- Email: [email protected]
Patient adherence with treatment
892 Letters
J AM ACAD DERMATOL MAY 2007
Jean-Claude Bystryn, MD,a and Sergei A. Grando, MD, PhDb Departments of Dermatology at New York University School of Medicinea and the University of California at Davisb Funding sources: None.
quantities, the correct answer is two bottles, and those who admit to still working on their second, or even first, bottle find it hard to argue with the math. I seem to find better compliance, improved appearances, and more satisfied patients by the subsequent visit. Manfred S. Rothstein, MD, FAAD, FACP
Conflicts of interest: None declared. Correspondence to: Jean-Claude Bystryn, MD, Department of Dermatology, New York University School of Medicine, 530 First Ave, New York, NY 10016.
Department of Medicine, Duke University Medical School, Durham, North Carolina Funding sources: None. Conflicts of interest: None declared.
E-mail: [email protected]
Reprint requests: Manfred S. Rothstein, MD, FAAD, FACP, 11308 Medical Dr, Fayetteville, NC 28304
REFERENCES 1. Lever WF. Pemphigus and pemphigoid. Springfield, IL: Charles C. Thomas; 1965. 2. Zelickson AS. Ultrastructure of normal and abnormal skin. Philadelphia: Lea & Febiger; 1967. pp. 336-8. 3. Barlow Y, Wray D. Ultrastructural alterations associated with in vivo and in vitro bound pemphigus antibodies in cultured oral epithelial cells. J Oral Pathol Med 1991;20:241-4. 4. Takahashi Y, Patel HP, Labib RS, Diaz LA, Anhalt GJ. Experimentally induced pemphigus vulgaris in neonatal BALB/c mice: a time-course study of clinical, immunologic, ultrastructural, and cytochemical changes. J Invest Dermatol 1985;84:41-6. 5. Bystryn JC, Grando SA. A novel explanation for acantholysis in pemphigus vulgaris: the basal cell shrinkage hypothesis. J Am Acad Dermatol 2006;54:513-6. 6. Amagai M, Ahmed AR, Kitajima Y, Bystryn JC, Milner Y, Gniadecki R, et al. Are desmoglein autoantibodies essential for the immunopathogenesis of pemphigus vulgaris, or just ‘witnesses of disease’? Exp Dermatol 2006;15:815-31. 7. Grando SA. Cholinergic control of epidermal cohesion in norm and pathology. Exp Dermatol 2006;15:265-82. 8. Rubenstein DS, Diaz LA. Pemphigus antibody induced phosphorylation of keratinocyte proteins. Autoimmunity 2006;39:577-86. 9. Grando SA. Pemphigus in the XXI century: new life to an old story. Autoimmunity 2006;39:521-30.
E-mail: [email protected]
doi:10.1016/j.jaad.2006.12.036
Patient adherence with treatment To the Editor: The letter by Krejci-Manwaring et al1 on patient adherence with topical medications showed that the compliance reported by patients often greatly exceeds reality. Similarly, patients taking oral medication may truly believe that they are following the physician’s directions, when in fact they actually have missed multiple doses. I have noticed this particularly in teenagers with acne who are upset that their complexions are not improving, despite vigorously affirming that they are taking their prescribed pills according to the label. I ask them how many bottles they have finished since their previous visit, typically 2 months earlier. Because I prescribe oral antibiotics in monthly
REFERENCE 1. Krejci-Manwaring J, McCarty MA, Camacho F, Carroll CL, Johnson K, Manuel J, et al. Adherence with topical treatment is poor compared with adherence with oral agents: implications for effective clinical use of topical agents. J Am Acad Dermatol 2006;54(Suppl):S235-6. doi:10.1016/j.jaad.2006.06.033
Reply To the Editor: We would like to respond to the letter submitted by Dr Chiu regarding our recent article.1 In essence, he compellingly asserts that sternal erythema may not be an entity sui generis, but represent a forme fruste of reticular telangiectatic erythema.2 Reticular telangiectatic erythema has been reported in conjuction with cardiac devices and an implanted intrathecal infusion pump.3-5 The histopathologic features in these cases showed similar changes to what we observed with epidermal atrophy (ie, papillary dermal telangiectases and a sparse perivascular lymphohistiocytic infiltrate). Common to all referenced cases was the presence of metal either in the form of cardiac devices, pumps, or sternal wires, engendering consideration that the metal itself may have pathogenically contributed to the eruptions. Of note, metal-induced hypersensitivity to common allergens and infectious etiologies were similarly excluded. More difficult to reconcile is the paucity of reported association between the aforementioned scenarios, especially given the ubiquity of implanted metallic devices in proximity to the skin. A more tenable possibility remains that unique anatomic relationships apropos of the thorax and/or antecedent trauma related to the surgery or postoperative healing relate to its development, inclusive of a possible physical mechanism, including electromagnetic induction.
J AM ACAD DERMATOL MAY 2007
Jean-Claude Bystryn, MD,a and Sergei A. Grando, MD, PhDb Departments of Dermatology at New York University School of Medicinea and the University of California at Davisb Funding sources: None.
quantities, the correct answer is two bottles, and those who admit to still working on their second, or even first, bottle find it hard to argue with the math. I seem to find better compliance, improved appearances, and more satisfied patients by the subsequent visit. Manfred S. Rothstein, MD, FAAD, FACP
Conflicts of interest: None declared. Correspondence to: Jean-Claude Bystryn, MD, Department of Dermatology, New York University School of Medicine, 530 First Ave, New York, NY 10016.
Department of Medicine, Duke University Medical School, Durham, North Carolina Funding sources: None. Conflicts of interest: None declared.
E-mail: [email protected]
Reprint requests: Manfred S. Rothstein, MD, FAAD, FACP, 11308 Medical Dr, Fayetteville, NC 28304
REFERENCES 1. Lever WF. Pemphigus and pemphigoid. Springfield, IL: Charles C. Thomas; 1965. 2. Zelickson AS. Ultrastructure of normal and abnormal skin. Philadelphia: Lea & Febiger; 1967. pp. 336-8. 3. Barlow Y, Wray D. Ultrastructural alterations associated with in vivo and in vitro bound pemphigus antibodies in cultured oral epithelial cells. J Oral Pathol Med 1991;20:241-4. 4. Takahashi Y, Patel HP, Labib RS, Diaz LA, Anhalt GJ. Experimentally induced pemphigus vulgaris in neonatal BALB/c mice: a time-course study of clinical, immunologic, ultrastructural, and cytochemical changes. J Invest Dermatol 1985;84:41-6. 5. Bystryn JC, Grando SA. A novel explanation for acantholysis in pemphigus vulgaris: the basal cell shrinkage hypothesis. J Am Acad Dermatol 2006;54:513-6. 6. Amagai M, Ahmed AR, Kitajima Y, Bystryn JC, Milner Y, Gniadecki R, et al. Are desmoglein autoantibodies essential for the immunopathogenesis of pemphigus vulgaris, or just ‘witnesses of disease’? Exp Dermatol 2006;15:815-31. 7. Grando SA. Cholinergic control of epidermal cohesion in norm and pathology. Exp Dermatol 2006;15:265-82. 8. Rubenstein DS, Diaz LA. Pemphigus antibody induced phosphorylation of keratinocyte proteins. Autoimmunity 2006;39:577-86. 9. Grando SA. Pemphigus in the XXI century: new life to an old story. Autoimmunity 2006;39:521-30.
E-mail: [email protected]
doi:10.1016/j.jaad.2006.12.036
Patient adherence with treatment To the Editor: The letter by Krejci-Manwaring et al1 on patient adherence with topical medications showed that the compliance reported by patients often greatly exceeds reality. Similarly, patients taking oral medication may truly believe that they are following the physician’s directions, when in fact they actually have missed multiple doses. I have noticed this particularly in teenagers with acne who are upset that their complexions are not improving, despite vigorously affirming that they are taking their prescribed pills according to the label. I ask them how many bottles they have finished since their previous visit, typically 2 months earlier. Because I prescribe oral antibiotics in monthly
REFERENCE 1. Krejci-Manwaring J, McCarty MA, Camacho F, Carroll CL, Johnson K, Manuel J, et al. Adherence with topical treatment is poor compared with adherence with oral agents: implications for effective clinical use of topical agents. J Am Acad Dermatol 2006;54(Suppl):S235-6. doi:10.1016/j.jaad.2006.06.033
Reply To the Editor: We would like to respond to the letter submitted by Dr Chiu regarding our recent article.1 In essence, he compellingly asserts that sternal erythema may not be an entity sui generis, but represent a forme fruste of reticular telangiectatic erythema.2 Reticular telangiectatic erythema has been reported in conjuction with cardiac devices and an implanted intrathecal infusion pump.3-5 The histopathologic features in these cases showed similar changes to what we observed with epidermal atrophy (ie, papillary dermal telangiectases and a sparse perivascular lymphohistiocytic infiltrate). Common to all referenced cases was the presence of metal either in the form of cardiac devices, pumps, or sternal wires, engendering consideration that the metal itself may have pathogenically contributed to the eruptions. Of note, metal-induced hypersensitivity to common allergens and infectious etiologies were similarly excluded. More difficult to reconcile is the paucity of reported association between the aforementioned scenarios, especially given the ubiquity of implanted metallic devices in proximity to the skin. A more tenable possibility remains that unique anatomic relationships apropos of the thorax and/or antecedent trauma related to the surgery or postoperative healing relate to its development, inclusive of a possible physical mechanism, including electromagnetic induction.