Saoirse Nolan had been on the same first-line treatment for three years, because nobody had booked the appointment at which it would be reconsidered.
Quantity is the most under-explained part of topical treatment. Patients are given a tube and an instruction and left to invent the dose.
The psychological load of a visible condition is asked about routinely at every appointment, because it does not correlate with severity and is otherwise never mentioned.
Without a review date, first-line becomes permanent. That’s not a clinical decision, it’s an administrative accident.
Illustrative composite
Flare plans are written down with thresholds, so treatment starts on day one of a flare rather than on day nine when it has become unbearable.
Every prescription on this pathway now carries a review date. “That’s it,” she says. “That’s the whole change.”
