Challenges, complexities, and dilemmas
Only a great debate can sort these matters out.
Treating patients with complex medical dermatology conditions takes knowledge, expertise, and even a cost-conscious mindset to manage such cases. Unfortunately, that combination is rare within many dermatology practices, leaving many dermatologists hungry for guidance.
The March 8 session, F023 – Great Debates in Medical Dermatology offered a look inside the challenges of caring for patients with medical dermatology disease, including neutrophilic dermatoses, SJS/TEN, and psoriasis as well as strategies for treating that unique patient population. Bridget Shields, MD, FAAD, assistant professor in the department of dermatology at University of Wisconsin, Madison, led the panel discussion that provided myriad points of view and case studies.
The evidence says…
“Identifying practice gaps and providing updates regarding existing and emerging dermatologic literature can help improve management in these patient populations,” Dr. Shields said. “For many complex skin conditions, evidence is lacking, and expert consensus can help guide our approach.”
During the session, panelists guided dermatologists through the process of formulating an evidence-based approach to treating patients with complex skin conditions and shared the consensus in the management of such cases.
For example, Dr. Shields said, for conditions like psoriasis, guidelines help drive management and care. Yet choosing among costly medications can present a unique challenge. For other conditions, such as SJS/TEN or neutrophilic dermatoses, Dr. Shields said there can be significant variability in care.
To lump or split
The discussion explored the debate over “lumping” versus “splitting,” which can improve diagnosis and management. Lumping and splitting refer to how dermatologic conditions can be grouped in various ways, Dr. Shields said.
This can be confusing to patients and other clinicians, Dr. Shields said. “Sometimes these differences are critically important to patient care and prognosis, and other times differentiation is trivial,” she said. “The debate surrounding ‘lumping’ versus ‘splitting’ will dive into whether dermatologists should be grouping conditions more broadly or splitting disease states into discrete entities.”
Cost-conscious practice
Not surprisingly, analyzing the costs of dermatologic care in patients with complex skin conditions is an important part of the discussion. Panelists provided pros and cons of a cost-conscious practice, sharing their approach to these conditions and the evidence supporting their management.
“It is an exciting time in dermatology due to the accelerated development of biologic medications and targeted therapies. These treatments are life changing for patients with severe disease and are used both on- and off-label to improve outcomes,” Dr. Shields said. “As dermatologists, we have the difficult role of selecting not only which patients receive treatment, but also which treatments patients receive. As contributors to the health care system, we should be aware of the associated costs of medication use. The debate focuses on the crucial balance between utilizing innovative therapies and cost-conscious patient care.”
