Filling a critical practice gap: experience with a dermatology day treatment center at Mayo Clinic

Treatment Strategies for Chronic Pruritus and Eczema/Dermatitis in Older Adults Under the Category of Chronic Eczematous Eruptions of Aging (CEEA)

Chronic eczematous eruptions of aging (CEEA) refers to a heterogenous group of longstanding, pruritic eczematous dermatoses with an unidentified etiology, or those which do not meet strict disease criteria. The literature has not yet established a single ubiquitous disease or term for these eruptions in adults over the age of 65 years. Instead, CEEA is attributed various names, including immunologic eruption of aging, and eruption of immunosenescence. Atopic dermatitis in the elderly, eczema in the elderly, and late- or adult-onset atopic dermatitis or eczema likely also fall under the umbrella of CEEA, given that older patients often do not meet strict criteria for atopic dermatitis. As a reflection of such terminological heterogeneity, CEEA does not have a standardized workup algorithm. This lack of uniformity can obscure the ability to study and understand appropriate treatments for this condition. Yet, as providers become increasingly aware of CEEA and more comfortable in making this diagnosis in older adults, it is necessary that dermatologists understand the safety and efficacy of common CEEA treatments in this population. Here, we discuss special considerations, challenges, and recommendations for treating older adults with CEEA with topical and systemic therapeutics. We provide an overview of therapeutic strategies and potential barriers to treatment and discuss the essential role of shared decision making when caring for this patient population.

The inevitability of change

Change is an absolute so long as time does not stand still. We should expect it, embrace it, and try to predict its direction. Dermatology, as a specialty practice, has been changing rapidly over the past 30 years concurrent with the changes in medicine. What are these changes, how did they come about, and what may be the consequences? The goal of this review is to follow the march of time, as we move from one era to the other in step with what is happening in the world as a whole and the United States in particular. The growth of our specialty, Dermatology, is divided into 3 eras which are quite different in generational cultures. The first era spanning the 1980s and 1990s is dubbed as "old school." The second era begins with the new century, 2000 until today. This era will forever be remembered as the business era, the rise of elite cultures, and the losses and threats to academia. The third era begins now; it is that of technology which is fast progressing into the future. One can theoretically project what may occur during this technologic revolution and the directions in medicine as a whole. Dermatology can be at the forefront of this era or it could be lost as a whole if we do nothing to keep up. These eras are based on my personal experience as a dermatologist in a large academic institution in the United States and may not apply to other communities or societies elsewhere. The United States serves as a good example of a western technologically oriented society that is often emulated by others.

The Patient's Guide to Psoriasis Treatment. Part 4: Goeckerman Therapy

Background

The Goeckerman regimen remains one of the oldest, most reliable treatment options for patients with moderate to severe psoriasis. Goeckerman therapy currently consists of exposure to ultraviolet B light and application of crude coal tar. The details of the procedure can be confusing and challenging to understand for the first-time patient or provider.

Objective

To present a freely available online guide and video on Goeckerman treatment that explains the regimen in a patient-oriented manner.

Methods

The Goeckerman protocol used at the University of California—San Francisco Psoriasis and Skin Treatment Center as well as available information from the literature were reviewed to design a comprehensive guide for patients receiving Goeckerman treatment.

Results

We created a printable guide and video resource that covers the supplies needed for Goeckerman regimen, the treatment procedure, expected results, how to monitor for adverse events, and discharge planning.

Conclusion

This new resource is beneficial for prospective patients planning to undergo Goeckerman treatment, healthcare providers, and trainees who want to learn more about this procedure. Online media and video delivers material in a way that is flexible and often familiar to patients.