Alan B. Fleischer

The Burden of Atopic Dermatitis: Impact on the Patient, Family, and Society

Abstract:u2002 Atopic dermatitis is a common disease of increasing prevalence. Affected individuals must cope with a significant psychosocial burden, in addition to dealing with the medical aspects of the disease. Furthermore, because this is primarily a disease of childhood, family members, especially parents, are also affected by the condition. Individuals and family members are burdened with time‐consuming treatment regimens for the disease, as well as dietary and household changes. The financial impact of atopic dermatitis on families can also be great. Moreover, the cost to society is significant, with estimates ranging from less than

Lifestyle high‐risk behaviors and demographics may predict the level of participation in sun‐protection behaviors and skin cancer primary prevention in the united states

100 to more than

Oral Griseofulvin Remains the Treatment of Choice for Tinea Capitis in Children

2000 per patient per year. It is estimated that the direct cost of atopic dermatitis in the United States alone is almost

Patient Demographics and Utilization of Health Care Services for Molluscum Contagiosum

1 billion per year. Reducing the onus of this disease must take into account the full breadth of its burden. Targeting parents and caregivers with education and psychosocial support can decrease family and personal burden, which in turn may decrease the cost of treating the condition because of better medical, psychosocial, and family outcomes.

Changing Age of Acne Vulgaris Visits: Another Sign of Earlier Puberty?

Sun and ultraviolet radiation exposure are major risk factors for skin cancer, and sun‐protective behaviors and skin cancer examinations are means of primary prevention of skin cancer. The objective of this study was to evaluate the extent to which demographics and other high‐risk behaviors may predict the reported level of participation in sun‐protection behaviors and skin cancer primary prevention in the United States adult population.

Trends in prescription of acne medication in the US: Shift from antibiotic to non-antibiotic treatment

Abstract: Tinea capitis is one of the most common infections of children. The standard treatment is griseofulvin. Itraconazole and terbinafine have in large part replaced griseofulvin in the treatment of onychomycosis and, in addition to fluconazole and ketoconazole, are evolving treatments for tinea capitis. The purpose of this review is to compare the efficacy, safety, and cost of oral antifungal agents for tinea capitis. Small, open‐label studies of itraconazole, terbinafine, and fluconazole have reported encouraging results, suggesting that these drugs may be effective alternatives to griseofulvin; however, in large controlled studies griseofulvin continues to exhibit greater or equal efficacy. Ketoconazole appears to be the least efficacious. All five drugs appear relatively safe, however, only griseofulvin has a long track record of safety, is Food and Drug Administration (FDA) approved for the treatment of tinea capitis in children, and has the least known drug interactions. Fluconazole is FDA approved for use in children more than 6 months of age, yet not for the treatment of tinea capitis. Oral griseofulvin and terbinafine tablets are the least expensive of the antifungal agents; griseofulvin suspension is, however, more expensive than fluconazole suspension. For the combined reasons of efficacy, safety, and cost, and a long track record of use, we feel oral griseofulvin is still the present treatment of choice for tinea capitis. Newer antifungals are currently under investigation, and their role in treating tinea capitis in children is still being defined.

The National Ambulatory Medical Care Survey: A resource for understanding the outpatient dermatology treatment

Abstract:u2002 Our objective was to describe the demographics of molluscum contagiosum patients and physician utilization patterns in the United States. We obtained weighted data for office visits throughout the United States for molluscum contagiosum and common warts from the National Ambulatory Medical Care Survey (NAMCS) from 1990 to 1999. Outpatient visit data for patients diagnosed with molluscum contagiosum were analyzed using statistical software and compared to those for patients diagnosed with common warts. The main outcome measures studied were physician office visits by patients with molluscum contagiosum and patient demographic parameters including age, gender, and race. We found that health care utilization for molluscum contagiosum was the greatest for patients ≤9 years of age (51%). Ninety‐three percent of patients diagnosed with molluscum contagiosum were white. The number of visits for molluscum contagiosum was evenly divided between males and females. Visits to dermatologists comprised the majority of health care utilization units for molluscum contagiosum (71%). In conclusion, visits for molluscum contagiosum are frequent and are most often handled by dermatologists. When compared to those for common warts, molluscum contagiosum visits are less common and have an age distribution more limited to children.

Solar radiation and the incidence and mortality of leading invasive cancers in the United States

Abstract:u2003 The objective of the current study was to assess changes in the onset of pubertal maturation by determining whether acne is occurring at an earlier age. We assessed the age at which acne is occurring by assessing trends in the age of people seeking medical attention for acne. The National Ambulatory Medical Care Survey database was used to analyze physician visits for acne vulgaris in children aged 6 to 18 from 1979 to 2007. The data were used to assess trends in the mean age of children with acne and to compare these trends according to race and sex. Regression analysis revealed a significant decrease in the mean age of children seeking treatment for acne over this 28‐year period (pu2003<u20030.001). There was no significant change in the mean age of black children seeking treatment for acne. Black girls had the lowest mean age whereas white boys had the highest mean age. There has been a decrease in the average age of children seeking treatment for acne that may be indicative of earlier acne onset. This finding provides supporting evidence of the increasingly earlier onset of puberty in girls.

Characterization of obesity rates for dermatologic ambulatory office visits to United States physicians.

Aim: To describe trends in the prescription of medication for acne vulgaris in the USA from 1990 to 2002 with particular reference to the shift from antibiotic to non‐antibiotic treatment. Methods: Retrospective cross‐sectional observational study which analysed the data from the 4922 patient visits for acne vulgaris from the 1990–2002 National Ambulatory Medical Care Survey (NAMCS) to assess medications mentioned or prescribed at office visits for acne vulgaris. We specifically analysed visits for benzoyl peroxide or combination benzoyl peroxide products, topical retinoids, clindamycin, erythromycin, tetracycline group antibiotics and isotretinoin. A priori predictions were made for changes in physician behaviour over time, and were tested by regression. Multivariate regression also assessed the impact of demographic variables such as patient age, gender, race and type of physician seen on prescribing behaviour. Results: From 1990 to 2002 there were significant declines (p<0.01) in the likelihood of use of several drug classes that are reliant on antimicrobial mechanisms for acne including the following: benzoyl peroxide, topical clindamycin, oral erythromycin and tetracycline group antibiotics. There were significant increases in likelihood of utilization for agents not reliant on antimicrobial mechanisms including topical retinoids and oral isotretinoin during this period. These changes in utilization were not affected by controlling for demographic factors in multivariate analysis. Conclusion: There has been a shift towards non‐antibiotic treatment in acne management. Growing awareness of antibiotic‐resistant Propionibacterium species may contribute to increased use of topical and systemic retinoid agents.

Per-gram cost of medication is by itself a poor indicator for comparing costs of different psoriasis treatments: a retrospective cohort study of the cost of psoriasis treatment with topical corticosteroids versus topical calcipotriene.

Abstract Background: The National Ambulatory Care Survey (NAMCS) collects information on outpatient medical care in the United States. Key characteristics of the NAMCS methodology are not well recognized. We describe the NAMCS survey design and patient visits to dermatologists and to present information on the validity of the NAMCS data by comparing key features of the dermatologist sample to other surveys of dermatologists. Methods: NAMCS data on dermatologists and skin-related visits from 1993 to 2010 were analyzed and compared to the Dermatology Physician Profile Survey (DPPS), a survey by the American Academy of Dermatology. Results: A total of 29u2009554 patient visits to dermatologists were sampled from 1993 to 2010. On average, 118 dermatologists were sampled annually to participate in the NAMCS, and response rates ranged from 47 to 77%. The NAMCS and the DPPS found similar dermatologist demographics, practice settings and reimbursement sources. Conclusion: Overall, the NAMCS achieves high-response rates and provides a generalizable sample that has been used in scores of studies of dermatology outpatient treatment. In a time of changing health care delivery systems, NAMCS is valuable for understanding how physicians care for patients with skin disease.