‘Sparingly’ for TCS falling by the wayside

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Less than 20% of pharmacists continue to advise people use topical corticosteroids sparingly to treat eczema, an AJP poll shows – but more needs to be done to change pharmacist advice.

Karalyn Huxhagen, AJP contributor and 2010 Pharmacist of the Year, told the AJP today that the findings of our poll were “progress, but not enough”.

We asked ajp.com.au readers, “What advice do you give/print regarding the use of corticosteroids?

More than half of respondents – 197 readers, or 55% – said they remove “sparingly” from labels and offer advice using fingertip units.

Another 15% (52 readers) said they remove “sparingly” from labels and advise customers to use topical corticosteroids more liberally.

Nearly one in five (18%) still advised patients to use the products sparingly. Another 5% remove “sparingly” from labels but don’t explain further.

Huxhagen encourages pharmacists to go to Australian Doctor Dermatology presentations, where they may meet some frustrated dermatologists, but will also receive up-to-date information on the use of TCS.

“I would strongly suggest that pharmacists who are still doing ‘sparingly’ take note of what the dermatologists are saying: that this scare tactic around skin thinning has been there since the 80s and it’s not applicable,” she says.

“We are actually causing patients, especially small children, to be undertreated, and that’s just not fair.

“I would strongly recommend one of these seminars – I attended one recently and it was an excellent forum and presentation, though some of the dermatologists really wanted to shoot pharmacists!

“And that was with quite a lot of justification – but really, it’s not our fault. When I graduated the advice was to lather it on.

“Then I started to have young pharmacists come to work with me who would advise to use it sparingly, and not for patients under the age of two. I thought, ‘Where did that come from?’ and then when I did post-graduate study on dermatology, the textbooks all said, ‘sparingly’.

“There’s a bigger problem than just focusing on pharmacists undermining what dermatologists want, because the prescribing software says ‘sparingly,’ the dispensing software, the textbooks say it, the universities teach it.”

Even fingertip units may not be enough product, Huxhagen was told at the recent seminar.

“It would be better practice if the pharmacist asked the patient what the doctor or dermatologist told them – ‘How did the doctor ask you to apply this?’” she says.

“Then work your way up from that answer.”

Huxhagen says that changes to the prescribing and dispensing of corticosteroids listed under the PBS from today may help, as these will make it easier to prescribe and dispense more appropriate amounts of product.

“To date, where we’ve had GPs trying to manage people’s eczema – especially here in North Queensland where there’s no dermatologist available – they’ve only been able to order one 15g tube and a repeat, and that’s not enough for the quantity you need to treat the eczema,” Huxhagen says.

“Even where a GP upskills in dermatology they’re still faced with this problem of giving enough quantity. So this will help.”

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1 Comment

  1. Drugby

    20% of pharmacists (who responded to the survey) still advising to use sparingly is not good enough. It should be zero. The evidence does not support this. The Colleges, guidelines and product information have moved towards FTUs.

    It’s time for unis to shift their teaching of undergrads if this is still happening, as Karalyn suggests.

    In general, the size of the tube reflects the strength of the steroid and appropriateness. But of course there are always exceptions, and some people will have a widespread condition which requires more product.

    Pharmacists should reinforce the need for emollients, and avoidance of hot baths/showers, soap and other irritants at every opportunity. You can never use too much moisturizer for eczema!!

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