Psoriasis treatment in the United States at the end of the 20th century

Authors

  • Daniel J. Pearce MD,

    1. From the Center for Dermatology Research, Departments of Dermatology, Public Health Sciences, and Pathology, Wake Forest University School of Medicine, Winston-Salem, NC
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  • Katherine H. Stealey bs,

    1. From the Center for Dermatology Research, Departments of Dermatology, Public Health Sciences, and Pathology, Wake Forest University School of Medicine, Winston-Salem, NC
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  • Rajesh Balkrishnan PhD,

    1. From the Center for Dermatology Research, Departments of Dermatology, Public Health Sciences, and Pathology, Wake Forest University School of Medicine, Winston-Salem, NC
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  • Alan B. Fleischer Jr MD,

    1. From the Center for Dermatology Research, Departments of Dermatology, Public Health Sciences, and Pathology, Wake Forest University School of Medicine, Winston-Salem, NC
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  • Steven R. Feldman MD, PhD

    1. From the Center for Dermatology Research, Departments of Dermatology, Public Health Sciences, and Pathology, Wake Forest University School of Medicine, Winston-Salem, NC
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  • Funding/conflicts of interest: This study was funded by a grant from Warner Chilcott, Plc. Dr Feldman has received research, verbal and/or consulting support from Connetics, Roche, Amgen, Biogen and Genentech.

Steven R. Feldman, md, phd Department of Dermatology Wake Forest University School of Medicine Medical Center Boulevard Winston-Salem NC 27157–1071 E-mail: sfeldman@wfubmc.edu

Abstract

Background  Psoriasis presents many management complexities. A cornerstone of therapy has been topical corticosteroids, although over the past 10 years there have been many additions to the medication armamentarium. Furthermore, various combination regimens and approaches have been advocated.

Objective  We sought to characterize various patterns of psoriasis health care delivery and the changes associated with these patterns from 1990 to 2001.

Methods  Visits for psoriasis were identified using National Ambulatory Medical Care survey data, a representative survey of visits to physician offices in the United States. We determined basic demographic characteristics, specialty of the physician provider and medications listed at these visits over the 1990–2001 interval.

Results  There were more than 13.5 million visits for psoriasis during the 12-year study period. Dermatologists were responsible for the majority of the visits over the study interval (82%) although there was an overall decline in the proportion of psoriasis visits to dermatologists. As a category, the most common medications used for psoriasis were topical steroids. Topical calcipotriene was the single-most listed medication. There was no observed use of noncorticosteroid topical agents at visits to nondermatologists. Non-dermatologists were as likely as dermatologists to list a systemic medication at a visit as well as use a systemic as monotherapy.

Discussion  In conclusion, the primary topical therapies for psoriasis remain clobetasol and calcipotriene. The decreasing role of dermatologists in the treatment of psoriasis is probably a complex issue, but may relate in part to the difficulty of obtaining access to dermatology care.

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