News in brief: Psoriasis flares not a barrier to ICI treatment; GPs have difficulty managing atopic dermatitis; Diagnostic thinking distracts physicians from patient communication

19 Oct 2021

Psoriasis flares not a barrier to ICI treatment

Flares of pre-existing psoriasis are fairly common in patients treated with immune checkpoint inhibitors for a range of cancers including melanoma.

A study of 76 ICI-treated patients from the US, Australian and Germany found 57% experienced a flare of cutaneous or extracutaneous disease such as arthritis or iritis.

Most psoriasis flares were grade 1 or 2 and resolved with topical therapies including corticosteroids, calcipotriol, and phototherapy.

“While cutaneous exacerbation was relatively manageable, arthritis flares more commonly required systemic immunosuppression, with five of six patients requiring prednisone, which may impact treatment decisions in patients with extracutaneous disease at baseline.”

Only five patients (7%) required ICI discontinuation.

“While it may require additional multidisciplinary management, these data indicate that psoriasis should not generally preclude treatment of advanced melanoma with immunotherapy.”

Read more in the Journal for ImmunoTherapy of Cancer

GPs have difficulty managing atopic dermatitis

Younger GPs may lack confidence in managing atopic dermatitis because they rarely encounter it during registrar training, an Australian study has found.

A review of more than 380,000 patient consultations by 2,783 GP registrars between 2010-2019 found that atopic dermatitis was encountered in 0.6% of consults.

While atopic dermatitis was most likely seen by registrars in infants, as expected, the findings of the review suggested that the registrars limited exposure to the condition in other age groups as well as deficits in undergraduate and hospital-based pre-vocational training may limit confidence in its management as a chronic disease, according to researchers from Newcastle University, NSW.

They found that registrars were more likely to nominate atopic dermatitis as an area where they would like more learning assistance within consultations in addition to seeking information and assistance from both supervisors and other sources about it.

There was also a suggestion of ‘steroid phobia’ in the management of atopic dermatitis, with most of the medications prescribed being mild/moderate potency steroids such as hydrocortisone rather than potent steroids.

Diagnostic thinking distracts physicians from patient communication

Patient communication tends to be less satisfactory in specialties in which physicians must use diagnostic reasoning during patient encounters, an Australian study has found.

Physicians have more ‘cognitive busyness’ and must mentally multitask more than specialists such as surgeons whose encounters are more focused on procedures, according to according to Queensland researchers who analysed communication ratings for 67 doctors across various specialties.

They said their findings suggested that patient communication may be relegated to a secondary task and the news of an adverse finding may be less well accepted from physicians than from a procedural specialist who was not distracted by cognitive multitasking.

Possible solutions included having separate consultations for making and conveying a diagnosis or taking a break during a consultation before delivering the diagnosis, they suggested in Internal Medicine Journal.

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