Clinical pharmacy practice in dermatology
Kläre Bryant is an experienced clinical pharmacist who has specialised in dermatology. For the past nine years she run outpatient clinics at Liverpool University Hospitals for dermatology patients receiving biologics and disease modifying drugs. In this series of short videos, she describes her work and the opportunities for pharmacists in this area.
“I actually monitor the infliximab cohort and also, I do monitoring for patients who are on systemic medications – DMARDs such as methotrexate and azathioprine”, she explains
“Having a skin condition is something that can take over people’s lives”, says Ms Bryant. “It just impacts people’s confidence and so it’s just so, so important and shouldn’t ever be underestimated …….. and we should do everything we can to support them [to] get the best out of their medicines so that they can achieve the very best skin that they can”.
Pharmacists can help patients to get the most out their medicines by helping them to work out regimens that achieve the best therapeutic effect with least impact on day-to-day life.
Feedback from a satisfied patient illustrates the impact that good pharmaceutical care can have on dermatological disease. After Ms Bryant had worked with him to optimise his treatment he said, “My skin is absolutely fantastic, it’s been the best it’s been for years! I can go out now and wear a pair of shorts and without feeling self-conscious”.
Psoriasis treatment can be thought of like “tools in a toolbox” says Ms Bryant. Whilst Systemic treatment takes much of the load, topical treatments be adjusted to meet the patient’s needs. Educating patients to manage their own skin is also an important part of her work. “It’s upskilling and educating the patient to know that they can manage their own skin condition”, she says.
After managing the switch to biosimilar infliximab at Liverpool University Hospitals, Ms Bryant continued to monitor the infliximab cohort of patients. Now, she routinely undertakes therapeutic monitoring – infliximab trough levels and anti-infliximab antibody levels – for this group of patients. As part of the assessment in the clinic Ms Bryant will also examine the patient’s skin and estimate the psoriasis area and severity index (PASI) score and the dermatology life quality index (DLQI) score. A PASI score is important when systemic treatments are started (and is required by some NICE guidance) and is also important for monitoring the response to treatment.
Pharmacists need to have patients’ skin in mind regardless of what initially brought them into hospital. She suggests that pharmacists should look out for medications associated with skin conditions as a matter of routine conditions even though that might not be the reason that the patient has been brought into hospital. “If we ignore the patient’s skin at that point …. then the skin might flare up and become a problem”, she says.
The establishment of a specialist dermatology pharmacist network and the collaborative work with the British Association of Dermatologists underlines the important contribution that pharmacists can make to this specialty.
Kläre Bryant is an advanced clinical pharmacist in dermatology at Liverpool University Hospitals NHS foundation trust. She has an outpatient clinic at Broadgreen Hospital for patients receiving biologic therapies and another clinic at Aintree hospital for patients receiving systemic disease modifying anti-rheumatic drugs (DMARDs)