurologist – Northwest Medicine
Treating eczema can require a multidisciplinary approach, involving allergists, neurologists, sleep specialists, and dermatologists. That’s because histamine impacts both eczema and insomnia — linking sleep medicine, allergology, and dermatology in treating eczema. For instance, a patient with eczema may have difficulty sleeping due to their itchiness. This creates a vicious cycle where poor sleep increases inflammation, making the itching worse, which makes it even more difficult for the patient to sleep, which further increases inflammation, and so on. Over the years, there have been scattered efforts in our community to create a multidisciplinary eczema clinic to better coordinate care. In 2013, Dr. Silverberg successfully formed the Northwestern Medicine Eczema Center.

At this clinic, patients come in for a single, comprehensive, two-to-three hour appointment. This coordination of care allows for a patient’s physicians to easily confer, ultimately developing the best treatment plan. It is also a much better experience for patients.

One example that stands out to me is an eczema patient who was having difficulty sleeping. We learned that due to her work schedule, she was getting up earlier than her natural circadian rhythm and couldn’t fall asleep early enough to get sufficient rest. This was increasing her inflammation and itching. We used a combination of light therapy and melatonin to naturally adjust her sleep cycle to fit her work schedule, which reduced her inflammation and itching and helped her respond better to her eczema medicine.

I’m pleased to have the opportunity to work in this type of multidisciplinary setting, and it is thanks to Dr. Silverberg’s initiative and hard work. It is incredibly rewarding as a physician to work as part of a team, and to see how that coordination improves the care we provide to our patients. 

The dermatologist's perspective

"Coordination of care is absolutely essential to get good outcomes. Before we started this clinic, not uncommonly, I had patients who were seeing me for their skin disease, someone else for their airway disease and allergies, and yet another institution for primary care. There was no coordination between us, and as a result there were a lot of mixed messages from allergists in one setting, primary care doctors in another setting, and myself. By working together in one clinic, sitting down after each patient and finding the best treatment approaches that we were all comfortable with, we really have reduced that confusion."

– Jonathan Silverberg, MD, PhD, MPH
Dermatologist and Director of the Northwest Medicine Multidisciplinary Eczema Center, Northwestern Medicine

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