Darren West, MPAS, PA-C; and Jayme M. Heim, MSN, FNP-BC, share their approaches to educating patients on use of steroids for dermatologic conditions, highlighting how they approach pediatric patient populations.
Linda F. Stein Gold, MD: So, let’s get back to education, because the bottom line is really just that…we hear so much about new agents, but we also hear online this backlash against topical corticosteroids. How do you educate your patients appropriately that this is still what is appropriate for them, especially in the acute flare?
Darren West, MPAS, PA-C: I still get the occasional mom [who] comes in with [her] child and says, “I don’t want my children on a steroid,” but you just almost have to sit down with them and say, “Well, we’ve had many advancements in the development of newer products. The way that they’re developed, the way that the vehicles are, and the way we prescribe topical corticosteroids today, it’s pretty safe.” So, you almost must break it down individually for our patient and…spell it out for them to talk them off the ledge a little bit…. [Y]ou…say, “Look…we don’t intend on having your child or anybody on any topical corticosteroid indefinitely.” We need to responsibly prescribe them rotation therapy, cyclical therapy, whatever you want to call it, and then just do it the right way. And so, you talk to these patients, you talk to adults, and say…we hope and the intention is eventually to maybe transition on to something different. And we can always come back to the steroid if we needed to. But we have many options and many tools in our tool bag now. This is just one of them.
Linda F. Stein Gold, MD: Jayme, any words of wisdom for [individuals] talking to their patients about…appropriate education?
Jayme M. Heim, MSN, FNP-BC: Absolutely. Appropriate education is just important. I agree exactly with what Darren was saying, that it’s very hard…I do see a lot of pediatric population[s] because before I came into dermatology, I worked for 23 years in pediatrics and then I’ve been working for 18 years now in derm[atology], and I’ve seen a lot of families, work[ed] with a lot of families…. [I]t’s really explaining to them and the difference between…something that’s a super-low potency and something that’s a super-high potency and how important it is and that these are not medications that are going to be used long term. These are medications that are used short term; they’re to put disease under control and then to go ahead and use for a flare…. [I]t’s really important to do that education with the patients and then…when we talk about other medications, too, that we have that are nonsteroidal and then we can go ahead…and…at some point transition to some of the nonsteroidal medications, too, for some patients. But for acute flares and…really cooling that skin down, that acute time is important to be able to utilize a topical steroid.
Darren West, MPAS, PA-C: I also think that…we need to properly prescribe it and have it written out. You know, the pharmacist sometimes gets a prescription from us and it doesn’t specify the length of time for some of these steroids; it says apply to affected area twice a day until clear. I’m having…whoever writes their [prescription] say, “Look, this is for 2 weeks maximum and then come off and then we can go back on it.” So, we need to also just make sure we do our part in how we write them.
Jayme M. Heim, MSN, FNP-BC: I think, too, follow-up is really important because especially when you have…younger patients or if you even have teenagers in there, the parents are really averse to using steroids because they’ve been told time and time again, “Oh no, they can’t use a steroid.” And I try to go ahead and follow up with them within 2 to 3 weeks after seeing them. Sometimes even 10 days to 14 days, because…I can go ahead and lend that reassurance, make sure that…I am safely monitoring [the patient]. And that’s one of those things that sometimes isn’t easy. I have usually the person at the front desk coming back to me and saying to me, “Jayme, I don’t know where I’m going to put this patient on your schedule.” I said, “Let’s take a look. We’ll find someplace.”
Linda F. Stein Gold, MD: So, the bottom line is steroids still have a really important place in the treatment of so many of our inflammatory skin diseases. I think the keys, as we’ve outlined really well, [are], first of all, appropriate patient expectations, a patient education, having a healthy respect for the medications, taking the time to educate our patients when it’s necessary for chronic conditions, using those potent steroids that are a little safer in terms of maybe depositing in the skin for a longer period of time and just making sure we utilize whatever medications we need to get our patients under control. So, I want to thank you both. I think this has been a nice recap. I think it’s a critical conversation to have as we really try to navigate through our new treatment options and our valued older treatment options as well. And thanks so much to both of you for joining me.
Transcript is AI-generated and edited for clarity and readability.