Combining home-care regimens with office laser procedures helps dermatologists achieve better results when targeting almost any skin problem, says Ranella Hirsch, M.D., clinical assistant professor of dermatology, Boston University School of Medicine. Not only do patients benefit from the laser treatment, the home-care regimen can offer an "extra oomph," Dr. Hirsch says. Furthermore, prescribing a skincare regimen engages patients in their own treatment so they become vested in their own care. "I'm a huge believer that patients do much better when they're engaged in the process," she says. Dr. Hirsch explains that she loves the analogy she learned from an extraordinary colleague, New Orleans dermatologist Mary Lupo, M.D., who likened the relationship between a dermatologist and a patient to that of a trainer and an athlete. "We're kind of like a trainer where we can really evoke great things from the athlete, but there's really still a lot of the homework to be done by them," Dr. Hirsch says. "They have to still go and do the work." Patients vested in their own skincare and skin health are more apt to adhere to routines that will improve results, such as remaining moisturized and applying sunblock, Dr. Hirsch says. Broad benefits Dr. Hirsch prescribes a complementary topical regimen for almost every office laser treatment she performs. Sunscreen is a requirement across the board. For example, Dr. Hirsch says she frequently prescribes Vaniqa cream (eflornithine hydrochloride, SkinMedica) after laser hair-removal treatments. "So you get this double benefit of the product working through its mechanism and also the laser procedure working through its mechanism," Dr. Hirsch says. "People get better results, are more engaged, and have a better outcome." After performing a nonablative laser treatment in the office, she often prescribes a prescription-strength or over-the-counter topical retinoid to be used at home. For patients treated for brown spots or mottling, she prescribes a bleaching agent for use at home. When treating acne with light treatments, Dr. Hirsch also prescribes topical treatments. In addition to involving patients in their treatment outcomes, combining treatments sets the stage for the concept of skincare maintenance, because most laser skincare procedures require a series of treatments, Dr. Hirsch says. "That is a really great way to sort of set them up with this idea that there's two parts to it. There's what we do in the office and then also what's done as maintenance," she says. Laying the groundwork Dr. Hirsch emphasizes the value of beginning skincare treatment regimens before the laser procedure. For example, she prescribes to patients a regimen for a month or two before a procedure such as a fractional resurfacing. This not only helps prepare the skin, it also enables her to gauge how well the patient will comply with treatment guidelines, she says. "If I say, 'You need to do this every day and apply sunblock every day,' and they come to me and they are clearly not following that advice, this is something I want to know before I do a major procedure on them," Dr. Hirsch says. It's best to know that a patient will be noncompliant prior to the procedure, Dr. Hirsch says, because compliance is critical in woundcare after a resurfacing treatment. "You don't want to find out afterwards the patient doesn't listen to you," she says. Doctor-patient partnership Everyone wins when dermatologists prescribe an at-home skincare regimen and the patient and physician work together, Dr. Hirsch says. "I think you get this brilliant synergy when they work together that's really very, very beneficial," Dr. Hirsch says. "And you just set these great habits for patients going forward, which I think have real benefit as well." Furthermore, prescribing at-home skincare regimens differentiates dermatologists in a competitive skincare environment where non-dermatologists also provide laser treatments. "One of the real things we can bring to the table that's so cogent as dermatologists is the ability to really buffer and supplement what we're doing with technology with some of the medications and other techniques that we have in home care and skincare," she says. Skincare regimens offer dermatologists a distinctive tool. "It really lets you stand ahead of the crowd because you're going to give someone not just acne treatment with light, but also a prescription strength that's going to help them," Dr. Hirsch says. "So you're not just treating for the moment. You're treating for the future. You're treating for prevention." Source
