Dermatologists and Allergists Have Far More Experience and Use More Complex Treatment Regimens in the Treatment of Atopic Dermatitis Than other Physicians

2001 ◽  
Vol 5 (3) ◽  
pp. 211-216 ◽  
Author(s):  
Robert L. Henderson ◽  
Alan B. Fleischer ◽  
Steven R. Feldman
Keyword(s):  
Atopic Dermatitis ◽  
Pediatric Population ◽  
Intensive Therapy ◽  
Skin Condition ◽  
Treatment Regimens ◽  
Topical Corticosteroids ◽  
Outpatient Visits ◽  
Care Survey ◽  
Ambulatory Medical Care ◽  
Relative Potencies

Background: Atopic dermatitis (AD) is a prevalent skin condition, especially in the pediatric population. Whereas it has been shown that dermatologists prefer using more intensive therapy for AD than generalists, actual drug utilization has not been quantified. Objective: The purpose of this study is to characterize visits for and treatment of AD in the office-based setting. Methods: National Ambulatory Medical Care Survey data from 1990 to 1997 was analyzed to determine the use of topical corticosteroids (including their relative potencies), oral antibiotics, and oral antihistamines in the treatment of AD. Results: There were an estimated 900,000 outpatient visits per year for AD. If in some visits to generalists the diagnosis for AD was miscoded as contact dermatitis, there may have been as many as 3 million outpatient visits per year for AD. Topical corticosteroids were used in 67% of visits with a mean potency rank of 4.5 (4.3, 4.8 95% CI). Dermatologists saw 48% of all visits for AD (63 yearly visits/physician) and allergists saw 10% of visits (30 yearly visits/physician). Other physicians saw from 0.1 to 2 yearly visits per physician. Dermatologists were the most likely to use topical corticosteroids (81% of visits) and high-potency corticosteroid agents (22% of visits). Dermatologists and allergists were the only physicians to prescribe ultrahigh-potent corticosteroid agents (12% and 9% of visits, respectively) and were more likely than other physicians to use multiple-agent regimens (21% and 27% of visits treated with a corticosteroid agent, respectively). Conclusions: Dermatologists and allergists have more expertise in the management of AD than other physicians, as suggested by their higher per capita visits and greater use of complex topical corticosteroid regimens.

Clinical Insights About Topical Treatment of Mild-to-Moderate Pediatric and Adult Atopic Dermatitis

2019 ◽  
Vol 23 (3_suppl) ◽  
pp. 3S-13S ◽  
Author(s):  
Charles W. Lynde ◽  
James Bergman ◽  
Loretta Fiorillo ◽  
Lyn Guenther ◽  
Jill Keddy-Grant ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Calcineurin Inhibitors ◽  
Skin Condition ◽  
Future Research ◽  
Barrier Dysfunction ◽  
Psychosocial Burden ◽  
Epidermal Barrier ◽  
Topical Corticosteroids ◽  
Topical Calcineurin Inhibitors ◽  
Inflammatory Conditions

Atopic dermatitis (AD) is a chronic inflammatory skin condition, also referred to as atopic eczema, that is identified by itching and recurrent eczematous lesions. It often starts in infancy where it affects up to 20% of children but is also highly prevalent in adults. AD inflicts a significant psychosocial burden on patients and their families and increases the risk of other immune-mediated inflammatory conditions, such as asthma and allergic rhinitis, food allergy, and mental health disorders. It is a lifelong condition associated with epidermal barrier dysfunction and altered immune function. Through the use of emollients and anti-inflammatory agents, current prevention and treatment therapies attempt to restore epidermal barrier function. Acute flares are treated with topical corticosteroids. Topical calcineurin inhibitors (TCIs) and topical corticosteroids (TCSs) are used for proactive treatment to prevent remission. There remains a need and opportunity to improve AD care through future research directed toward an improved understanding of the heterogeneity of the disease and its subtypes, the role of autoimmunity in its pathogenesis, the mechanisms behind disease-associated itch and response to specific allergens, and the comparative effectiveness and safety of therapies.

Practice Trends in the Treatment of Actinic Keratosis in the United States: 0.5% Fluorouracil and Combination Cryotherapy plus Fluorouracil are Underused despite Evidence of Benefit

2012 ◽  
Vol 16 (2) ◽  
pp. 107-114 ◽  
Author(s):  
Thomas J. Hagele ◽  
Michelle M. Levender ◽  
Scott A. Davis ◽  
Phillip M. Williford ◽  
Steven R. Feldman
Keyword(s):  
Combination Therapy ◽  
Actinic Keratosis ◽  
Lower Cost ◽  
The United States ◽  
Similar Efficacy ◽  
Comparable Efficacy ◽  
Treatment Regimens ◽  
Patient Demographics ◽  
Care Survey ◽  
Ambulatory Medical Care

Background: Topical fluorouracil and cryotherapy are among the most commonly used treatments for actinic keratosis. Evidence shows that 0.5% fluorouracil has similar efficacy and is better tolerated than 5% fluorouracil. Evidence also shows that combination therapy with cryosurgery and fluorouracil is beneficial. Objective: To examine fluorouracil and cryotherapy use in the treatment of actinic keratosis. Methods: The National Ambulatory Medical Care Survey database was queried for visits for actinic keratosis. Visits were analyzed for patient demographics, provider specialty, and treatment regimens. Fluorouracil and cryotherapy use was analyzed over time. Results: Cryotherapy was the most commonly used treatment for actinic keratosis. Fluorouracil products were prescribed to 1.1 million patients (6.6%) between 2001 and 2008; of these, dermatologists prescribed 0.5% fluorouracil in 51.8% of cases and 5% fluorouracil in 38.9% of cases. Combination fluorouracil and cryotherapy was used for only 1.1% of actinic keratosis visits between 1993 and 2008 and was never used by nondermatologists. Conclusions: Despite evidence suggesting comparable efficacy, greater tolerability, and lower cost of 0.5% fluorouracil relative to 5% fluorouracil, 5% fluorouracil is used by dermatologists almost as often as 0.5% fluorouracil. Among nondermatologists, 5% fluorouracil is used exclusively. Combination therapy of fluorouracil and cryotherapy is underused despite evidence of its benefit.

scholarly journals Racial and Gender Differences in the Presentation of Pruritus

Medicines ◽  
2019 ◽  
Vol 6 (4) ◽  
pp. 98 ◽  
Author(s):  
Katherine A. Whang ◽  
Raveena Khanna ◽  
Jamael Thomas ◽  
Crystal Aguh ◽  
Shawn G. Kwatra
Keyword(s):  
Gender Differences ◽  
Atopic Dermatitis ◽  
Medical Care ◽  
Lichen Planus ◽  
Common Disease ◽  
Prurigo Nodularis ◽  
Cross Sectional ◽  
Care Survey ◽  
And Gender ◽  
Ambulatory Medical Care

Background: Pruritus is a common disease symptom with a variety of etiologies known to reduce patient quality of life. We aimed to characterize the racial and gender differences in the presentation of pruritus for itch-related patient visits both within a single institution and nationally. Methods: Cross sectional study of patients ≥ 18 years old seen at Johns Hopkins Health System between 1/1/12 and 1/1/18. Results were compared to data from 2005–2011 from the National Ambulatory Medical Care Survey (NAMCS) and the National Health Ambulatory Medical Care Survey (NHAMCS). Results: Our findings indicate that itch patients at JHHS (n = 18,753) were more likely to be black compared to white patients (37% vs. 19%, p < 0.01) when compared to patients without itch—a trend also noted nationally based on data from NAMCS/NHAMCS (26% vs. 21%, p = 0.05). Black itch patients are also more likely to be diagnosed with prurigo nodularis (OR 2.37, p < 0.0001), lichen planus (OR 1.22, p < 0.0001), and atopic dermatitis OR 1.51, p < 0.0001). Female itch patients are more likely to be diagnosed with autoimmune (OR 1.66, p < 0.0001) and psychiatric comorbidities (OR 1.2–1.8, p < 0.0001) than male itch patients. When compared to black itch patients nationally, white itch patients were more likely to visit a dermatologist (29% vs. 18%, p = 0.028). Our data can identify associated conditions and demographic differences but are unable to support a causal relationship. Conclusions: Black and female patients are more likely to present with pruritus, a symptom associated with comorbidities such as prurigo nodularis, lichen planus, atopic dermatitis, and psychiatric conditions.

scholarly journals Trends in Outpatient Visits for Insomnia, Sleep Apnea, and Prescriptions for Sleep Medications among US Adults: Findings from the National Ambulatory Medical Care Survey 1999-2010

SLEEP ◽  
2014 ◽  
Vol 37 (8) ◽  
pp. 1283-1293 ◽  
Author(s):  
Earl S. Ford ◽  
Anne G. Wheaton ◽  
Timothy J. Cunningham ◽  
Wayne H. Giles ◽  
Daniel P. Chapman ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Medical Care ◽  
Outpatient Visits ◽  
Care Survey ◽  
Ambulatory Medical Care

A Comparison of the National Ambulatory Medical Care Survey (NAMCS) Measurement Approach With Direct Observation of Outpatient Visits

Medical Care ◽  
2004 ◽  
Vol 42 (3) ◽  
pp. 276-280 ◽  
Author(s):  
Valerie J. Gilchrist ◽  
Kurt C. Stange ◽  
Susan A. Flocke ◽  
Gary McCord ◽  
C. Bourguet
Keyword(s):  
Medical Care ◽  
Direct Observation ◽  
Outpatient Visits ◽  
Care Survey ◽  
Ambulatory Medical Care ◽  
Measurement Approach

scholarly journals Complementary and Integrative Therapies for Childhood Atopic Dermatitis

Children ◽  
2019 ◽  
Vol 6 (11) ◽  
pp. 121 ◽  
Author(s):  
Adrienne L. Adler-Neal ◽  
Abigail Cline ◽  
Travis Frantz ◽  
Lindsay Strowd ◽  
Steven R. Feldman ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Skin Condition ◽  
Clinical Severity ◽  
Randomized Controlled Clinical Trials ◽  
Treatment Regimens ◽  
Length Of Treatment ◽  
Severity Scores ◽  
Complementary And Integrative Medicine ◽  
The Individual ◽  
Integrative Therapies

Background: Childhood atopic dermatitis is a chronic inflammatory skin condition that causes significant psychological and financial costs to the individual and society. Treatment regimens may require long-term medication adherence and can be associated with poor patient satisfaction. There is considerable interest in complementary and integrative medicine (CIM) approaches for childhood atopic dermatitis. Objective: To assess the effects of CIM approaches on childhood atopic dermatitis outcomes as defined by randomized, controlled clinical trials. Methods: A PubMed review of CIM-related treatments for pediatric atopic dermatitis was performed, and data related to age, study population, efficacy, treatment regimen, length of treatment, and sample size were included. Results: The search yielded 20 trials related to probiotic/prebiotic treatments for atopic dermatitis, three on the effects of vitamins on children with atopic dermatitis, and two on the effects of Chinese herbal treatments for atopic dermatitis in children and adolescents. The strongest evidence was for supplementation with the probiotics L. fermentum and L. plantarum. Conclusions: Certain strains of probiotics, specifically L. plantarum and L. fermentum, may improve clinical severity scores in children with atopic dermatitis. However, additional trials are needed to more thoroughly delineate the effects of additional integrative therapies on childhood atopic dermatitis.

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