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Tired of Annual Derm Visits for Same Old Prescription Renewal
from Mike C.

Hey! 40 year-old male here. Had P since I was 3. Pretty severe as a child, almost disappeared in my 30's, now back moderately, but in inconvenient places, (face, back, ears and of course the scalp). Have used fluocinonide creams on face and chest with amazing results. I use so little that a tube lasts me a year or so, but just a bit will make a spot disappear in a few days. Like you, I am fair-complected, so the bleaching isn't noticeable, but even if it was, I think it would be better than red and crusty.

Anyway, my gripe is that anytime I need more fluocinonide, I must go to the doctor to get a new prescription. I know he will give me one, because he is aware that I know best what works and what doesn't. I just wish I didn't have to blow that money every year. I know if a new, silver bullet kind of treatment comes along , I'd run to the dermatologist and get signed up, but for now it's just a waste of my money.

This is a great site! Keep up the good work! -Mike C.

*****

Ed’s Response: I’ll bet every flaker whose long-term therapies are topical potions and unguents has felt, at one time or another, just like you, Mike. The derms know exactly why we’re calling, coming ... they don’t even have to look us over to appreciate the complaint ... they scribble the prescript and, $40 poorer, we toddle off to the pharm for our fixes — from which we’ll leave poorer still. The derms, of course, are required by law to do this, and every so often you’ll run into one who takes advantage of the opportunity to review our chart and make sure we’ve tried — or at least heard about — the latest and greatest palliative. (Too often, though, the derms will look at we flakers and ask if we’ve learned anything about P they ought to know! Too often we have and it’s news to them.)

The form of fluocinonide most frequently prescribed for flakers in the U.S. is Lidex (cream, ointment and solution) and it is rated a "Group 2" — second most powerful group — corticosteroid. Reflecting on what happened in the Skin-Cap debacle two years ago helps maintain my appreciation for the prescript requirements attached to these drugs. No one knew clobetasol propionate (a Group 1 corticosteroid) was in Skin-Cap and people were using this spray-on formulation without prescriptions. In retrospect, their positive results are understandable. Unfortunately, when Skin-Cap distribution became prohibited in the U.S. many flakers rebounded terribly, experiencing their worst-ever lesion outbreaks, which is typical of overuse followed by sudden discontinuance of these powerful topicals.

Now the Brits are going through a similar exercise with the non-prescription drug Psorigon (discontinued for the same reasons as Skin-Cap) and PS-98 (its virtually useless replacement).

But back to those annual required visits to our derms. I foresee a time in the not too distant future, Mike, when we’ll be able to accommodate these little "encounters" via videoconference (which might or might not save us any money). I had the opportunity to participate in some of the very early telemedicine-via-satellite experiments back in the late 1970s and, if a surgeon in Seattle can oversee an appendectomy performed by a PA in an isolated Alaskan Eskimo village, I see no reason why a derm can’t zoom in on or two of our lesions and say, with confidence, "I’ll phone in your prescription renewal." -Ed

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