DR. STEIN GOLD: The first thing, Hilary, I want to talk to you about is adherence or compliance. When we talk about clinical trials and we do studies, we expect a certain result from these drugs. We study them as monotherapy. In real life, though, we're dealing with people, and the people have to do what we ask them to do in order to see the results that we expect. So let's start with a teenager. Do you have any key tips that you can give us to get those patients to do what we'd like them to do?

Dr. BALDWIN: Well, I think the first and most important thing is to make sure that the patient actually wants to be treated. As we all know, very frequently the kid, especially teenage boy, gets dragged in kicking and screaming by his mother, and he has no intention of doing anything that is coming up in our conversation.

So I think the first thing is to find out who they are, because it's entirely possible that that child should not be treated just yet. If he has very mild acne and he doesn't care about it and his life is going along fine, why put that added stress on the family, right?

The second I think is to enroll him or her in the decision-making process. Sometimes we're on the fence as to whether oral or topical is more appropriate, perhaps get them involved in that conversation, get them invested in the treatment plan and make sure that they understand why we're doing each one of these things, that it's not a plot to ruin their lives, right?

And then the last thing is that adherence is often just because they forgot. Sometimes it's because they don't want to, but other times it's because they just don't remember to do it, and I have all sorts of tricks for that. My daughters would kill me if they actually heard me saying this, but I used to tape the tube of acne medicine onto the door handle of the refrigerator, and the rule was when you came home from school, you're not allowed to go into the refrigerator until that medicine went on your face.

DR. STEIN GOLD: There you go. That works. And that's such an interesting perspective, Hilary, because if the patient is not invested in what we're offering, game over. It's not gonna happen. But if we can simplify the regimen, instead of giving that patient, "Here's something to take by mouth. Here's something for the morning. Here's something for the evening. Here's something for special areas," it's too much.

DR. BALDWIN: One thing.

DR. STEIN GOLD: One thing. Do you have any tips to get that parent to say, "Okay, I'm going to do it"?

DR. BALDWIN: That's often quite difficult, but if they have scars, that's the way to do it. So I haul out the magnifying glass, and I search for a couple of scars, and then I point them out, "This is what's going to happen, and these are permanent.” And we treat acne for 2 reasons: to make him better now and make her happier with her life currently but also so that she's not a 30-year-old regretting that she never treated herself when she was younger.

DR. STEIN GOLD: The other thing I like to do is when a parent is resistant, to say to the parent – to the child in front of the parent, "Does anyone make fun of you at school? Are you willing to get up in front of the room when your face is flaring up and go to the board?" And a lot of times I think they don't really understand the true impact that this is having psychologically on everybody. Whether you're a kid or an adult, acne is devastating.

And what I like to do is I like to set the stage by saying, "I'm going to be treating you with a topical medication. Let me talk to you about the clinical trials. And what I see is you get after one month here, two months here, three months here." So I think by setting the stage of expectations, by looking at the clinical research data, that helps. I say it's not days. It's not weeks. It's months. And even after we get you under control, I didn't necessarily cure you. We are going to have an ongoing relationship. We are partners for the long term, and we're going to, together, get you to the best point possible.

DR. BALDWIN: I always tell them we're going to be good friends by the end, and we've heard many of our colleagues call it a – say it's not a sprint; it's a marathon, because this is the long-haul deal, and these medications are going to be used for a very, very long time, which, of course, makes us even more concerned about making sure that it's not just efficacious but tolerable as well.

DR. STEIN GOLD: And actually setting those patients up to understand how to deal with tolerability issues so that they are set up for success, they're in control of their treatment, they know they have to use it, they know what to expect. And, therefore, together, we can get great results. So I really say to people, aim for clear or almost clear – but really aim to get those patients as clear as possible, and then tell them it's an ongoing marathon to keep it under control.

Hilary, thank you. This has been a wonderful conversation. I think we have a lot of good treatment pearls, and I hope people will go forward and feel more confident in getting those patients to feel like they're in control of their treatment and hopefully increasing adherence. Thanks so much.