Simplifying Topical Treatment

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Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of The Dermatologist or HMP Global, their employees, and affiliates.

Treatment Vehicle Choice

Steroid responsive inflammatory scalp dermatitis generally requires a liquid formulation of a topical treatment. If there is a coexisting dermatitis on the trunk and extremities, a cream or ointment formulation of a topical medication is also needed. This requires 2 prescriptions and 2 copays. The 2 formulations are at times confusing to the patient regarding which medication goes to which area. One way to simplify this topical treatment is to prescribe only the cream formulation, noting that this works best with emollient-based creams. Instruct patients to put a pea-sized amount of the cream into the palm of their hand, wet the index finger of their other hand with tap water, mix the water into the cream reducing its viscosity, and then apply sparingly to the scalp. This will result in a cosmetically acceptable and therapeutically efficacious treatment for the scalp using the same medication as for the trunk extremities. For example, fluocinonide cream could be used to treat both scalp and elbow psoriasis.

Wayne Fujita, MD | Aiea, HI

Watch Your Attitude With Staff

I recently had a discussion with my son, who is a veterinarian, about dealing with his office staff. He was upset about the way they were talking to patients and that they were giving advice they should be leaving up to him. He said he was going to have a meeting and tell them about all they were doing wrong. I told him he needed a complete turnaround in his attitude and ap-proach if he wanted his staff to respect him and work hard for him. Build a team of allies! Instead of starting the conversation with what a staff member should not do or what they are doing wrong, always start with something positive to get them listening and on your side. Then review what the best way to approach a discussion with a patient would be, what you would like them to include, and what you would like them to defer to you. Staff members who feel respected and who are happy with the office environment will work harder and make your patients happier.

Jo Herzog, MD | Vestavia Hills, AL

Over-the-Counter Nasal Spray for Poison Ivy

When neighbors or friends have poison ivy or some other steroid responsive dermatosis, if I do not want to write a prescription, I recommend they use over-the-counter Flonase (fluticasone) or Nasacort (triamcinolone) nasal spray applied to the affected areas. Too often we think that 1% hydrocortisone is the strongest topical steroid available without a prescription.

Steven R. Feldman, MD | Winston-Salem, NC

Doxycycline Tablets vs Capsules

When it comes to gastrointestinal side effects, oral generic doxycycline tablets are less irritating than the capsule form.

Benjamin Barankin, MD, FRCPC | Toronto, Ontario, Canada