In Clinical

Follow this topic

Bookmark

Record learning outcomes

How can adherence to dermatological treatments be improved?

Correct use and adherence to the treatment regimen is critical for the successful management of dermatological conditions. Although this area is large, there are some commonly-occurring points that can make all the difference.

Eczema

When treating eczema, patients need to know that:

• Topical corticosteroids are for treating flares and emollients for maintaining skin condition
• Following the stepped care process – step up to control flares, step down when the flare subsides – minimises the risk of steroid side-effects (e.g. skin thinning, telangiectasia)
• Emollients should be used all the time, even when eczema is not flaring
• Finding emollients that they like and will therefore use is critical

  Emollients should be used all the time, even when eczema is not flaring

• Hydrocortisone can safely be applied to the face
• “Weekend maintenance treatment” with potent corticosteroids is safe and effective. This should be done on two consecutive days out of every seven (many people find the weekend the best time). 

Acne

When treating acne, patients need to know that:

• Topical acne products need to be applied for a minimum of six weeks before giving up or switching to an alternative
• Topical benzoyl peroxide 2.5-5% cream or gel works for mild-moderate inflammatory acne
• Topical acne treatment must be applied to the whole of the acne-prone area as developing microcomedones are un-detectable
• Acne treatments can be drying and patients often need a light moisturiser
• A mild skin cleanser that does not dry the skin out further is needed (wash/scrub products alone cannot treat acne)
• Epiduo (POM) combines two effective acne treatments (adapalene and benzoyl peroxide) in a moisturising base and may help with adherence for some people.

Psoriasis

NICE recommendations for psoriasis start with alternating (morning and evening) a potent topical corticosteroid and a vitamin D analogue for trunk and limbs. Patients need to know:

• Which potency of topical corticosteroid is for which body areas
• When to start and stop steroid treatment
• Mild or moderate potency corticosteroids are used for the face, flexures and genitals for a maximum of two weeks
• Patients using Dovobet gel (combined calcipotriol and betamethasone) should not also be using separate betamethasone cream or ointment
• Everyone with psoriasis needs an emollient to keep skin pliable, reduce cracking and the shedding of skin scales.