PracticalDermatology

There is a big push across all medical specialties to offer personalized medicine. From the analytic specificity of genomic blueprints to the mentality shift of patients and providers toward patient-centered care, this individualized approach is what patients want. This approach can be particularly beneficial in dermatology, especially when treating acne patients of all ages. Interestingly, it is also an important exercise in mindfulness, something we need more of as dermatologists.

My role as a dermatologist who loves treating acne is to identify the correct combination of medicines, conducting a mini orchestra on my patient’s skin that crescendos at just the right time. I have to consider both topicals and orals, both anti-inflammatory and keratolytic agents, both creams and washes, both AM and PM, and the list goes on! However, the biggest part of my job is to understand the patient’s lifestyle so that I can create an individualized treatment plan.

With acne, it’s not always the “what” that’s most critical, it’s often the “how.” This means it’s often more important to learn how, when, and where patients are using their medications than it is to learn what specific medications they are using.

Basics of Patient-Centered Acne Care

Patient-centered acne care starts with getting a clear picture of what is going on at home. I always ask my patients to bring all of their products with them when they come into the office for a new acne appointment. If it touches their skin, I want to see it. We go through what they like and why, along with how and when they use all of their products.

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This accomplishes several key things right off the bat.

For starters, I can see what got them to this point, for better or worse. I can also offer real-time feedback about what they need to do more of or less of to treat their acne. In addition, this exercise engages patients from the start due to the sheer hassle of collecting all their skin care products. We can also incorporate the new plan using the “old” products. If the patient is more likely to wash and apply medications in the morning or evening, we can tweak the regimen accordingly. Sometimes just moving the benzoyl peroxide (BPO) wash to the shower from the sink will significantly improve adherence and maximize the effects of the acne regimen (not to mention rescue all the pajama tops that have not yet been bleached by using BPO washes at the sink!).

More frequent follow-up visits with acne patients also improve treatment outcomes, and the additional face-time helps foster the doctor-patient relationship. I never wait longer than four to six weeks to see an acne patient after their first visit. I also have my staff document each patient’s progress using “acne mug shots,” which are three face photos taken at each visit. Patients love to watch their progress! Having this photo evidence also counters subjective comments, such as, “my acne is not any better than last time.”

Make it Personal

I handwrite my plan for each patient. In the days of electronic medical records, e-prescribing, and digitized appointment reminders, this provides the personal touch that patients appreciate and that can be lacking in modern healthcare. Cognitive behavioral research shows us that any small personalization of patient education material leads to a significant return on investment with a greater likelihood of patient adherence. Lastly, I tell them for the first week I want their plan taped to the bathroom mirror, and I get a verbal “yes” to that commitment, as a humorous homage to the privilege of exit row seating.

Start Conducting

This patient-centered approach to medicine has a spillover benefit on physicians as it gets us back to our roots and allows us to put our patients before paperwork. Personalized care allows us to be present, truly understand patient barriers to adherence, and not just say, “let’s start doxy, some BPO, and a topical retinoid and check back in two months.” We should allow ourselves the opportunity to have fun and get creative with conducting this carefully crafted orchestra for our patients.