Ashley Crew, MD: Barriers to Topical Steroid Use


An expert dermatologist explains.

If something is out of a provider’s wheelhouse, they may inaccurately prescribe something to a patient. That means the provider could be unsure about the side effects to a prescription or exactly how it can benefit a patient or be used.

In a recent interview with HCPLive®, Ashley Crew, MD, of Keck Medicine of USC, said that comes into play a lot in rheumatology—and other specialties—with topical steroids.

One of the biggest issues Crews, a dermatologist, sees, is a failure of the provider to pick the appropriate strength topical steroid, whether it be low, moderate, or strong potency.

“We basically decide which class we want to use depending on the location we’re treating and the disease-process we are treating,” Crew said. “So, the strength is 1 important component, and oftentimes non-dermatologists undershoot with strength because they are anxious and don’t want to treat with something too strong because they are worried they might do damage, which I think is a good caution to have if you haven’t been coached on how to do it appropriately.”

It is also necessary to think about the actual steroid being used—a solution, a cream, or an ointment. That’s important because it affects the potency of the topical steroid and if the patient hates what is prescribed to them, they aren’t likely to use it.

For example, if someone presents to the rheumatologist with scalp psoriasis and is prescribed an ointment, they likely will not use it, Crew said. Instead, if an alcohol-based solution is prescribed, it might better be suited to address the needs of the patient while actually being used and benefitted from.

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