Clinical aspects of the treatment of atopic dermatitis with topical glucocorticoids and calcineurin inhibitors - a pilot questionnaire study.

Atopic dermatitis (AD) is the most common inflammatory skin disease. However, recent reports concerning the simple clinical aspects of treatment with topical glucocorticosteroids (TCS) and calcineurin inhibitors (TCI) are lacking. The objective of this study is providing an update on these characteristics of AD management. A group of 150 adults suffering from AD treated with TCS during last year was asked to fill an anonymous questionnaire. The course of topical treatment was analyzed in the context of the severity of symptoms and the knowledge of the patients about therapy. During the last year, the majority of patients (66%) were treated with class IV TCS; however, in the last two weeks, class I TCS was used the most frequently (35%). Only 11% were familiar with the concept of intermittent therapy and 4% used the fingertip unit (FTU). In total, 77% of them used TCI. Most of the patients used the same class of TCS permanently. Unfortunately, patients are unaware of simple approaches (like intermittent therapy or FTU) that increase both the effectiveness and safety of the treatment. Practicians should be aware of these problems to identify and eliminate them, primarily through the education of patients.

Clinical study on the effects of the applied volume of moisturizer in patients with asteatosis.

Asteatosis is characterized by decreased stratum corneum water content, and the basic treatment is to keep the skin moisturized. Poor application of moisturizers by patients may reduce treatment efficiency, so it is important to continue application as instructed by dermatologists. Application instructions based on the finger-tip unit are useful for patients, but there is no clear evidence of its efficacy. We investigated the effects of the volume of the moisturizer (Hirudoid® Cream 0.3%) administrated with 1/3 finger-tip unit and 1 finger-tip unit equivalent doses per target lower leg of patients with asteatosis (twice daily, 28 days) on the overall dry skin scores, itch numerical rating scale scores, and skin physiological parameters (stratum corneum water content, transepidermal water loss, and skin pH). Sixty patients were randomized with a 1:1 allocation ratio into two groups: the 1/3 finger-tip unit and 1 finger-tip unit equivalent dose groups. The results showed that 43.3% of the patients in the 1 finger-tip unit equivalent dose group, compared with 13.3% in the 1/3 finger-tip unit equivalent dose group, presented zero overall dry skin scores 1 week later. As the overall dry skin scores improved, the stratum corneum water content also increased. In patients with moderate itching, the itch numerical rating scale scores of the 1 finger-tip unit equivalent dose group decreased significantly compared with those of the 1/3 finger-tip unit equivalent dose group. The results suggested that the application of 1 finger-tip unit equivalent dose of the moisturizer twice daily in clinical practice could induce remission more quickly. With the 1/3 finger-tip unit equivalent dose, prolonged treatment may be necessary to achieve the desired effect; therefore, application adherence is strictly required. In conclusion, the application of a 1 finger-tip unit equivalent dose would be quite reasonable in clinical practice.

Standardization of topical preparations for finger-tip unit-Awareness and attitudes among pharmacists and dermatologists and suggestions to improve standardization of topical drug dosing-A two-phase cross-sectional survey.

BACKGROUND: Standardization of topical therapy dosage is important to ensure optimum use and dosage of topical medications. One of the concepts frequently used in the standardization of topical treatment is the Finger-tip unit (FTU). While practitioners, both dermatologists and pharmacists, are generally aware of FTU, practical use is less. OBJECTIVES: We aimed to evaluate views and practices related to FTU among both dermatology and pharmacy faculty and to elicit and validate suggestions for improving standardization. METHODS: We surveyed a group of Dermatologists and Pharmacists-in two phases-in phase 1 (n = 44), an electronic survey was used as a tool to understand their practices regarding FTU, and to obtain suggestions regarding standardization of topical medication delivery. In phase 2 (n = 40), the main suggestions for improvement were resent to the group to rate and validate the same. RESULTS: The awareness of FTU was high among the experts, but practical use of the FTU for patient counselling was less frequent. The group gave suggestions to standardize applications. All these suggestions got high ratings on both feasibility and possible effectiveness in the second phase, with the highest rating being for the suggestion of "Placing QR codes on ointment/cream tubes which link to websites with educational materials/ videos on FTU/topical drug dosing." CONCLUSION: Awareness regarding FTU is high among both dermatologists and pharmacists, however practical use is less. Strategies to improve standardization of topical drug dosing can be formulated through collaboration involving both dermatologists and pharmacists.

A survey on awareness of the "finger-tip unit" and medication guidance for the use of topical steroids among community pharmacists.

Atopic dermatitis (AD) is a common chronic, pruritic inflammatory skin condition. AD is most commonly treated with topical corticosteroids, and the finger-tip unit (FTU) should be used as a guideline for the amount to be used per application. In this study, we investigated the adequacy of pharmacists' instructions on the amount of topical steroids to be applied and the way in which they enhance the effect of pharmaceutical interventions. A self- administered anonymous questionnaire was distributed using QLifePro to 300 pharmacists working in insurance pharmacies that filled at least one dermatologist's prescription per month on average in Japan. Out of 300 pharmacists, 196 (65.3%) recognized the Japanese Dermatological Association's 2016 guidelines for the treatment AD, 107 (35.6%) gave instructions using the FTU as an index of external dose of topical steroids, 157 (52.3%) explained the amount of steroid application using an index other than FTU, and 61 (38.9% of 157) had inadequately instructed AD patients to apply steroids as a thin layer. Pharmacists who had read the guidelines for AD tended to give an appropriate instruction using FTU as an index of external dose of topical steroids (p < 0.001). We found that many pharmacists in pharmacies gave inadequate instructions on the amount of topical steroid application and deviated from the guidelines for AD, mainly because of inadequate knowledge of the guidelines.