Patient Expectations Regarding Treatments in the Age of Social Media and Misinformation

Dr. Todd Schlesinger (00:07):

Hi, I'm Dr. Todd Schlesinger. I'm a board certified dermatologist and member of the American Academy of Dermatology. I practice in Charleston, South Carolina, and I founded the Clinical Research Center of the Carolinas and I also work with Epiphany Dermatology as my practice location.

(00:23):

When thinking about systemic steroids and atopic dermatitis, I think one really has to think hard about whether you want to put your patient on a systemic steroid. So I think it's becoming clear in our clinical practice, not only with all the new medications we have to treat atopic dermatitis, but yet the adverse event profile that we know with systemic steroids is present. So we know about all the more common things. Of course, increased risk blood sugar, weight gain, irritability, risk of avascular necrosis of the femoral head and other concerns with systemic storage, which can happen really even in the short term. So I think the literature is quite clear if you take a look at it that systemic steroids really only should be used in our patients in those extreme circumstances, dire circumstances, where that's something that is needed to be to control someone's acute flare in atopic dermatitis. There's a lot we can do with topicals now, non-steroidal topicals and also some steroids, and then systemics.

(01:27):

So that's where I think it's important to think about that use of systemic steroids. I think in my practice it's day-to-day clinical, I really think long and hard before I expose one of my patients to systemic steroids. I counsel them to let them know what the side effects are and the possible benefits, but yet all the different medications that we now have and targeting the inflammatory pathways of atopic dermatitis that we have, I think we can do a lot without even having to resort to systemic steroids. And when I say resort, I mean resort. I think it's an option that we have in the clinic, but yet, based on what we know now in 2025, that's something and then going forward that we can try to avoid and limit the use of our patients, especially to limit those to very short-term courses that we know can help the patient maybe early, early, but yet get them onto a more appropriate systemic therapy over time. So I think long and hard before we start somebody on systemic steroids.