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Cleveland dermatologist uses power of teamwork to tackle eczema challenges

Susan T. Nedorost, M.D., is on a mission to change what she says is a problem for patients plagued by eczema.

"Dermatitis has been the poor stepsister to psoriasis," Dr. Nedorost says. "Now, I think it's going to get the attention that it deserves because the burden of disease is just as great as psoriasis."

Susan Nedorost, M.D.
Part of the solution, she says, is to offer patients an interdisciplinary approach to their care. So in 2010 she co-founded the University Hospitals Interdisciplinary Eczema Clinic in Cleveland.

Overcoming challenges

Several things work against dermatitis, according to Dr. Nedorost. For one, healthcare providers vary in how they define the term. "We did a survey and even dermatologists use it differently," she says. "Some define dermatitis as any inflammation of the skin. And some people, like me, use it to mean a very specific type of inflammation that is characterized by spongiosis histologically, and by itching, oozing and fissuring, clinically."

Dermatitis often is multifactorial, says Dr. Nedorost, who is associate professor of dermatology and associate professor in environmental health sciences, University Hospitals Case Medical Center, Cleveland. Because it's harder to define the cohort, dermatitis hasn't gotten nearly the attention in research that psoriasis has, she says.

The eczema team includes: back row (from left), Eli Silver, M.D.; Nicole Lidyard, R.D.; Mary C. Smith, R.N., C.N.S.; front row (from left), Joan E. Tamburro, D.O.; Susan T. Nedorost, M.D. (Photos: Susan T. Nedorost, M.D.)
The result? Eczema patients often get different messages from different disciplines. That creates confusion and mistrust of the healthcare system among those with the disease, she says.

Working together

Dr. Nedorost helped to spearhead an interdisciplinary eczema clinic, bringing together dermatologists, allergists, a psychologist, a dietician and a nurse practitioner. While there are several multidisciplinary models of care, few interdisciplinary clinics are devoted to eczema, she says. In a multidisciplinary clinic, patients might have access to many disciplines, but the specialists don't necessarily work together on patients' care plans.

One of the biggest barriers, she says, was for physicians from different disciplines to learn how to work together. "Among institutions, there really isn't much faculty development on teamwork, so we've had to work on that on our own," she says. "But I do think that a team is always better than an individual in caring for a patient. We're learning how to get the patient to the providers that they need the most. Once we achieve that, it will increase efficiency."

Immunology interest

Dr. Nedorost says she went into dermatology because of her love for immunology. "Contact dermatitis is my specialty focus, and that's immunology played out in the skin. Being able to discern the subtypes of dermatitis and providing patient education at each step of the management process can lead to really good outcomes."

Dr. Nedorost, who has begun writing a dermatitis monograph, has other big plans, as well. As residency program director in dermatology at University Hospitals Case Medical Center, she wants to impact residents by teaching frugality of care. "My legacy is to help redesign healthcare practices ... so that we better teach physicians how to really think through everything on an individual level. I honestly think that will decrease cost of care."

Susan Nedorost, M.D.

Born: Cincinnati

Medical degree: Case Western Reserve University, Cleveland

Internship: Cleveland Clinic Foundation

Residency: Cleveland Clinic Foundation

Hobbies: Decorating her urban townhouse; taking care of her two Havanese dogs; growing and cooking with herbs; playing tennis.

Family: Husband Bob Nedorost, an engineer; two daughters in their 20s.

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