|GD - Online||Press Releases 1999|
- news from the 3rd annual meeting of the Society for Dermopharmacy
The interview partners on the press conference were:
med. Winfried Klövekorn (dermatologist in Gilching and member of the committee
of the GD)
Kaspar Müller-Bringmann (Medienbüro Müller Bringmann)
Treatment of skin diseases in crisis?
The reform of the Public Health system by the new red-green Federal Government in Germany (socialist and ecologic party) already shows first effects: since the introduction of the practice budget the dermatologists’ turnovers have decreased by more than 50 percent. This figure has been mentioned by the dermatologist Dr. med. Winfried Klövekorn on the occasion of the 3rd Annual Meeting of the Society of Dermopharmacy on 9 June in Berlin. The case limitation per quarter and the point value restriction per treatment case led above all within the dermato-surgical and allergiologic-diagnostic field to drastic performance reductions. Furthermore, he pointed out that the number of drug prescriptions shows a severe downward tendency. He explained that the expenditures for dermatological prescription have reached the level of 1992 in the meantime. Precipated savings by the dermatologists already entailed in 1998 a sales decrease of industrially manufactured dermatics by approximatively five percent compared to 1996. Especially concerned from this development are expensive and innovative drugs. In the opinion of Dr. Klövekorn a change of this situation is only possible by an operationally controlled attitude of the dermatologists.
Prescription drugs from the pharmacy
Every other drug prescribed by a dermatologist has to be prepared at the pharmacy first. Although patients often have to accept a waiting period, prescription drugs are very much asked for. Patients appreciate it to get an individually prepared drug. It is true that prescriptions have advantages compared to industrially manufactured drugs but they should only be prescribed in therapeutically justified cases and in case they can be prepared in the required quality in pharmacies, this has been emphasized by the pharmacist Dr. Holger Reimann from the Laboratory New Prescription Formulary (NRF), Eschborn, at the 3rd Annual Meeting of the Society of Dermopharmacy in Berlin. He explained further that physicians and pharmacists permanently face new professional challenges regarding the prescription and preparation of prescription drugs. This challenge can only be mastered by interdepartmental co-operation. The Society of Dermopharmacy of which Reimann is a member of the managing committee, deals therefore in its Department Extemporaneous Preparations with all medicinal and pharmaceutical aspects of the dermatological prescription. On its initiative, guidelines containing principles for prescription, preparation and sale of dermatological prescriptions have been passed on the occasion of a consensus conference. They should serve in practice as orientation for physicians and pharmacists, give reference as to responsibilities and approach for solutions and facilitate communication among the persons involved.
Remedies for dry skin
Several million people in Germany suffer from dry skin according to estimates by experts. The skin phenotype of these patients is rough and scaly, a sensation of tension and itching appears. Although a variety of products is available for the care of dry skin, the selection of suited preparations is difficult even for experts as dermatologists and pharmacists. The department Dermocosmetics of the Society of Dermopharmacy demands therefore the stipulation of minimum requirements concerning quality and documentation of dermocosmetics for the dry skin care, so explained the president of the GD, pharmacist Dr. Joachim Kresken at the 3rd Annual Meeting. The department consisting of dermatologists, pharmacists, representatives from industry and other experts has established guidelines "dermocosmetics for the care of dry skin "in this context. These guidelines have now been presented during the meeting to a wide expert public.
Loss of hair coming to an end?
Lecturer Dr. med. Hans Wolff, dermatologist at the Ludwig-Maximilians University in Munich informed about new treatment methods for inherited loss of hair at the 3rd Annual Meeting of the Society of Dermopharmacy in Berlin. In a study comprising 1500 men affected by inherited loss of hair, the active substance "Finasterid" has been tested. After a treatment period of twelve months, the result was that the persons subject to the treatment with "Finasterid" had fuller hair than the persons which had received a placebo treatment: after 24 months’ use the difference was even more significant. However, more important than the numerical increase of hair for the test subjects was the change in their appearance. After twelve months of use, an assessment commission - without having knowledge of the respective therapy - confirmed that 48 percent of the "Finasterid" test subjects had thicker hair but only seven percent of the placebo-group. After 24 months’ use the results of the "Finasterid" test subjects had increased to a sixty-six-percent-amelioration in the opinion of the assessing team whereas the placebo-group remained at seven percent. Concerning the side effects there was only a slight difference. They were not significantly more frequent for the "Finasterid" group than for the placebo-group.
Is the treatment of skin diseases in a crisis?
Since the introduction of the practice budgets in the course of the Public Health reform, the dermatologists’ quarterly turnovers decreased by more than 50 percent. Dr. med. Winfried Klövekorn, dermatologist in private practice at Gilching and member of the Society of Dermopharmacy’s managing committee explained this development at a press conference on the occasion of the GD’s 3rd Annual Meeting in Berlin on 9 June 1999 .
As Klövekorn commented, the decline in turnover in the meantime has rendered a profitable practice management within the field of the statutory health insured for many of his specialist colleagues impossible. Case restrictions per quarter and point limitations per treatment case lead above all to drastic benefit restrictions within the dermato-surgical and allergiological-diagnostic sector. Furthermore, the margin for drug prescriptions has been drastically restricted by the corset of the budget restriction prescribed by law. Since 1 January 1999 according to the GKV solidarity enhancing act overall budgets as well as department-specific standards have been stipulated. As a rule, two exceptions are possible by not considering certain drugs or clinical pictures for the assessment of standard exceedings. However, the dermatologists are not in a position to get the benefit of this facilitation due to the reason that the recommendations pronounced by the panel doctors’ Federal Association are not related to substance groups nor clinical pictures which are relevant for dermatologists. He further explained that this has resulted in a departing of dermatologists’ prescription attitude from the general trend:
while the total expenditures of the statutory health insurance for drugs further increased, the expenses for dermatological prescriptions remain at the level of 1992 and thus nearly twelve percent lower than permitted by law. The turnover of industrially produced dermatics diminished by approximately five percent in 1998 by the precipitated savings of the dermatologists compared with 1996. Especially concerned from this development have been expensive, innovative drugs as for example antihistaminics, adrenocortical steroids, systematic and local antimykotics, retinoids and antiviral pharmaceutical products on the basis of nucleosidanalogics.
Conclusion: the dermotherapy is in a crisis, caused by turnover losses and budgeting and this process is intensified by an over-correction of prescription expenses under the pretext of existential economic fears. In the opinion of Klövekorn, this crisis can only be moderated by an operational monitored attitude.
What is the reason for dermatologists for having prepared every other drug in pharmacies?
Supposing there was such a competition, then dermatologists would be German champions in dispensing of prescriptions - of drugs hence which are especially prepared in the pharmacy for the patient in question. Pharmacist Dr. Holger Reimann of the Laboratory of the New Prescription-Formulary (NRF) at Eschborn stressed this fact at the 3rd Annual Meeting of the Society of Dermopharmacy on 9 June 1999 in Berlin.
One of two medicaments prescribed by a dermatologist, is generated in a pharmacy, i.e. the patient cannot take along his drug immediately but he has to accept a waiting time. In spite of this slight inconvenience, prescription drugs are highly esteemed by many patients. They appreciate it not to receive an industrially manufactured product "off the peg" but to get a "tailor-made drug" escpecially prepared for them.
From a dermatologist’s point of view prescriptions may have advantages compared with ready-to-use drugs. On the one hand the dermatologist can adapt the prescription individually to the patient’s skin condition, the respective stage of the course of disease and the affected part of the body. On the other hand he can select active substances, active substance concentrations und -combinations which are not available in form of ready preparations on the market. Furthermore, prescription drugs may be cost-saving if for instance larger quantities are required for the extensive use or long-term application.
These advantages, nevertheless, are according to Reimann not a sufficient justification for the remarkable prescription emergence of dermatologic prescriptions. He emphasized that prescriptions are only acceptable if they can be justified therapeutically and at the same time prepared in the required quality in pharmacies. It is especially difficult to safeguard the quality of individually composed prescriptions with which the physician pursues a certain therapy aim in good intention and not rarely they are subject to preparation difficulties in pharmacies. According to Reimann’s remarks, physicians and pharmacists permanently face new professional challenges when prescribing and preparing prescription drugs which can only be coped with in an interdepartmental cooperation. The Society of Dermopharmacy to which Reimann belongs as a member of the managing committee, therefore deals in its department Extemporaneous Preparations with all medicinal and pharmaceutical aspects of the dermatological prescription. At the end of last year they gathered experts from different fields of activity during a consensus conference at Eschborn. They have passed guidelines with principles for the prescription, preparation and sale of dermatological prescriptions which serve as orientation for the physicians and pharmacists in practice, draw their attention to responsibilites and approaches and facilitate the communication among the persons involved.
What can be done about dry skin?
According to experts’ estimates several million people suffer from dry skin in Germany. This concerns a skin condition which is characterized by a lack of moisture and fat. The skin thus appears rough and squamous, a feeling of tension and itching appears. There is a defect in the barrier function of the horny layer of the epidermis: mainly horny layer lipids are lacking and on a minor scale also sebiferuous oil gland lipids. The consequences of this shortage of lipids are a reduced water storing capacity and an increased transepidermal dehydration.
The care of dry skin is an essential part of the prophylaxis and an important accessory symptom during and after a therapy. A rationally justified selection of qualified preparations, however, is very difficult even for experts as dermatologists and pharmacists due to the varied and unclear product supply. A product recommendation is very difficult even for experts as dermatologists and pharmacists. A product recommendation should, however, only be expressed if certain quality requirements are met, i.e. if the pharmaceutic-technological properties as well as the wanted and unwanted effects are sufficiently examined and documented. The department dermocosmetics of the Society of Dermopharmacy expresses these demands in its directive "dermocosmetics for the care of dry skin". In the department cooperate dermatologists, pharmacists, representatives from industry and other experts aiming at developing interdepartmental concepts regarding cosmetic questions capable of obtaining a consent. As the chairman of the GD, pharmacist Dr. Joachim Kresken explained at the 3rd annual meeting of the GD in Berlin on 9 June 1999, the minimum requirements of dermocosmetics concerning quality and documentation for the dry skin care are layed down.
According to the GD’s definition the notion dermocosmetics comprises cosmetic products for the cleaning, protection and care of skin the application purpose of which is achieved under consideration of dermatological and pharmaceutical aspects. Dermocosmetics for the care of dry skin are to compensate its lack of moisture and fat and bear supplementary designations as "for dry skin" or "for the use of dry skin". According to this directive, effects as an increase of lipid and water content of the skin, skin smooting, a reduction of scale formation and an improvement of the barrier function can be proven by using adequate proof methods which come up to the latest scientific findings. The same applies to the selection of methods for the examination of the tolerance. Unwanted effects of cosmetic products can be acute or chronical-cumulative contact dermatitis, sensoric irritations or allergic contact dermatitis on basis of a supersensitation of the delayed reaction type. According to the departments’ opinion qualified methods are available for the investigation and assessment of tolerances caused by irritation whereas for the registration of the sensitisation potential no validated and ethical generally accepted test methods are availabe at present. In this connection a recommendation is given to product manufacturers to make a thorough selection of raw materials and to avoid the most frequent allergens known from pertinent publications.
All information necessary for the assessment of dermocosmetics for the dry skin care are to be documented by the producer respectively seller and made accessible to the experts. It should contain as a minimum information regarding the galenic system, stability and microbiological quality, an efficacy proof and tolerance examinations performed.
Can hair loss be stopped now?
Lecturer Dr. med Hans Wolff, dermatologist at the Ludwig-Maximilians-University in Munich, informed about new therapeutic possibilities of androgenetic alopecia at the 3rd Annual Meeting of the Society of Dermopharmacy in Berlin on 9 June 1999. The androgenetic alopecia of men (hair loss conditioned by heredity) leads to a gradually shrink of the hair roots and finally to the loss of hair. The cause of this process is besides a genetic disposition a presence of androgens, in special dihydrotestosterone (DHT). DHT is produced in the hair follicle under the influence of the enzyme 5-alpha-reductase from its precursor testosterone.
In a study conducted at 64 clinics involving 1500 men suffering from androgenetic alopecia it has been tested now whether the active substance Finasterid is in a position to stop the loss of hair. Finasterid is a 5-alpha-reductase-type-II-inhibitor, i.e. it inhibits the transformation of testosterone into dihydrotestosterone. After a duration of treatment of twelve months, the Finasterid probationers had on average 107 hair more than the placebo probationers at an exactly fixed area of their head. The difference increased to 138 hair after 24 months. However, more important for these men than the growth of hair in number was the change in their appearance. After twelve months an assessment commission confirmed - without having knowledge of the respective therapy - that 48 percent of the Finasterid probationers had fuller hair but only seven percent of the placebo group.
After 24 months the Finasterid probationers had achieved a 66 percent improvement in the opinion of the assessors whereas the placebo group still remained at seven percent. Nevertheless, there was only a minor difference regarding the side effects which were not significantly more frequent than in the placebo group also in view of a loss of potency and libido.
Prescription preparation in pharmacies
Half of the drugs which are prescribed by dermatologists have to be prepared in pharmacies. An inter-departmental interplay of physicians and pharmacists is therefore imperative. On the 3rd Annual Meeting of the Society of Dermopharmacy (GD) the member of the managing committee, Dr. Holger Reimann, reported about principles for prescription, preparation and sale of dermatologic prescriptions. Appropriate guidelines giving orientation to physicians and pharmacists have recently been passed during a consensus conference organized by the GD.
Foto: K. Müller-Bringmann
Less is sometimes better. This is especially true for persons suffering from dry skin that not the quantity of the care product decides about the effect but the quality of the product. The department Dermocosmetics of the Society of Dermopharmacy (GD) has therefore established guidelines in which the minimum requirements concerning quality and documentation of dermocosmetics for the care of dry skin have been defined. The pharmacist Dr. Joachim Kresken, chairman of the GD explained this on the occasion of the 3rd Annual Meeting of the GD in Berlin.
Foto: K. Müller-Bringmann
Bald head at an end? The dermatologist and lecturer Dr. med. Hans Wolff from the Ludwig-Maximilians-University of Munich informed about new methods of treatment for inherited hairloss at the 3rd Annual Meeting of the Society of Dermopharmacy in Berlin. A two-year study of more than 1500 men has achieved evident results with the ethical active substance "Finasterid".
Foto: K. Müller-Bringmann
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