At the 2024 American Academy of Dermatology Annual Meeting in San Diego, California, Peter Lio, MD, FAAD, presented sessions on treating systemic malignancies with alternative or adjunctive therapies and the importance to minimize pain in dermatological procedures.
Lio, clinical assistant professor of dermatology and pediatrics at Northwestern University’s Feinberg School of Medicine and founding director of the Chicago Integrative Eczema Center, spoke with Dermatology hours to discuss highlights and gems from his sessions, “Cutaneous and Systemic Malignancy” and “Pain-Free Dermatology: Minimizing Discomfort During Procedures for Children and Adults.”
Transcription
Peter Lio, MD, FAAD: Hi, my name is Peter Lio. I am a clinical assistant professor of dermatology and pediatrics at the Feinberg School of Medicine at Northwestern University and the founding director of the Chicago Integrative Eczema Center here in Chicago, Illinois.
Another wonderful session was on the role of skin and its different aspects in malignant tumors. This is a very broad topic, because we know that there are many skin problems induced by chemotherapy, we know that there are certain paraneoplastic syndromes that present on the skin. The article I talked about was really about alternative and complementary approaches, and how can they play a role?
One of the things I do first is talk about things that shouldn’t be part of this plan. For example, we’re talking about black ointment, we’re talking about this idea that using things topically to try to, for example, treat melanoma, is generally not a standard of care and can actually cause all kinds of problems, and we talked about some of the case reports and the literature that say it can be extremely dangerous. So we want to eliminate that.
Then we talked about some of the major issues that affect our patients with malignancies, and the biggest issue for me, at least that I’m called to see for, is itching. So this ends up being a little session for me on: How can we approach it holistically? Because we know that a lot of patients have had everything but the kitchen sink thrown at them, and they still have a lot of itching, and that’s an interesting place for alternative and complementary treatments. Some of the things we’ve talked about are acupuncture and acupressure. We’ve talked about some herbs that can actually help. Certain supplements like quercetin, which can play a role especially if they are histaminergic mediated. So there are some things we can do, including relaxation techniques, distraction techniques, and cognitive behavioral therapy; all of these things can play some role for patients who are suffering.
Again, they’re not necessarily going to solve the problem, and they’re certainly not going to circumvent conventional medicines. But for the patient who’s still uncomfortable, and you say, “My God, I don’t know what else to do.” » These can be very interesting adjunctive therapies, generally very gentle and well tolerated, particularly in a sick person. In polypharmacy, you say, “Hey, you know what? We have actually improved their quality of life; we helped them. Often, patients are incredibly grateful that we didn’t just give up and say, “Well, we tried all 6 drugs that are in the book.” Bye. It’s not humanist. This is not taking good care of the individual. So sometimes we have to do more, and sometimes just that tender love and care, that commitment to trying things, is enough to help the patient get over that hurdle and say, “You know what? I feel a little better about all of this. this, and I appreciate your attention. I’ve had patients tell me that everything I do doesn’t always work. I don’t hit a home run every time. I don’t even always get to the base every time. A lot of times you try things and it doesn’t work. But I think if the patient feels like you’re truly invested in improving their condition and you’re willing to think outside the box, that goes a long way.
For several years, I have had the chance to teach a course on painless dermatology, and the idea is that it really thinks about children. But that’s not all: who can benefit from it? Adults can benefit just as well. In fact, in my own practice, I’m about 50/50, children and adults. I use these techniques everywhere.
One of the most important messages to take away is that giving someone a more comfortable procedure isn’t just about helping them feel better. That’s great. This is a huge victory. But in reality, there is also a selfish goal in this. It turns out that procedures are more effective when the patient is more comfortable, which helps everyone; everyone wins.
We talked about a lot of different things during these sessions. In this session we talked about, first of all, some basic pharmacological things for pain relief, so things like topical anesthetic and how to maximize that, things like using cooling and vibration to alleviate the nervous feeling again. We are talking about distraction techniques, because it turns out that the attention, if the patient is attentive to the procedure, is much more intense. So we can use distraction methods. It can be as simple as talk therapy, getting them to talk about something, taking their mind off it. This can be as sophisticated as using something like an iPad, or even a virtual reality type headset, where they are completely immersed in another world; their attention is far, far away.
It turns out that engagement, if they’re engaged in something, if they’re watching a movie or a show, it’s definitely helpful. But if they actually do something and think about things, they tend to be incredibly easy to take care of in that scenario, especially kids. Frankly, they are in some sort of state akin to hypnosis. What’s great is that some studies have shown that this type of engagement is comparable to, or even better than, pharmacological sedation and things like that. So it’s really interesting to be able to see how powerful these complementary tools can be, and then I think the final piece is really about creating an environment that allows all of these things to come together: the best pharmacological treatments, in some ways. kind of the gentlest, the good techniques, warming up our solutions, if we have to inject things, go slowly. Then, of course, using these distraction techniques so that all of these aspects of the procedure go smoothly and patients walk out of the office saying, “That was a breeze.” This practitioner was incredible. That’s really our goal.
(The transcript has been edited for clarity.)
