Role of pharmacists in patient education Zinc Code: UK/RET/0123/16b Date of Prep: November 2016  Role of pharmacists in patient education The pharmacist plays an important role in educating and advising the patient around TCS use – this is essential to help them to use their treatment appropriately and consistently.

Pharmacists can reinforce the importance of adherence to treatment Zinc Code: UK/RET/0123/16b Date of Prep: November 2016 Pharmacists can reinforce the importance of adherence to treatment The effectiveness of TCS is often hampered by patients not adhering to their treatment1 Poor adherence can lead to: x Little improvement from topical therapy1 Temporary improvement and subsequent treatment failure1 39% of patients with psoriasis (47/120) reported not adhering to their topical therapies;2 fear of side effects is an important reason for non-adherence3 24% of patients with AD (48/200) admitted to being non-compliant due to fear of TCS side effects4 Pharmacists’ advice and guidance can improve adherence to medication5 Low adherence can substantially impact the effectiveness of therapy, so it is essential that patients use TCS as prescribed by their doctor.1 However, patients often do not adhere to their topical therapies for many reasons, one of which is fear of adverse effects of TCS.2,3 This fear has been shown to be disproportionate to the actual risks involved.4 Patient understanding of steroid potencies has also been found to be poor,5 which may further contribute to inappropriate use. As shown by a Cochrane review, advice and support from pharmacists can be a key contributor to patient adherence to medication.6 References Feldman SR & Yentzer BA. Am J Clin Dermatol. 2009; 10:397–06. Brown KK, et al. J Am Acad Dermatol 2006; 55:607–613. Charman CR, et al. Br J Dermatol. 2000; 142:931–36. Zuberbier T, et al. J Allergy Clin Immunol 2006; 118:226–232. Beattie PE. et al. Clin Exp Dermatol 2003; 28:549–53. Ryan R, et al. Cochrane Database Syst Rev 2014, Art. No.: CD007768. 1. Feldman SR, Yentzer BA. Am J Clin Dermatol. 2009; 10:397–06; 2. Richards HL, et al. J Am Acad Dermatol 1999; 41:581–583; 3. Brown KK, et al. J Am Acad Dermatol 2006; 55:607–613; 4. Charman CR, et al. Br J Dermatol 2000; 142:931–36; 5. Ryan R, et al. Cochrane Database Syst Rev 2014; Art No. CD007768.

Pharmacists can advise on the practical use of emollients Zinc Code: UK/RET/0123/16b Date of Prep: November 2016 Pharmacists can advise on the practical use of emollients General advice1,2 Can be used as a soap substitute when bathing or washing Apply by smoothing into the skin along the line of hair growth (do not rub in!) Do not share with other people Consider keeping separate packs of emollients at work or school to facilitate frequent application Consider using better tolerated products (e.g. creams, lotions) during the day and ointments at night Emollients for AD1 Use liberally and frequently, even when skin appears improved or clear Use during or after bathing For very dry skin, applying every 2–3 hours should be considered normal Emollients for psoriasis2 Apply as often as required The amount of emollient used should far exceed the amount of TCS (by over 10:1) Apply before anti-­psoriasis topical treatment Wait 30 minutes before applying any other treatments Practical tip for patients: If a skin reaction occurs, stop the product and use an alternative emollient or return to your prescriber As a key element in topical therapy for AD and psoriasis, it is important to use emollients correctly and liberally to support skin moisture and the effectiveness of other topical therapies: well-moisturised skin may reduce the amount of TCS required.1 If patients experience any issues with their emollient therapies, they can consider an alternative or return to their primary care physician for an alternative, Reference NICE. Eczema – atopic. Clinical Knowledge Summaries 2015; http://cks.nice.org.uk/eczema-atopic. Accessed September 2016. All image licenses obtained from dreamstime.com 1. NICE. Eczema – atopic. Clinical Knowledge Summaries 2015; http://cks.nice.org.uk/eczema-atopic. Accessed September 2016; 2. NICE. Psoriasis. Clinical Knowledge Summaries 2014; http://cks.nice.org.uk/psoriasis. Accessed September 2016.

Pharmacists can provide practical advice on the use of TCS Zinc Code: UK/RET/0123/16b Date of Prep: November 2016 Pharmacists can provide practical advice on the use of TCS Be aware of the different FTUs required based on age and disease location1 The patient’s doctor will commonly prescribe the lowest potency TCS capable of achieving the desired effect;2 different potencies may be prescribed for different areas of the body or of disease severity,1,3 and patients may need support to use them appropriately Patients should follow their prescriber’s advice when using TCS (typically they are used 1–2 times daily for a maximum of 4 weeks)4–7 When TCS are used as directed, most side effects are rare and TCS are generally well tolerated4–7 TCS should be used alongside daily skin care routines1 The patient should return to their doctor if treatment is unsuccessful, they encounter side effects, or they have any concerns regarding their treatment 1. NICE. Eczema – atopic. Clinical Knowledge Summaries 2015; http://cks.nice.org.uk/eczema-atopic. Accessed September 2016; 2. Eichenfield LF, et al. J Am Acad Dermatol 2014; 71(1):116–132; 3. NICE. Psoriasis. Clinical Knowledge Summaries 2014; http://cks.nice.org.uk/psoriasis. Accessed September 2016; 4. Cutivate cream. Summary of Product Characteristics, February 2014; 5. Betnovate cream. Summary of Product Characteristics, Sept 2013; 6. Dermovate cream. UK Summary of Product Characteristics, Nov 2014; 7. Eumovate cream. Summary of Product Characteristics, March 2014. In addition to advice on using emollients, pharmacists can provide key practical support and guidance on TCS use, including how and where to apply the formulations. It is common for patients to be prescribed a selection of TCS with different potencies; therefore, it is important that they understand which therapy should be used where, and for how long. In case of any doubt, the patient should return to their HCP for further assessment and guidance.

Role of the pharmacist in the rational use of TCS: Summary Zinc Code: UK/RET/0123/16b Date of Prep: November 2016 Role of the pharmacist in the rational use of TCS: Summary TCS are an important treatment option for AD and psoriasis but patients can be hesitant to use them, potentially leading to poor treatment adherence Appropriate use of TCS is central to maximising efficacy and minimising side effects Pharmacists can play a key role in educating patients about appropriate use, supporting them to get the most out of their treatment

Prescribing information Zinc Code: UK/RET/0123/16b Date of Prep: November 2016 Prescribing information Prescribing information for Dermovate, Betnovate, Cutivate and Eumovate can be found below if you are viewing this webinar in adobe or can be found above if you are viewing this webinar in HCP.gsk.co.uk. Adverse events should be reported. Reporting forms and information can be found at ww.mhra.gov.uk/yellowcard. Adverse events should also be reported to GlaxoSmithKline on 0800 221 441.

Zinc Code: UK/RET/0123/16b Date of Prep: November 2016 Live Q&A (6th December live broadcasts only) Please send through any questions to the speakers by using the Q&A box within the adobe meeting room. Thank you.

Zinc Code: UK/RET/0123/16b Date of Prep: November 2016 Post 6th December webinar broadcast If you have any further questions please send these through to GSK’s Customer Contact Centre: Email: customercontactuk@gsk.com Phone: +44 (0)800 221 441 For those who wish to review the webinar’s content again we will upload 4 short videos onto our healthcare professional website, which is a promotional website. The content will be made available as soon as possible via the link below: https://hcp.gsk.co.uk/events.html Thank you.