RESUMEN
BACKGROUND: Isotretinoin is an effective treatment for severe juvenile acne, but it appears to be underused in relation to the recommendations. Therapeutic inertia is defined as a failure to initiate or intensify treatment even when warranted by the recommendations. The aim of this study was to investigate therapeutic inertia among dermatologists (D), paediatricians (P), and general practitioners (GPs) in initiating isotretinoin for moderate-to-very severe juvenile acne. METHODS: Data were collected using a questionnaire distributed to French physicians through medical societies via Internet. The questions explored the role in inertia of factors related to physicians, patients, parents, and the healthcare system, and evaluated barriers and facilitators to prescribing isotretinoin. RESULTS: In all, 768 physicians responded to the survey (528 D, 178P, and 61 GPs; mean age: 51â¯years; women: 78â¯%). Their responses revealed that 99â¯% of dermatologists felt comfortable prescribing isotretinoin, compared with 8â¯% and 15â¯% of paediatricians and GPs (pâ¯<â¯0.05); 93â¯% of dermatologists were aware of the current guidelines compared with 37â¯% of paediatricians and GPs. Under 50â¯% of the physicians had received training on acne in the previous 3â¯years, regardless of specialty. The most frequently identified factors for inertia were concerns over the psychological consequences of the treatment in adolescents, exclusive requests from parents, and patient unavailability. Paediatricians reported having insufficient knowledge of current recommendations, a lack of training, and a tendency to anticipate poor compliance. Paediatricians and GPs considered that access to first-time prescriptions and peer-to-peer exchanges would constitute facilitating factors in their use of isotretinoin. DISCUSSION: Concerns over the psychiatric consequences of isotretinoin in adolescents, the need for frequent follow-up, and lack of continuing medical education were identified as factors favouring inertia in the initiation of isotretinoin treatment in patients with moderate-to-very severe juvenile acne, particularly among paediatricians and GPs. Potential strategies to overcome these barriers include regular training, simplified recommendations in French, and access to first-time prescription for paediatricians and GPs.
Asunto(s)
Acné Vulgar , Fármacos Dermatológicos , Médicos Generales , Adolescente , Humanos , Femenino , Persona de Mediana Edad , Isotretinoína/uso terapéutico , Dermatólogos , Acné Vulgar/tratamiento farmacológico , Pediatras , Fármacos Dermatológicos/uso terapéuticoAsunto(s)
Adenosina Desaminasa/deficiencia , Trasplante de Médula Ósea , Síndromes de Inmunodeficiencia/terapia , Nucleósido Desaminasas/deficiencia , Preescolar , Supervivencia de Injerto , Reacción Injerto-Huésped , Humanos , Síndromes de Inmunodeficiencia/enzimología , Masculino , Trasplante HomólogoRESUMEN
Two unrelated individuals are reported with the same clinical picture and trisomic for the same segment of chromosome 11 (q23 leads to qter). That both were seen because of micropenis raises the possibility that genes interfering with the reproductive function are located on chromosome 11 and that the q23 band might be a preferential breakage point of chromosome 11. Certain earlier reports support such a possibility.