PracticeUpdate: Dermatology & Rheumatology

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2016 Top Stories in Dermatology

EDITORIAL Managing Editor Anne Neilson anne.neilson@elsevier.com Editor Carolyn Ng carolyn.ng@elsevier.com Designer Jana Sokolovskaja j.sokolovskaja@elsevier.com SALES Commercial Manager Fleur Gill fleur.gill@elsevier.com Account Manager Linnea Mitchell-Taverner l.mitchell-taverner@elsevier.com

PracticeUpdate Dermatology Editorial and Advisory Boardmembers Dr Eliot Mostow and Dr Jane Grant-Kels, as well as Dr Robert Brodell of the University of Mississippi Medical Centre, discuss their top stories in dermatology for 2016, focusing on topical retinoids, shared care to optimise patient outcomes, and exciting advances inmelamona. Dr Robert Brodell on the use of topical retinoids Robert Brodell MD, FAAD, is Professor and Chair of the Department of Dermatology at the University of Mississippi Medical Center. W hile there were many articles involving new treatments, new tech- nologies, and even new diseases, my favourite articles are those that highlight gaps in care for common diseases. The article by Barbieri et al is just such an article ( J Am Acad Dermatol 2016;75:1142-1150.e1). This English study demonstrated that 62% of practitioners did not use a topical retinoid as part of their acne regimen. It validates the work of a team using data from the United States ( J Am Acad Dermatol 2016;74:1252-1254). In 40% of acne patients treated by dermatologists and 70% treated by other physicians, no topical retinoid was used.

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This represents a significant gap in patient care. Experts agree that patients with acne should be treated with topical retinoids. Guidelines from the American Acne and Rosacea Society, the American Academy of Pediatrics, and the Global Alliance to Improve Outcomes in Acne support the use of topical retinoids as first-line therapy for acne. Attacking the pathophysiology of acne with strong comedolytics should decrease the length of time systemic and topical antibiotics are needed and minimise the potential for recurrence because the microcomedone is the source of acne infection. If retinoids were used immediately when systemic antibiotics are used to treat acne, the need for prolonged systemic antibiotic use would be reduced, with obvious benefits to society with regard to the development of resistance. Of course, there is an explanation for this behaviour. Topical retinoids are hard for patients to use! They can be drying, irritating, cause redness, and both post-inflammatory hyper- and hypopigmentation. The physician should initiate topical retinoid therapy using milder products (lower concentrations, creams instead of gels, and products with special vehicles to decrease irritation) and prescribing them for use every other night or twice weekly initially for patients with dry skin. Patients develop tolerance to these products and can often increase the frequency of use over time. Using team-based care techniques, the physician and his/her nurse or medical assistant must take the time to educate patients about other approaches to increase the tolerability of topical retinoids. These include application of the topical retinoid at bedtime to a dry face, using a non-comedogenic moisturising lotion in the morning, and using mild soapless cleansers instead of harsher soaps. Finally, patients should avoid other topical products that might be drying. My experience has been that, by using all of these techniques, the vast majority of patients can tolerate a topical retinoid and benefit from its comedolytic and anti-inflammatory effects. This results in acne clearing faster, minimising the time systemic antibiotics are required, and minimising acne recurrences after patients are clear.

ISSN 2206-4702 (Print) ISSN 2206-4710 (Online)

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