Joslyn Kirby, MD, walked us through how to manage patient expectations and social perceptions when “prescribing” over-the-counter products in practice. She started with evidence-based treatments for itch, specifically the use of second-generation antihistamines for chronic spontaneous urticaria. While hydroxyzine and lorazepam require prescriptions prior to procedures, diphenhydramine can be kept in the office and used 30 minutes prior at 25-mg to 50-mg dosages for anxiety. She also gave us the recipe for orange juice mixed with 10 x 50 mg naltrexone tablets, which can be dosed in 1-tsp (5-mL) quantities for various pruritus-inducing dermatoses, though patients should be counseled on vivid dreams and headaches.
Dr Kirby had even more hacks for our patients as she presented a study from JAAD that demonstrated that salicylic acid improves the penetration of topical steroids. N-acetyl cysteine functions as a glutamate modulator and antioxidant but has demonstrated efficacy for treatment of picking disorders at 600 mg to 2400 mg daily. If picking becomes pimples, an alternative to antibiotics is zinc gluconate at 90 mg daily for more conservative patients with acne. Pimple patches are also remarkable at keeping hands away from these lesions. Her last pearls are to try out adapalene for acanthosis nigricans, which has more evidence than calcipotriol, and don’t forget to recommend compression stockings, which can be layered at lower strengths for ease of application.