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Topical Steroid Side Effects & Safer Alternatives · The Science of Skin

• 0:00
  SPEAKER_01: Thank you to our sponsor, Arcutis Biotherapeutics, for their support of the Science of Skin podcast and furthering Durham Education.
• 0:07
  SPEAKER_01: Arcutis is a medical dermatology company that champions meaningful innovation to address the urgent needs of individuals living with immune-mediated dermatological diseases and conditions.
• 0:18
  SPEAKER_01: With a commitment to solving the most persistent patient challenges in dermatology, Arcutis has a growing portfolio of advanced targeted topicals.
• 0:27
  SPEAKER_01: Arcutis's unique dermatology development platform, coupled with their dermatology expertise, allows them to develop differentiated therapies against biologically validated targets for a range of inflammatory dermatological conditions.
• 0:41
  SPEAKER_01: Arcutis strives to simplify disease management and optimize drug efficacy, safety, and tolerability.
• 0:48
  SPEAKER_01: They're determined to elevate the current standard of care, solving for the challenges others haven't.
• 1:02
  SPEAKER_02: Hello and welcome to the Science of Skin Podcast.
• 1:04
  SPEAKER_02: My name is Dr.
• 1:05
  SPEAKER_02: Ted Lane.
• 1:05
  SPEAKER_02: I'm a board certified dermatologist in Austin, Texas, and I am super excited to introduce my guest for today, Dr.
• 1:12
  SPEAKER_02: Ali Galant.
• 1:13
  SPEAKER_02: Allie is the associate professor of dermatology and vice chair of the Department of Dermatology.
• 1:19
  SPEAKER_02: Congratulations at Mount Sinai.
• 1:22
  SPEAKER_02: Ali, how are you?
• 1:23
  SPEAKER_00: I'm good, Ted.
• 1:24
  SPEAKER_00: Thanks for having me.
• 1:25
  SPEAKER_02: Oh my gosh, super excited to have you.
• 1:26
  SPEAKER_02: So just real quick, guys, before we get started, if you have any questions or comments about today's episodes, please send us an email, inquiry at scienceofskinsummit.com.
• 1:36
  SPEAKER_02: Okay, wanted to put that out there first.
• 1:39
  SPEAKER_02: Allie, we are discussing the effect of topical steroids on our patients.
• 1:43
  SPEAKER_02: And this episode is sponsored by Arcutis, which we know makes Zareve both cream and foam, which has multiple indications now.
• 1:51
  SPEAKER_02: And it's a non-steroidal alternative, which is amazing because when you and I started, I'm older than you, so when it's by a little bit, you know.
• 2:00
  SPEAKER_02: Um we didn't have many topical steroid alternatives, but we really do now, don't we?
• 2:06
  SPEAKER_00: We really do.
• 2:07
  SPEAKER_00: You know, I think um I have either a student or trainee or both in my practice most days that I'm in the clinic, and I always think about how different um their education, what their learning is, versus just 10, 15 years ago, how different our prescribing habits are, what the considerations are, and really just what an incredible amount of options we have to offer our patients, which is a total testament to the advances of science, especially in the topical space in dermatology.
• 2:37
  SPEAKER_02: Uh, you know, you're totally right.
• 2:39
  SPEAKER_02: I'm just thinking about when I was in training, we had tachylimus and pimecrolimus as well.
• 2:44
  SPEAKER_00: 2000, 2001, right?
• 2:45
  SPEAKER_00: And then nothing quite a while.
• 2:47
  SPEAKER_02: Nothing.
• 2:47
  SPEAKER_02: And you know, those can sting and burn, and they weren't great, and they had the box warning, and oh my gosh, it like wasn't good.
• 2:55
  SPEAKER_02: Uh, but now we have these great alternatives.
• 2:57
  SPEAKER_02: But so so we have these alternatives, and I think it's really important to discuss why they're so important, right?
• 3:03
  SPEAKER_02: Yeah, you always get to have more, you know, tools in our tool chest, of course, but when you're talking about topical steroids, there's some major issues there, and and I'm not sure many of our colleagues take that into account.
• 3:18
  SPEAKER_02: So, you know, first of all, we've got the local skin reaction type issues, Ali.
• 3:22
  SPEAKER_02: If you can do you mind just reviewing those for us?
• 3:24
  SPEAKER_00: Sure, yeah.
• 3:25
  SPEAKER_00: I think um, you know, there's so much of how we use topical steroids within dermatology, I think is kind of baked into how we were all trained.
• 3:34
  SPEAKER_00: Um, and topical steroids are uh inexpensive, they're easily accessible.
• 3:38
  SPEAKER_00: And I think uh no matter where this space moves will always remain a mainstay of treatment for those reasons.
• 3:45
  SPEAKER_00: Uh, we know at the cutaneous level that topical corticosteroids can lead to skin side effects.
• 3:52
  SPEAKER_00: So these can be things like skin thinning, um, can be striae, especially in skin of color populations, we see a significant amount of dispigmentation, either hypopigmentation or otherwise.
• 4:03
  SPEAKER_00: Um, and you know, in inappropriate quantities or patients getting these topical corticosteroids over multiple touch points with multiple different providers, be it at their dermatologist's office, urgent care, primary care, uh they often come in with these, this, this bag of, you know, this collector's item of topical corticosteroids of different potencies, um, have often lost the boxes, so don't know what should go on their eyelid versus their hand, for example.
• 4:36
  SPEAKER_00: And it creates, uh, it really sets patients up to use these either inappropriately in duration or body part or both.
• 4:46
  SPEAKER_02: You make so many good points there.
• 4:48
  SPEAKER_02: First of all, the polypharmacy aspect of it, where you know, you have to really think about the concentration and the formulation of the topical steroid per the body part that you're treating.
• 4:58
  SPEAKER_02: And so that leads to patients having two, maybe even three different steroids to use for different body areas, which can get really confusing for patients.
• 5:07
  SPEAKER_02: And I I found, Ali, and I'm sure you found this as well, that you know, patients find that clobetazole works well on my body.
• 5:14
  SPEAKER_02: Why am I trying this decenite on my face?
• 5:16
  SPEAKER_02: I'll just use the clebatazole there too.
• 5:18
  SPEAKER_02: It works so well.
• 5:19
  SPEAKER_02: And as we know, that can lead to problems very quickly, uh, or in entergenous areas or in genitalia, for example.
• 5:27
  SPEAKER_02: So there's lots of problems with, especially polypharmacy for these patients.
• 5:32
  SPEAKER_02: And then certainly the the local side effects are really important for us to take into account.
• 5:38
  SPEAKER_02: I'm just thinking, um, recently I had a patient come in and it was like a primary care special where they had acne and eczema.
• 5:45
  SPEAKER_02: And so for their acne, of course, they got benzoclin, because that's pretty much what everybody gets for their acne, at least in where I live.
• 5:50
  SPEAKER_02: Yeah.
• 5:50
  SPEAKER_02: And and then and for their eczema, it was a pound jar of 0.1% triumpcinolone, right?
• 5:57
  SPEAKER_02: Do you have that as well?
• 5:58
  SPEAKER_00: All the time.
• 5:59
  SPEAKER_00: And in fact, I think, you know, I think it's partially because of um our work over the last couple of years in this space, talking about topical corticosteroid stewardship, but really just steroid stewardship in general in the house of medicine and being able to work with so many different specialists on on projects like that.
• 6:17
  SPEAKER_00: Um, that I I almost, I mean, I can count on maybe one hand the number of times a year I'm prescribing that pound of triumpcinolone for the exact reason that we're just talking about, because it comes, it is so easy for patients then to use that.
• 6:33
  SPEAKER_00: It becomes like Winnie the Pooh in the honeypot.
• 6:35
  SPEAKER_00: And that triumpcinalone then becomes their moisturizer after the shower, and patients are saying, Yeah, I just put it from head to toe, you know, five to seven days out of the week.
• 6:45
  SPEAKER_00: Um, and so, you know, there's so many ways to look at stewardship.
• 6:50
  SPEAKER_00: Um, why that's happening, I think they're um I, you know, in part that that pound jar of triumph is very easily accessible to very inexpensive, and it's patients can get it at their local pharmacy, they can get it at their target, et cetera.
• 7:04
  SPEAKER_00: So um, and I think that um the misconception for a number of years was that topical steroids are risk-free.
• 7:15
  SPEAKER_00: Um, I think they are necessary um tools in our specialty and beyond, but we know that like any medication, they are not risk-free.
• 7:25
  SPEAKER_00: And therefore, we have to have a healthy respect for them and uh understand how we should guide their use more appropriately.
• 7:32
  SPEAKER_00: And and largely we uh have the opportunity to drive that, I think, as the as the skin experts in dermatology.
• 7:40
  SPEAKER_02: You know, I had a patient recently come in who um skin of color patient, horrible eczema, and had just been on triumcinol, again, it was triumcinolin or beta methane, I think, but it was triumcinolin, I believe, and just forever, right?
• 7:53
  SPEAKER_02: And so had horrible atrophy, had a horrible stri um in the most visible areas, and was just kind of crying in my office.
• 8:00
  SPEAKER_02: Please help me.
• 8:01
  SPEAKER_02: And I was just uh that got me thinking about how I deal with topical steroids.
• 8:06
  SPEAKER_02: It you know, when when you have an electronic medical record, it's so easy to click refill when you get that patient task or that request.
• 8:16
  SPEAKER_02: And and it's a pound jar of triumcinal, and you're like, oh, well, the last time it was filled was nine months ago.
• 8:21
  SPEAKER_02: They can't be using very much, and you just click the refill because that helps the patient, and you can't get somebody in for six months into your practice anyway.
• 8:29
  SPEAKER_02: So you might as well do something to help the patient.
• 8:32
  SPEAKER_02: But it takes a little bit more work, doesn't it, to click open the patient's chart, see exactly when the last time you prescribed it, why they're using it, where they're using it, to kind of make sure that you're doing the right thing.
• 8:43
  SPEAKER_02: So I don't blame the dermatologist who was treating her previously because I'm sure I've done that.
• 8:49
  SPEAKER_02: It's just so easy to in our medical records now, uh, but we we have to go that extra step, don't we?
• 8:56
  SPEAKER_00: 100%.
• 8:57
  SPEAKER_00: And I I think often you're exactly right.
• 9:00
  SPEAKER_00: Patients will come in saying, oh, you know, I got the jar.
• 9:02
  SPEAKER_00: I want the jar of that greasy ointment.
• 9:05
  SPEAKER_00: It lasted me two years last time, whatever it is, right?
• 9:08
  SPEAKER_00: Um, and very, very few dermatoses uh, you know, require 454 grams of a topical corticosteroid.
• 9:19
  SPEAKER_00: I mean, for me, that's you know, it's it's a uh full-body poison ivy or it reaction or something really dramatic where patients are miserable.
• 9:28
  SPEAKER_00: I know they're gonna use it for a short period of time and stop.
• 9:30
  SPEAKER_00: But when you're giving a patient with a chronic uh sometimes inflammatory dermatosis like atopodermatitis or psoriasis tools to um to use these things too often inappropriately on the wrong body parts, that's where we really run into trouble.
• 9:46
  SPEAKER_00: And I find that particularly, especially in AD and psoriasis, it's those, it's those moderate patients, it's those patients that are at the cup of cusp of, you know, probably needing some escalation and care, but that are holding on to their disease control by overusing their topical corticosteroids because, you know, either they weren't told otherwise or it makes their skin feel better in the immediate.
• 10:11
  SPEAKER_00: Um, and I love the anecdote you just shared.
• 10:14
  SPEAKER_00: We see so many patients, especially in New York City and our various clinics, residents, private practice with skin of color, that come in sometimes talking about the hypopigmentation, right?
• 10:24
  SPEAKER_00: Because of the the years, sometimes decades of topical corticosteroids in the setting, especially of atopic dermatitis.
• 10:30
  SPEAKER_00: Some of these patients have started have really been used using these agents since childhood, um, and come in talking about the fact that their skin tone doesn't look even or they have these light spots.
• 10:41
  SPEAKER_00: And it's how I view kind of acne scarring, right?
• 10:44
  SPEAKER_00: The acne scarring sometimes becomes more difficult to treat than the acne itself because of all the changes that have gone on over time.
• 10:52
  SPEAKER_00: So um there are so many challenges.
• 10:55
  SPEAKER_00: Um, I think we, you know, I practice in a hospital system where I probably have more visibility than most to what the patient's got.
• 11:03
  SPEAKER_00: I have some external pharmacy pull-through data to understand where else they're getting their steroid exposure, right?
• 11:10
  SPEAKER_00: Because it as important as it is to look at what other topicals they're using, it's also what steroid are they getting from their primary care?
• 11:18
  SPEAKER_00: Did they just do a course of prednisone recently?
• 11:21
  SPEAKER_00: Did they get an intramuscular injection of steroid from their orthopedic orthopedic doctor?
• 11:27
  SPEAKER_00: Patients are exposed to steroids in so many different um specialties and avenues, and sometimes they don't even, they aren't even aware uh that a treatment is steroidal versus non-steroidal, and really all of those uh all of those um delivery mechanisms, etc., uh kind of amount to a total steroid load for a patient and are so important to look at, um, but difficult, especially in for for practitioners that aren't in a hospital and don't have an EMR that's pulling or shared across specialties.
• 12:03
  SPEAKER_02: You know, I don't do that.
• 12:05
  SPEAKER_02: I I need to start doing that, actually, which is asking patients about other steroid prescriptions.
• 12:12
  SPEAKER_02: Um, it's such a good point, Allie, and one that I haven't paid a lot of attention to because especially with our atopic patients, they've got the atopic march, they've got the triad most likely, they've got some asthma going on, maybe some seasonal allergies.
• 12:26
  SPEAKER_02: And so maybe on an inhaler, maybe on a dose pack here or there, or an IAM catalog, like you totally agree.
• 12:33
  SPEAKER_02: I need to do a better job at that.
• 12:34
  SPEAKER_02: So that thank you for that.
• 12:36
  SPEAKER_02: That's a great clinical pearl.
• 12:37
  SPEAKER_02: Like, make sure your medical assistants are asking, or when you get in the room, are asking about you know other sources of steroid prescription so you have a really good idea of the total load that these patients are on.
• 12:52
  SPEAKER_02: Because it's all cumulative to your point, whether it's topical or systemic, it's all cumulative.
• 12:56
  SPEAKER_02: And and while in dermatology we have amazing opportunities to treat without steroids, that may not be the case in other specialties who who rely on them.
• 13:04
  SPEAKER_02: I mean, think about a rheumatoid arthritis patient somehow on steroids forever, right?
• 13:08
  SPEAKER_01: Exactly.
• 13:09
  SPEAKER_02: Um, so so such a such a good point.
• 13:12
  SPEAKER_01: Thank you to our sponsor, Arcutis Biotherapeutics, for their support of the Science of Skin podcast and furthering Durham Education.
• 13:19
  SPEAKER_01: Arcutis is a medical dermatology company that champions meaningful innovation to address the urgent needs of individuals living with immune-mediated dermatological diseases and conditions.
• 13:30
  SPEAKER_01: With a commitment to solving the most persistent patient challenges in dermatology, Arcutis has a growing portfolio of advanced targeted topicals.
• 13:39
  SPEAKER_01: Arcutis's unique dermatology development platform, coupled with their dermatology expertise, allows them to develop differentiated therapies against biologically validated targets for a range of inflammatory dermatological conditions.
• 13:53
  SPEAKER_01: Arcutis strives to simplify disease management and optimize drug efficacy, safety, and tolerability.
• 14:00
  SPEAKER_01: They're determined to elevate the current standard of care, solving for the challenges others haven't.
• 14:06
  SPEAKER_02: You know, I was also thinking, Allie, topically, we used to have topical steroids that were branded.
• 14:12
  SPEAKER_02: And so we knew about the formulation, we knew exactly what the excipients were, and they were kind of, you know, elegant.
• 14:20
  SPEAKER_02: And now you get these, you know, who knows what is in that propylene glycol to enhance penetration like crazy, which causes stinging and burning.
• 14:28
  SPEAKER_02: And so that's the other issue I have with steroids is that we're in this age now where our pharmaceutical companies that are producing these new topicals are paying so much attention to the formulations and the ingredients.
• 14:40
  SPEAKER_02: And it's like it's so elegant and beautiful.
• 14:43
  SPEAKER_02: And then you've got this like gritty, nasty topical steroid that we're asking patients to use.
• 14:49
  SPEAKER_02: It just doesn't like corroborate, right?
• 14:51
  SPEAKER_02: There's there's like what's happening at the tip of medicine is is really pushing us towards a user experience that's that's wonderful.
• 14:58
  SPEAKER_02: And then you've got these nasty topical steroids, which unfortunately are cheap and easy to get, but the user experience there is not great.
• 15:07
  SPEAKER_02: Uh and and it may actually push people out of the medical system because they feel like all they're getting are these nasty medications that they don't like to use.
• 15:15
  SPEAKER_00: Right.
• 15:15
  SPEAKER_00: And that they they their experiences that they go from one office to another, and you know, that you're getting uh, you know, you're going from a fluacinonide to a mametazone to a cobatazole down to, you know, who knows a destinide, right?
• 15:28
  SPEAKER_00: But it's all variations on the theme.
• 15:30
  SPEAKER_00: Um, I think to your point, because of the experience with the earliest kind of non-steroidals in the space, which were tacrolimus and pimecrolimus, because we know the really significant both tolerability issues with the burning and stinking, but also just efficacy limitations.
• 15:48
  SPEAKER_00: They were just um always regarded as not as potent, not as effective in terms of skin clearance or itch reduction as our topical corticosteroids.
• 15:58
  SPEAKER_00: Uh, the non-steroidals um space in general always had this kind of association with not being as effective as a topical corticosteroid.
• 16:09
  SPEAKER_00: And I think we've seen so much innovation, to your point, not just in the science, but the formulation, the delivery mechanism that have made our kind of newer, novel, current generation non-steroidals so much more effective, so much more tolerable.
• 16:26
  SPEAKER_00: Um, and for many of them, just a once-daily application.
• 16:29
  SPEAKER_00: It's just a completely different user experience for patients.
• 16:33
  SPEAKER_00: And also, in part, um, kind of taking the burden away from patients.
• 16:38
  SPEAKER_00: When you think about how we trained, which was okay, you're gonna start with a high potency topical corticosteroid for two weeks, then that's gonna go, at least that's you know, this was Dr.
• 16:46
  SPEAKER_00: Lovell's method, to the weekends.
• 16:48
  SPEAKER_00: And then you're gonna start something like calcivatrine or tacholimus Monday to Friday, but don't put that here and there.
• 16:54
  SPEAKER_00: And then on Saturday, Sunday, you're gonna go back to your topical steroid.
• 16:58
  SPEAKER_00: There, there's so much burden to keep track of this regimen.
• 17:02
  SPEAKER_00: And I think, you know, it it kind of contributes to these feelings of responsibility or not doing enough or not being proactive enough that patients sometimes come in with as to why their disease is not controlled.
• 17:15
  SPEAKER_00: So the ability now to give uh an appropriate patient a non-steroidal agent that can be applied once daily, literally anywhere on the body.
• 17:23
  SPEAKER_00: You use it when you need to, you can stop when you don't, you can stop and start as needed is incredibly liberating and incredibly like a just a beautiful advancement in our specialty.
• 17:34
  SPEAKER_02: Keeping it simple is so much easier, you know.
• 17:36
  SPEAKER_02: I find, and I'm I'm a culprit there because I know for my acne patients, I'm like, I want you to use this cleanser at this time of day and this cleanser at this time of day, and then I want you to use this moisturize.
• 17:46
  SPEAKER_02: Make sure you use your SPF and don't use a toner.
• 17:48
  SPEAKER_02: Come on now.
• 17:49
  SPEAKER_02: And like I'm like all over the place with my acne patients.
• 17:51
  SPEAKER_02: I write it all down.
• 17:52
  SPEAKER_02: I'm like, can this 13-year-old really do this?
• 17:54
  SPEAKER_02: I don't know.
• 17:55
  SPEAKER_02: I know.
• 17:55
  SPEAKER_02: Oh, but for atopic patients, which are, you know, unfortunately, these patients are so you and our psoriasis patients are so used to having to apply a topical, keeping it simple for them is incredibly important.
• 18:07
  SPEAKER_02: Um, so thank you for that.
• 18:09
  SPEAKER_02: It's that's that's such a good point.
• 18:11
  SPEAKER_02: The last thing I want to touch on, Allie, is the effect of the absorption of topical steroids for the systemically.
• 18:18
  SPEAKER_02: Which I again, you know, we don't pay a lot of attention to, but there's so much data to show uh that that the use of topical steroids absolutely leads to a systemic burden of steroids that when we think about you know prolonged pregnisone use, we think of osteoporosis and diabetes and glaucoma.
• 18:37
  SPEAKER_02: Well, we're not immune from that just because we're applying it to the skin, right?
• 18:40
  SPEAKER_00: 100%.
• 18:42
  SPEAKER_00: Um, we're not immune to it.
• 18:43
  SPEAKER_00: And I think that when people think about the risk, when we think about the risk, which we don't always, of the topical corticosteroids we're prescribing, we are almost exclusively thinking about cutaneous risk.
• 18:56
  SPEAKER_00: And we are almost exclusively counseling about cutaneous risk.
• 18:59
  SPEAKER_00: This is bad for your skin, this can harm your skin, this is this can, you know, impair the integrity of your skin, make your skin more crepey, wrinkly, et cetera.
• 19:07
  SPEAKER_00: Um, what we, I think, under counsel on, and I think there's just truly an educational gap here, um, and a lack of awareness really uh on multiple levels, is that we know that with a high enough potency of the topical corticosteroid and or use over a uh enough time, we get systemic level absorption.
• 19:33
  SPEAKER_00: And that contributes or sometimes is the sole cause of that kind of cumulative steroid burden for the patient.
• 19:40
  SPEAKER_00: And then you have to think of adverse events that that kind of span organ systems, endocrine, bone, metabolic, to your point, ocular.
• 19:49
  SPEAKER_00: We think, you know, that the the risk of you know, pressure changes, glaucoma is is restricted to use around the eye.
• 19:56
  SPEAKER_00: There's evidence to suggest it is not, for example.
• 19:59
  SPEAKER_00: So it is so critical, to your point, especially for patients that are on a steroid inhaler, on steroid eye drops, for example, may not know what they're doing or what's a steroid or or or is a non-steroid, that at every opportunity when I can substitute something out, I am trying to do so.
• 20:17
  SPEAKER_00: Um, because it we have to be kind of cumulative steroids, the stewards, right, of this very ubiquitous uh medication in medicine.
• 20:28
  SPEAKER_00: And if we can do our part in dermatology, we prescribe so much of the steroids that patients are exposed to, we really can uh make a dent in moving this needle.
• 20:38
  SPEAKER_00: And I would add that um one of the most beautiful parts of uh I think the work that's been done in this space is seeing kind of the um kind of cumulative tide shift around this topic, right?
• 20:52
  SPEAKER_00: I think it's being driven by us in the House of Medicine, us as dermatologists, if you look at publications within our specialty around steroid stewardship, but also it's being driven by the patients and patient organizations and advocacy talking about steroids, potential harm of steroids.
• 21:08
  SPEAKER_00: I think there's there's incredible amounts of advocacy groups, really impactful um patient-led organizations, uh, that there is more noise on the patient side of things.
• 21:19
  SPEAKER_00: And for the first time ever in the last few years, sometimes I have patients coming in proactively asking me, and this could be a New York City phenomenon, but asking me, is this a steroid?
• 21:29
  SPEAKER_00: Is this what what you're prescribing me?
• 21:31
  SPEAKER_00: Is this a is this a topical corticosteroid, or even saying, you know what, I prefer something non-steroidal.
• 21:36
  SPEAKER_00: Never in my life, my practice lifetime before this, had that been a uh a comment initiated by a patient.
• 21:42
  SPEAKER_00: And I love it.
• 21:44
  SPEAKER_02: We're experiencing that here as well, where patients are coming, especially parents for their children, yes, are acutely aware of the effects of steroids and their desire to avoid them at all costs, which I love, as you mentioned, because it it indicates that they're bought into.
• 22:00
  SPEAKER_02: To their own health and their child's health.
• 22:02
  SPEAKER_02: So it's um it's it's a wonderful thing, I think, when patients take control of their own health.
• 22:07
  SPEAKER_02: I know we hate you know the Googling and now the um L people are using, you know, to come in.
• 22:15
  SPEAKER_02: And I appreciate that.
• 22:16
  SPEAKER_02: I don't it's it's not easy to deal with that, but but it the the flip side is that there's such a benefit when they come in and they understand why I cannot just give them another tube of triumcinolone, right?
• 22:27
  SPEAKER_02: That that helps us a lot because otherwise it's almost like you know, opioid addiction where people just are like so mad if you don't give them what they want.
• 22:36
  SPEAKER_00: I had a patient uh this week came in for a refill of clobatosol.
• 22:44
  SPEAKER_00: He had used clobetosol every day on his hands for the last 22 years.
• 22:52
  SPEAKER_00: And really um was was quite upset when I um you know told him that things run a little bit differently in my practice.
• 23:01
  SPEAKER_00: Um and it it it these can sometimes be difficult conversations because of just the precedent that has been set.
• 23:09
  SPEAKER_00: Um but it's a really uh I don't know, for me, um worthwhile conversation, just kind of doing things differently and and helping patients move the needle towards better, safer, more effective drugs.
• 23:22
  SPEAKER_00: Um, the reason these are accessible is because of their cost, right?
• 23:26
  SPEAKER_00: So um we all want to practice good medicine and we we we have to really follow the science here, in my opinion.
• 23:33
  SPEAKER_02: See, and and that's where I get concerned, Ali, because you know that patient is then gonna get online, find an online provider that is getting, you know, getting paid by a compounding pharmacy and get his, you know, clobetazole plus whatever compounded that's gonna cost him$35 and he'll be able to keep using it.
• 23:53
  SPEAKER_02: That's that's that's a soapbox thing for me where we have all these you know online providers.
• 23:58
  SPEAKER_00: So many touch points.
• 23:59
  SPEAKER_02: Yeah, and the the incentive for them is is not necessarily great patient care, and it makes makes me very nervous.
• 24:06
  SPEAKER_02: So that's another thing we have to deal with, but that's a whole other episode.
• 24:09
  SPEAKER_02: We can go through that another time.
• 24:10
  SPEAKER_02: Yeah, absolutely.
• 24:11
  SPEAKER_02: I agree.
• 24:12
  SPEAKER_02: Ali, this is great.
• 24:13
  SPEAKER_02: Thank you so much for your time.
• 24:15
  SPEAKER_02: Um, it's summer, you know, where we're recording this, and so I know you have many other things to do with your children.
• 24:20
  SPEAKER_02: Uh, so I really appreciate your time.
• 24:22
  SPEAKER_02: Thank you.
• 24:23
  SPEAKER_02: Awesome as always.
• 24:24
  SPEAKER_02: Hopefully, we can get you back on.
• 24:26
  SPEAKER_00: We'd love it.
• 24:26
  SPEAKER_02: Uh that awesome.
• 24:28
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• 24:30
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• 24:33
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• 24:35
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• 24:38
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• 24:39
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• 24:44
  SPEAKER_02: We surely would appreciate it.
• 24:45
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• 24:51
  SPEAKER_02: And of course, we'd love to see you at the meeting September in Austin, uh, 2026.
• 24:56
  SPEAKER_02: And then we've got our longevity meeting coming up in February 2027 in Scottsdale.
• 25:00
  SPEAKER_02: More information, ScienceSkinsummit.com.
• 25:03
  SPEAKER_02: For Dr.
• 25:03
  SPEAKER_02: Ali Galant, I'm Dr.
• 25:04
  SPEAKER_02: Ted Lane.
• 25:05
  SPEAKER_02: Thank you so much for listening and enjoying.
• 25:14
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• 25:21
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