Year : 2018 | Volume
: 22 | Issue : 2 | Page : 45-
Don't trust what I tell you
Steven R Feldman
Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
Steven R Feldman
Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
|How to cite this article:|
Feldman SR. Don't trust what I tell you.J Dermatol Dermatol Surg 2018;22:45-45
|How to cite this URL:|
Feldman SR. Don't trust what I tell you. J Dermatol Dermatol Surg [serial online] 2018 [cited 2019 Jun 27 ];22:45-45
Available from: http://www.jddsjournal.org/text.asp?2018/22/2/45/241917
One of the most resistant forms of psoriasis, I used to think, was scalp psoriasis. For my first 15 years in dermatology, I could not get my patients' scalp psoriasis to clear up. I tried all kinds of tricks, including various combinations of anti-inflammatory and antibiotic treatments, but nothing had worked.
I had been told, had believed, and used to teach my trainees, that scalp psoriasis is resistant to treatment because patients dig and scratch their scalp psoriasis (thereby inducing the Koebner phenomenon) and because topical medications have trouble penetrating the thick scale. For a long time, I did not consider how these explanations made little sense. Patients scratch all their psoriasis lesions; the Koebner phenomenon did not explain why the scalp was so uniquely resistant to treatment. Moreover, research studies on percutaneous absorption show that absorption through scalp is similar to the axilla, and we know that diseased skin has poorer barrier function than normal skin.
I did not come to question that scratching and poor penetration did not explain the resistance of scalp psoriasis until after I realized how poor patients' adherence to topical treatment was. After that realization, it is easy to clear scalp psoriasis in just a few days; by telling patients the treatment was only for a few days, they used the treatment much better and, sure enough, tended to clear very rapidly, as described in Vaidya et al.'s article in this issue of the Journal of Dermatology and Dermatologic Surgery.
For too long, I simply had believed what I had been told. A lot of times we are told things that we should believe and things that are true. And, there are some times when we are told things that are just plain wrong. It may be hard to tell the two apart. We should be on the lookout, in and beyond medicine, for those times when well-meaning people tell us with great confidence things that they think are true but which are not.