Many new options for improving patients' care

This issue of the Journal of Dermatological Treatment offers several obliquely related articles that will help promote better patient care. Among these is a review of topical calcitriol ([1]). While Europe has had this product for some time, topical calcitriol was recently approved for use by the US Food and Drug Administration. US patients now have access to a topical vitamin D ointment for psoriasis. Topical vitamin D analogs are particularly helpful in combination treatment regimens for providing long-term control of psoriasis while minimizing the side effects associated with long-term topical corticosteroid use. Topical vitamin D analogs are also helpful for their synergistic effects when used with various forms of phototherapy.

Unfortunately, office-based phototherapy isn't always a convenient or feasible option for psoriasis patients. Home phototherapy is an option, and a recent study demonstrated that the efficacy and short-term side effects of home phototherapy are comparable with those of office-based phototherapy treatments ([2]). Another potential option described in a review article in this issue is the use of the ubiquitous tanning bed ([3]). While tanning bed use is anathema to most dermatologists, it may be a very effective treatment for many psoriasis patients. Some dermatologists have strong feelings that tanning beds are not effective for psoriasis; their experience in this regard may be influenced by selection bias ([4]). Patients who try a tanning bed before coming to the dermatologist do not visit the dermatologist if the tanning bed is sufficiently effective. The dermatologist tends to see only those patients who didn't get better with the treatment.

When prescribing combination treatment regimens such as topical vitamin D analogs in conjunction with topical corticosteroids or with phototherapy, we must be cognizant that what may seem simple and straightforward to us may seem complicated and difficult to remember from the patient's perspective. In what should be a major wake-up call to our specialty, the landmark study by Storm et al. describes how the basic drug information we give patients may be inadequate ([5]). This may represent a clear opportunity to improve the care we provide patients. With all the resources we have today, it should not be too difficult to put into place educational systems such as nurse educators and written action plans to help patients better understand their treatment.

Finally, as we consider improving our systems of care, we should attend to the article by Balkrishnan et al. discussing the monitoring of medication errors in dermatology ([6]). Electronic prescribing systems may help alleviate the misreading of poor handwriting, but such systems also introduce the potential for new errors, including hitting the wrong key on the keyboard. We need systems to ensure that we minimize medication errors and to track our progress in that regard. Without monitoring and obtaining data on how we are doing now, it will be very difficult to move forward and improve upon current practices.