Dr Peter Lio Lists Dermatology Treatment Barriers

Peter A. Lio, MD, clinical assistant professor of dermatology and pediatrics at Northwestern University's Feinberg School of Medicine, discussed barriers to dermatology care he has observed, including medication costs and the lack of dermatologists in rural areas.

At the 2023 Fall Clinical Dermatology Conference, Lio presented his session titled, "Closing the Healthcare Gaps in the Management of Moderate to Severe Atopic Dermatitis With Biologics."

Transcript

What barriers to care are you seeing in dermatology?

There are so many barriers to care. I mean, some of them are just getting an appointment with a dermatologist. Even in big cities, there can be months and months of waiting for patients. As you get to more rural areas, we know that many areas are just truly underserved with dermatology. They might not have anybody, or, if they have one person, maybe that person is overwhelmed with skin cancer; they're trying to take care of skin cancers and surgeries, and they don't really have a ton of time to see pediatric patients—or the expertise or the interest. So, we know that's a hurdle.

We know that the cost of medications, the access to them, are very difficult, and there are many pitfalls. Some of the newer medicines, paradoxically, are easier because there are often company programs to help us get those to the patients or do copay assistance, things like that. Again, paradoxically, generic medications sometimes can be even harder because a lot of times they're still very expensive, but then they don't have anybody behind them.

So, if the insurance company says, "No, we're all stuck," the patient calls us and says, "Well, what do I do now? How am I supposed to handle this?" Our answer is, "Well, we'll try everything. Maybe we'll have to switch, but we have fairly limited resources, as well."

I think the final piece that's really tough is the educational barriers that people, I think, sometimes have a strange understanding of what this condition is. Many of my patients say, "So, when are we going to start finding the root cause?" My answer is, "I would love to. Anybody who honestly knows the root cause for this particular patient, I'm all ears."

I think we've seen people do very extensive diets, they've done lifestyle changes, they've really tried to change everything, and it's especially intense for a baby. The baby is coming into the world pretty innocently, so I don't think it's drinking, drugs, and hard partying; this 3-month-old, this poor guy has really gone through a lot. Our job there is maybe to support and try to say, "Listen, we're all looking, we think some of these may be genetic things."

Some of them may be environmental things but may be unavoidable. There's pollutants in our air and water, there's stress in modern life that's very different than what we did before. People don't go outside very much, and we're all probably a bit on the low side of vitamin D, so all of these pieces come together, some of them are easy to fix, and some of them are darn near impossible, and that's part of the challenge.