PHILADELPHIA — Given that some dermatological conditions present similar symptoms, it is critical for nurse practitioners and primary care physicians to make the proper differential diagnosis before starting treatment, according to a presenter here at the annual meeting of the American Association of Nurse Practitioners.
Lakshi Aldredge, MSN, ANP-BC, Portland VA Medical Center, Portland Oregon, provided a few examples to illustrate her point.
“Rosacea can mimic lupus on the face. Acne can look like contact dermatitis or psoriasis,” she said. “Make sure you know what you are treating before you begin treating it,”
Aldredge shared other pearls with attendees.
Knowing medication prices
She suggested knowing medication costs, as well as a patient’s budget and insurance plan.
“It’s most heartbreaking to treat a patient, then you write a prescription, the patient is super excited [to be getting treatment], he or she gets to the pharmacy, and gets a bill for $600.
“Just because something is generic doesn’t mean it’s going to be cheap,” she added. “Explore all [pharmaceutical] options and don’t always go with the name brand or what’s advertised.” She also suggested recommending web apps like Good RX to patients to help them get the best price.
Set realistic expectations
Patients need to be lenient about time frames and expectations when being treated for some dermatological conditions, Aldredge said.
“Fifty percent of improvement in a skin condition like rosacea or acne is a victory,” noting that something advertised as a “fast cure” should be viewed cautiously.
In addition, Aldredge recommended asking patients to use treatments as recommended, to avoid multiple treatments at the same time so that a medical professional can ascertain which one is working, and to not rely exclusively on Google or blogs for cures.
Aldredge also encouraged PCPs to take advantage of the clinical guidelines and research available from associations with expertise in managing dermatologic conditions.
“You have a ton of resources,” she said. “The American Academy of Dermatology, the Dermatology Nurses Association, the National Psoriasis Foundation, the National Eczema Association — all of these associations have websites that once you get a diagnosis you can go to their websites and get patient care guidelines for you, so you don’t have to do all the background work.” – by Janel Miller
Aldredge L. Abstract 17.4.034. Presented at: American Association of Nurse Practitioners National Conference; Jun. 20-25, 2017; Philadelphia.
Disclosure: Aldredge reports receiving consulting, advisory board and speaker fees from AbbVie, Celegene, Lilly, and Novartis.