MIAMI BEACH (FRONTLINE MEDICAL NEWS) – Worry less about reactions, and more about counseling patients on what to expect following actinic keratosis treatments, according to Dr. Neal Bhatia.
“I just want to take everyone’s finger off the panic button when it comes to managing reactions of actinic keratoses,” he said at the South Beach Symposium.
It’s easy to get hung up on side effects and redness, as well as other issues related to treatment, said Dr. Bhatia of Therapeutics Dermatology in San Diego.
“Let’s not forget we’re treating something that could cause skin cancer if left alone,” he added.
AKs are “no longer a Medicare disease,” he said, explaining that AKs are increasingly common in 30- and 40-year-old patients, and the focus of their care should be on outcomes, not reactions.
“The reactions, more often than not, are anticipated,” Dr. Bhatia said.
Patients should be counseled in advance about possible side effects from AK treatments, as well as about anticipated responses, and they should be advised about how to modify symptoms, he said.
“More importantly, we want to give them something that’s going to keep them adherent to the program … we tell them ‘these are things that are going to happen. Be prepared. If you have a problem, you can call the office,’ ” he said.
A patient who doesn’t know what to expect will run to a primary care doctor and post negative reviews on every rating site out there, he cautioned, but that can be prevented by counseling in advance and by choosing the correct therapy with a duration that is a good fit for the patient. He noted that clinicians who suspect a patient won’t be compliant should choose a 2-day treatment, and if they think the patient can handle it – choose a 90-day treatment.
There are numerous treatment choices that will have some benefit for the right patient, Dr. Bhatia added.
When it comes to managing an aggressive treatment response, consider the mechanism of the response. Antibiotics can be used to reduce inflammation without changing the immune process, while steroids can undo the immune response that some therapies are trying to recruit.
“We can emphasize keeping the lesion calmed down while reducing symptoms that are going to be dose limiting,” he said.
Dr. Bhatia advised prescribing medications to be filled only on Monday-Thursday to avoid substitutions being given on Friday-Sunday when “we can’t defend them.” He recommends that patients start treatment on Sunday, so any reactions occur mid-week and can be addressed by the office.
To further reduce the chance of reactions, be sure to avoid office procedures in the 4-7 days before or after AK treatment. Also, when starting any AK drugs, advise the patient to use as many adjunctive therapies as possible, including topical anesthetics, moisturizers, sunblock – “anything to reduce the potential for going overboard,” he said.
Dr Bhatia has been a consultant, researcher, and/or speaker for companies including Allergan, Aqua Pharmaceuticals, Bayer Healthcare Pharmaceuticals, DUSA Pharmaceuticals, Exeltis, Ferndale Pharma, Galderma Laboratories, Genentech, LEO Pharmaceuticals, Nerium Novartis, Promius Pharma, Sandoz, Novartis, and Valeant.
