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LIVE BLOG: Innovative Topical Therapy with Alan Fleischer, MD

 

In our ongoing series of Live Blogs from the Fall SDPA Conference in Las Vegas, we present the highlights from Dr. Alan Fleischer, “Topical Therapy: Going Back to the Basics.”

 

In this lecture, Dr. Fleischer offered quick and easy-to-remember tips on Retinoid use, Occlusion, and how delivery of your treatment plan can affect its success were all discussed.

 

+ Retinoids are Helpful in Treating Acne 

It may be hard to prescribe to your acne patients simply because it takes time to prescribe them.  You have to be willing to put a few more minutes in.

 

2003 Published Report: Shows Retinoids should be primary treatment for most forms of acne vulgaris. (Should be applied to entire affected area, not just the spots!)

 

Pump Study

 

Tretinoin Gel Micrisphere was added to an existing regimen in unsatisfied acne patients

– patients were allowed up to 3 other acne RXs

People improved 80-85% when other retinoid was added to the regimen!

 

Counsel Patients to Use Enough Meds and Use it Right

A prospective study of patient adherence to topical treatments: 95% of patients underdose (Study published in 2008 out of Denmark)

 

“When I want People to Use A Lot…Use the Firefighter Analogy”

Firefighter Analogy:

-Your skin is on fire.  Do firefighters put the water on with a teaspoon?  No, they 

use a hose and they’re done in 20 min. 

Hospital Inpatient Rx:

– In the hospital, patients would use 1 pound per day of topical treatment per 

treatment.  No less.  200-300g for kids.  2 days with a pound application per day 

will work in the hospital.  At home it’s different.  But the point is that when you use a lot, you really do get results.  

 

+ Occlusion for Rapid Effects

You can use occlusion with Clobetasol, Vitamin D, Calcinerurin Inhibitors and beyond.

 

Total Body Occlusion 

This is helpful with patients that have 60% coverage and are willing to use a sauna suit.

Testimonial:

“After I used the suit twice, I’d already seen a huge improvement.  It has been 2 weeks and I have cleared more than 90%”  

 

It works!  (For the highly motivated patient.)

 

 

+ Simplify!

Prescribe once daily rather than twice.

Simplify the treatment plan.

 

 

Study

Group 1 was given 2 tubes of medicines

Group 2 was given 1 tube of the two medicines combined

 

People did better with just one tube!

 

 

What Motivates Patients?

 

Know some basic psychology:

 

Different regimens to enhance acne adherence

The parent that nags their kid will not successful 

Most effective was bring the patient back to the office often

 

 

TEENAGERS

+ Teens are notoriously poor with acne adherence

+ DON’T make the parent responsible for the use

+ DO let them know the time commitment

+ Tell the child it’s their acne, it’s their responsibility

+ Give them time commitment: 2 minutes each day!

 

ADULTS AND TEENS ARE NOT THE SAME

Do adults respond better in treatment? Study showed female adults responded better than teen girls.

Perhaps this is because they care more. Adults commented that the acne was stressful.  

 

 

What Vehicles do People Want?

Consider:

cream

ointment

gel

solution

foam

lotion

tape

 

When treatment fails, try to discover why they didn’t use their medication.

 

Reasons: Failure to Use Meds

Regimen is too complex

Drugs are too irritating

Patient used too much (Show with a moisturizer what size the drop should be)

Medication is too messy 

Forgets to do it (give them another habit to link it to: when you brush your teeth?)

Hates to apply skin things (“Fine with me, but you won’t get better!”)

 

 

[Image by Ms. Phoenix]




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