Dermatology Weekly

Consider poor adherence rather than recalcitrant disease in psoriasis patients who do not respond to topical treatment. Dr. Vincent DeLeo talks with Dr. Nwanneka Okwundu and Dr. Steven Feldman about strategies to promote better treatment adherence. They discuss factors that contribute to poor adherence and offer tips to motivate patients to stick to their treatment regimens. “There’s a lot we can do to get people to use their medicine better.  ... Our job is to get people well. And to do that, we have to make the right diagnosis, prescribe the right therapy, and do those things that need to be done to get patients to put the medicine on,” explains Dr. Feldman.

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We also bring you the latest in dermatology news and research:

1. Coronavirus outbreak prompts cancellation of AAD annual meeting
The American Academy of Dermatology annual meeting is the latest large medical conference to be canceled because of the coronavirus disease 2019 (COVID-19) outbreak.

2. Antifungal drug terbinafine appears safe for pregnancy
Treatment with terbinafine during pregnancy does not appear to increase the risk of major malformations or spontaneous abortions.

3. Toys may be the culprit for children with contact allergies
A variety of toys such as video game controllers, tablets, dolls, bikes, and toy cars, can cause contact dermatitis in children because of the nature of their respective ingredients.

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Things you will learn in this episode:

• A recent study evaluated whether psoriasis patients who were resistant to topical corticosteroids responded under conditions designed to promote treatment adherence, which included telephone reminders, frequent study visits, and use of a spray vehicle vs. an ointment.
• Most participants improved in all measurement parameters, but the randomized group of patients who received telephone calls showed more improvement in disease severity than those who did not receive telephone calls. “This idea that topical therapy doesn’t work, I think, is based on a misconception. It’s based on our observations that it doesn’t work, but we’re not seeing how poorly compliant patients are. If we take people who fail topical therapy and do things to really get them to use their topical medication well, their skin disease clears up,” Dr. Feldman explains.
• In addition to making the diagnosis and prescribing treatment, dermatologists play an important role in getting psoriasis patients to use their medications: “If you tell people, ‘Here, put this topical therapy on. It’s messy, I’ll see you in 3 months,’ you’ll be like a piano teacher saying, ‘Here’s a really complicated piece of music, practice it every day, I’ll see you at the recital in 3 months.’ It’s just not going to sound like a very good recital,” Dr. Feldman notes.
• Practical alternatives to frequent office visits that dermatologists can use to answer patient questions and promote treatment adherence include virtual visits (teledermatology) and electronic interactions (telephone calls, email correspondence).
• It is important to prescribe therapies that are consistent with a patient’s preferred vehicle. “If the patient prefers a spray, give them a spray. If they want an ointment, give them an ointment. They are more likely to use it that way,” Dr. Okwundu recommends.
• When starting patients on a new treatment, hold them accountable by having them check in with you to let you know how they are doing. “Maybe we don’t need to see people every 3 days, but we need to make sure patients realize we care about them, because they don’t want to let us down if we have the kind of strong human relationship with them and then we have to hold them accountable,” Dr. Feldman advises.

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Hosts: Nick Andrews; Vincent A. DeLeo, MD (University of Southern California, Los Angeles)

Guests: Nwanneka Okwundu, DO; Steven R. Feldman, MD, PhD (both are with Wake Forest University, Winston-Salem, N.C.).

Show notes by: Alicia Sonners, Melissa Sears, Elizabeth Mechcatie

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