Overcoming fear of systemic therapeutics

“There is a difference between being cautious, being prepared, and being afraid,” said Neal Bhatia, MD.

Rarely do dermatologists receive the warning: “Do not be afraid.” This is the key message of Friday’s symposium “Advanced Systemic Therapeutics” (S007). The purpose of the session, which will take place Friday from 1 to 4 p.m. in Grand Ballroom EF, is to educate dermatologists on the latest systemic therapies and ensure they use them correctly and courageously in order to care for and keep their patients.

“In short, my goal is to get dermatologists off the bench and into the game of using systemic therapies without trepidation,” said session director Neal Bhatia, MD. “We cannot let dermatology be looked at as a soft specialty, afraid to use anything but triamcinolone ointment. Allergists, rheumatologists, and other specialists are eroding our scope of practice and it cannot continue or we will become marginalized.”

Promise for the future

Systemic therapies possess a lot of promise for the field of dermatology. The session’s nine lecturers will discuss fundamental features, such as lab monitoring schedules, management of follow-up visits and tapering plans, and assessment of adverse outcomes. Speakers will also evaluate off-label applications and define the method of matching mechanisms of diseases to mechanisms of therapies.

“The individual sessions are intended to present management strategies on approved and existing therapies independent of costs and coverage issues, but also to introduce new therapies on the horizon and their incorporation into practice,” Dr. Bhatia said.

Attendees will hear presentations on a range of topics, including:

  • Management of systemic therapies in specific patient populations, such as children and pregnant women
  • Adjunctive treatments for tumors
  • JAK inhibitors
  • PRP safety and optimization
  • Emerging hormonal therapies

Overcoming anxieties for application

The application, or trepidation for application, of biologics is a controversial subject that will also be discussed. Over time, patients have adopted an aversion to biologics due to misinformation in the media. This, along with anxiety of adverse side effects, has created increasing timidity across the specialty. In the symposium, experts on various diseases will clarify facts and help resolve misconceptions that have impeded patient care. They will also examine the consequences of not treating patients with the most impactful therapies for their diseases.

Examples of nontraditional uses of currently available therapies are:

  • Using antibiotics to augment anti-inflammatory activity in rosacea
  • Extending the use of JAK inhibitors to conditions traditionally treated with steroids, such as atopic dermatitis, vitiligo, and alopecia areata
  • Repurposing chemotherapy antibiotics to manage difficult conditions, such as bullous dermatoses

While this session will clarify and increase understanding of systemic therapies, Dr. Bhatia said dermatologists must still be vigilant.

“There is a difference between being cautious, being prepared, and being afraid,” he said. “Being afraid is usually a function of bad information, where either the dermatologist or the patient has preconceived notions about a treatment that probably has fewer negative impacts than the disease not being treated. Being cautious is a function of practicing good medicine.”

Weighing all your options

It is critical to look at the big picture and be open-minded. Assessing the benefits, opportunities, and alternatives of a therapy is equally essential to weighing the risks and side effects. Then, of course, one must illustrate the comprehensive approach and potential outcomes to the patient in order to achieve consent and agreement among all parties.

“We have to remember the needs of the patient,” Dr. Bhatia said. “Quality of life, long-term remissions, and managing expectations are all important measures of treatment success.”

Members who attend this symposium should expect to leave invigorated and enlightened. The American Board of Dermatology (ABD) has approved the course for up to 30 MOC Component 2 Self-Assessment credits. Attendees also can receive 3 continuing medical education (CME) credits.


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