Home ultraviolet light therapy for psoriasis: why patients choose other options.

Background: Psoriasis is a common inflammatory skin condition for which office-based and home phototherapy are safe and effective treatments. However, patients who are prescribed home phototherapy devices often choose other treatment options.

Objective: To determine the reasons why patients do not purchase a home phototherapy device after it has been recommended and prescribed by their physician.

Explicit and implicit copayments for phototherapy: examining the cost of commuting.

Background: Whereas phototherapy is a safe and cost-effective treatment modality for psoriasis, economic disincentives discourage its use, including both direct and indirect costs to the patient.

Purpose: To determine when it may be cost-effective for patients to purchase a home light unit versus driving to clinic for outpatient phototherapy sessions.

Methods: Estimates of expenses associated with 3 months of outpatient phototherapy were determined and compared to the price of a home phototherapy unit.

Patterns of vitamin D analog use for the treatment of psoriasis.

Background: Psoriasis is a chronic disease that significantly impacts patients' quality of life. It most commonly manifests as localized disease, for which there are various treatment options.

Objective: To determine the prescription patterns of topical corticosteroids and vitamin D analogs for the treatment of psoriasis in the United States and how their use has changed over time.

A double-blind, randomized clinical trial of 20% alpha/poly hydroxy acid cream to reduce scaling of lesions associated with moderate, chronic plaque psoriasis.

Background: Salicylic acid is a topical keratolytic agent used to reduce scaling and hyperkeratosis associated with psoriasis vulgaris. However, its use is limited due to potential systemic toxicity. Hydroxyacids also modulate keratinization and desquamation.

Acitretin prescribing patterns in women of childbearing potential.

Background: Acitretin is indicated for severe psoriasis, but it is also a potent teratogen whose use should be avoided in women of childbearing potential. Topical medications, phototherapy, cyclosporine A, and new biologic agents provide safer alternatives for women of childbearing age with moderate to severe psoriasis.

Purpose: To determine the demographics of acitretin prescribing patterns as an assessment of acitretin use in women of child-bearing potential.

Skin manifestations of outpatient adverse drug events in the United States: a national analysis.

Background: Cutaneous reactions to drugs are among the most common clinical manifestations of adverse drug events (ADEs); however, data on outpatient cutaneous adverse drug events (CADEs) are limited.

Purpose: To provide national estimates of outpatient CADEs and determine their most frequent causes.

Methods: Outpatient CADEs recorded in the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) between 1995 and 2005 were analyzed.

Focusing and depth of field in photography: application in dermatology practice.

Background: Conventional photography obtains a sharp image of objects within a given 'depth of field'; objects not within the depth of field are out of focus. In recent years, digital photography revolutionized the way pictures are taken, edited, and stored. However, digital photography does not result in a deeper depth of field or better focusing.

Timing of return office visit affects adherence to topical treatment in patients with atopic dermatitis: an analysis of 5 studies.

Objective electronic monitoring systems have demonstrated poor adherence to topical therapies. We compared 5 clinical trials that measured adherence to topical therapy in patients with atopic dermatitis to identify characteristics of the study designs that affect patient adherence. Mean adherence among the trials ranged from 32% to 93%, and the length of time between baseline and first return visit was inversely proportional to adherence.

Sleep disturbances in psoriasis.

Background: Psoriasis negatively impacts sleep, but the factors that cause this sleep disturbance are not well characterized.

Purpose: To assess sleep quality in subjects with psoriasis.

Methods: 35 outpatients diagnosed with chronic plaque psoriasis affecting at least 10 percent BSA and 44 controls completed the Pittsburgh Sleep Quality Index, Patient Health Questionnaire, Itch Severity Scale, Insomnia Severity Index, and Epworth Sleepiness Scale.

Trends in pediatric psoriasis outpatient health care delivery in the United States.

Objective: To characterize patterns of childhood psoriasis health care delivery from 1979-2007.

Design: Retrospective, cross-sectional investigation using National Ambulatory Medical Care Survey data.

Setting: US ambulatory physician offices from 1979 through 2007.

Topical antibiotic trends from 1993 to 2007: use of topical antibiotics for non-evidence-based indications.

Background: Systemic antibiotic use has become more conservative with the emergence of drug resistance. Topical antibiotics are employed for a variety of indications, although there are only a few evidence-based indications.

Objective: To examine topical antibiotics use in the outpatient setting.

Acitretin for the treatment of psoriasis: an assessment of national trends.

Background: Combination therapy is a common and appropriate treatment strategy for moderate-to-severe psoriasis, as it provides for enhanced efficacy and decreased toxicity compared to the use of a single agent. Acitretin is an effective oral retinoid for psoriasis that seems to find its greatest value when complemented by other topical and systemic treatments.

Objective: The primary aim of this study is to assess the use of acitretin in combination with other treatments for psoriasis.

How good are US dermatologists at discriminating skin cancers? A number-needed-to-treat analysis.

Background: Identification of skin cancer requires discrimination of malignant lesions from benign lesions. The number of biopsies performed to yield one cancer diagnosis can be presented as a number needed to treat (NNT), and provides an assessment of the efficiency of skin cancer detection.

Objective: To assess the clinical accuracy of US dermatologists screening for skin cancer, the NNT for both melanoma and non-melanoma skin cancer was examined.

Acitretin in dermatology: a review.

Introduction: Acitretin is a systemic retinoid drug used in the treatment of severe psoriasis. It has also been used for a spectrum of other difficult-to-treat dermatoses, including hyperkeratotic and inflammatory dermatoses and non-melanoma skin cancers. Here we review the available data regarding both FDA-approved and off-label uses of acitretin, clinically relevant adverse events, precautions and monitoring.

An over-the-counter moisturizer is as clinically effective as, and more cost-effective than, prescription barrier creams in the treatment of children with mild-to-moderate atopic dermatitis: a randomized, controlled trial.

Background: Atopic dermatitis (AD) is a prevalent skin disorder with significant cost of treatment. Several prescription device moisturizers have been approved by the FDA to treat AD but are significantly more expensive than well-crafted over-the-counter (OTC) moisturizers. No studies have been performed to compare both the clinical efficacy and cost-efficacy of these prescription devices to OTC moisturizers.

A review of phototherapy protocols for psoriasis treatment.

Phototherapy is a mainstay in the treatment of psoriasis and is available as psoralen plus UVA (PUVA), broadband UVB (BB-UVB), and narrowband UVB (NB-UVB). Phototherapy can be administered in the hospital, outpatient clinic, or in the patient's home. The purpose of this review is to provide some practical guidance to general dermatologists and residents on the specifics of using phototherapy, which, despite its decreasing use, remains one of our most safe and effective treatment strategies for psoriasis care.

Review of home phototherapy.

Background: Outpatient phototherapy is a safe, effective, and low-cost treatment modality for moderate to severe psoriasis. Barriers to outpatient phototherapy including patient inconvenience, patient co-pays, decreased physician compensation, and insurance disincentive structures have led to decreased use and underutilization of phototherapy. Home phototherapy can potentially overcome many of the barriers associated with outpatient treatment but is not widely used because of concerns over safety and efficacy, lack of resident and physician education, and lack of insurance coverage.

Improvement in treatment adherence with a 3-day course of fluocinonide cream 0.1% for atopic dermatitis.

Variations in adherence may cause variations in treatment outcomes with topical corticosteroid therapy for atopic dermatitis. An intensive short course of outpatient treatment may promote good adherence and provide a high level of efficacy. The purpose of this study was to assess the efficacy, tolerability, and adherence to short-term treatment with fluocinonide cream 0.

Changes in rosacea comorbidities and treatment utilization over time.

Background: Rosacea is a chronic skin condition that requires lifelong treatment. Given the rise in antibiotic-resistant bacteria, many physicians are re-evaluating their use of antibiotics for long-term treatment of rosacea.

Purpose: To examine trends in the treatment of rosacea and the comorbidities associated with this skin condition.

Simplifying regimens promotes greater adherence and outcomes with topical acne medications: a randomized controlled trial.

New combination topical formulations for the treatment of acne may improve outcomes by increasing adherence. We assessed adherence to and efficacy of a combination topical medication for acne applied once daily compared with daily applications of 2 separate generic subcomponents. Twenty-six participants with mild to moderate acne vulgaris were randomized to 12 weeks of once daily application of clindamycin phosphate 7.

Acne vulgaris in the United States: a descriptive epidemiology.

While acne vulgaris is a common skin disease, many misconceptions still exist. The purpose of this study is to provide epidemiologic data to accurately describe the US population affected with acne and its associated comorbidities. Patient information was obtained from a third-party database of administrative claims from more than 80 public and private healthcare plans, representing approximately 9.

The economic impact of non-melanoma skin cancer: a review.

Non-melanoma skin cancer (NMSC) is the most common cancer in the United States. Cost of NMSC care primarily depends on 2 factors: care settings and treatment modalities. However, the cost efficacy of NMSC care has been insufficiently addressed in previous literature.