Conclusions

Applying evidence back to patient is often the most difficult and neglected step in the practice of evidence-based dermatology. This step requires consideration of several factors, including an appraisal of the magnitude and meaning of the treatment benefit and adverse events in relation to the patient's values and preferences.27 Presenting the evidence back to the patient is a complex process requiring good communication skills and an appreciation of the limitations of the generalisability of trial data in terms of trial participants, relevance and size of benefits.

Having illustrated the chapter with examples of some of the difficulties in applying evidence to individual patients, I would like to close with an example of how easy and fruitful practising evidence-based dermatology can be. I was recently called to see a young woman with cutaneous larva migrans that was causing intense itching on her feet. My first-line treatment would have been oral albendazole, probably because I had been involved in writing up a case series several years earlier.28 I was just about to recommend this when I reminded myself to practise what I preached by conducting a search of Medline using the term "cutaneous larva migrans" as a sensitive textword search. To my surprise, I quickly found a small but good RCT published in the American Journal of Tropical Medicine and Hygiene (not a journal I read every week) suggesting that a single 12 mg dose of ivermectin was more effective than albendazole.29 And so that is what I recommended. The itching stopped within 24 hours and the visible eruption was cleared within a few days.

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