Optimizing and Expediting Care: A Novel Treatment for SD

Transcript

Linda Stein Gold, MD: So, Neal, in terms of what we see with a new option, how does it compare with what we’ve had?

Neal Bhatia, MD: The first thing is what we’ve had has been a lot of hodgepodge. It’s been throwing things at the disease and hoping it works. That’s the unfortunate part of it. I go back to 2008 when the first 510(k) came out. Even that as monotherapy had its shortcomings, unfortunately. But at the same time, incorporating a wash, incorporating a kind of moisturizer, those are separate from maybe just having a reliable once-a-day foam that we can use on all surface areas. When we have this available, this is the point where we say, “All right, take your next 10 patients and give it a try.” Because this way, if we get them out of the routine of azoles and higher-potency steroids, we can maximize their compliance and also not have to see them back as often.

Linda Stein Gold, MD: Now, I want to ask all of you, and just be honest. When a patient comes in, say they come in with toenail fungus, and they walk in and you see kind of moderate seborrheic dermatitis, in the past, do you bring it up? Do you bring it up yourself or is that something that you just kind of [wait on]?

Shawn Kwatra, MD: Sometimes I wait because in my mind, I’m like, “OK, what are we going to do? A little ketoconazole wash or maybe cream, maybe a topical calcium inhibitor, maybe a topical steroid. It’s going to take me 20 minutes to explain this. I don’t know how well it’s going to work. Is it even bothering him?” So, those are all the thoughts that are coming through.

Linda Stein Gold, MD: James, what do you think? I just came in, I have a full skin check. I have toenail fungus that I’m really obsessing over, but you look at me and you say, “Oh my gosh.”

James Song, MD: To your point, I’m always running behind. We have 3 or 4 other complaints that we’re trying to address, and we know that this is going to take another 5 minutes to talk about the 2 or 3 different topicals we’re going to prescribe. So, in the past, it was something that I wouldn’t proactively bring up, but I do think the results of that that quality-of-life study showing just how much it impacts people…was somewhat illuminating, that maybe I need to be asking to be a better doctor.

Linda Stein Gold, MD: And what about, Adelaide, in the pediatric world, do you bring it up or you don’t?

Adelaide Hebert, MD: We do bring it up. We try to give comprehensive care, and I also mentioned to the parent, is this bothering your child, or if the child is old enough to answer I can ask them. Sometimes the parent is far more worried than the child seems to be at the moment. The child may grow into a greater concern as they begin to have more advanced ages into the teenage years, but the 9-year-olds, usually they’re pretty oblivious, and that’s fine. We do offer it if they decide to just wait. I’m OK with that, but I always leave the door open. You can come back or, if you decide you want the medication, give me a call; we’ll fill out the paperwork [and] we’ll take care of that for you.

Neal Bhatia, MD: I don’t buy that, because if you see patients scratching in the exam room you have to ask them, “OK, what’s going on up here?”

Adelaide Hebert, MD: So you will ask if I’m sitting here in your [office]. I just said I want a full skin check, I want to talk about my toenails, and I have a little hair loss, [but] you’re going bring it up absolutely.

Neal Bhatia, MD: Absolutely. If they have seborrheic dermatitis on their face, I’ll go like this with my thumb I’ll say, “What’s going on here?”

Linda Stein Gold, MD: And that’s great, but Shawn, I’m going to come back to you now, before it was a conversation of, this is what you have, you have a condition, I can help you, but it’s going to be a conversation that’s going to take a little while, and I’m going to be able to help you in a very limited way. Does the option of having an effective and safe and well-tolerated drug now change it? Even though I’m squeezing you for time and I don’t want to let you out of the room, will you now maybe say, “Is that bothering you?”

Shawn Kwatra, MD: Absolutely, because we have good data behind it and it’s one agent and it’s one time daily. I think it’s an easy thing to tell a patient about. It’s easy for the patient to understand it doesn’t take long, so absolutely. I think we were waiting for this type of agent because it was complicated to explain the different options, and we honestly have no idea how those options even work. But now we have clear therapy that has great efficacy [and] it’s easy to give to patients.

Linda Stein Gold, MD: Yeah, and I agree. I think that we can provide better care, and as Neal and Adelaide mentioned, a more holistic approach to our patients because we’re given a gift. This is something that’s not going to consume our appointments.

Neal Bhatia, MD: Absolutely. Even if you’re watching the clock and you’ve got people waiting, I’ll give them the sample and I’ll say, “Here, try this,” and I’ll go back to something else. Let them sit for 10 minutes and I’ll say, “OK, how did we do?” Because at least, for 1, that’s buying you a little time, but for 2, they’re trying the medication that you’re trying to give them, and then you know if there’s any tolerability issue on the spot.

Transcript was AI-generated and edited for clarity.