Christopher B. Yelverton

Adherence to acitretin and home narrowband ultraviolet B phototherapy in patients with psoriasis

BACKGROUND In the treatment of psoriasis, patient adherence to oral medications is poor and even worse for topical therapy. However, few data exist about adherence rates to home phototherapy, adding to concerns about the appropriateness of home phototherapy as a psoriasis treatment option. OBJECTIVE We sought to assess adherence to both oral acitretin and home ultraviolet B phototherapy for the treatment of psoriasis. METHODS In all, 27 patients with moderate to severe psoriasis were treated with 10 to 25 mg of acitretin daily, combined with narrowband ultraviolet B, 3 times weekly at home, for 12 weeks. Adherence to acitretin was monitored by an electronic monitoring medication bottle cap, and to phototherapy by a light-sensing data logger. RESULTS Adherence data were collected on 22 patients for acitretin and 16 patients for adherence to ultraviolet B. Mean adherence to acitretin decreased steadily during the 12-week trial (slope -0.24), whereas mean adherence to home phototherapy remained steady at 2 to 3 d/wk. Adherence was similar between patients who reported side effects and those who did not. LIMITATIONS Small sample size and lack of follow-up on some patients were limitations of this study. CONCLUSIONS Adherence rates to home phototherapy were very good and higher than adherence rates for the oral medication. Side effects of treatment were well tolerated in this small group and did not affect use of the treatment. Home phototherapy with acitretin may be an appropriate option for some patients with extensive psoriasis.

The cost-effectiveness of rosacea treatments

Background: Topical and oral antibiotic/anti-inflammatory agents are mainstays of therapy for rosacea. However, costs and efficacies of these therapies vary widely. Objective: To determine relative cost-effectiveness of common therapeutic regimens using published data. Methods: Average daily costs (ADC) were determined based on treatment frequency and estimated gram usage for facial application of topical regimens of metronidazole (0.75%, 1%), azelaic acid (15%, 20%), sodium sulfacetamide and sulfur 10%/5%, and oral regimens of tetracycline, doxycycline, and isotretinoin. The ADC was compared with published efficacy rates from clinical trials, with efforts to standardize outcome measures. Based on these efficacy rates, costs per success were calculated and combined with office visit costs to estimate the total cost for each treatment for a 15-week period. Results: The medication cost per treatment success of topical regimens ranged from

Home Narrowband UV-B Phototherapy in Combination With Low-Dose Acitretin in Patients With Moderate to Severe Psoriasis

60.90 (

Use of a silklike bedding fabric in patients with atopic dermatitis.

205.40, total, including office visits) for metronidazole 1% gel once daily, to

UV light abuse as a substance-related disorder: clinical implications.

152.25 (

The utility of a data-logging device for measuring adherence to home phototherapy

296.75, total) for azelaic acid 20% cream twice daily. Tetracycline 250 mg/day was the least costly oral agent at

The rise of the generic drug market and its implications for dermatology.

6.30 per treatment success, or

A Medicare cost comparison of minor cutaneous procedures by surgical setting

150.80 total. Conclusion: Based on our best assessments of retrospective data from the literature, metronidazole 1% gel, once daily, was considerably less costly than several other branded and generic alternatives.

Exogenous factors in itch response.

A citretin plus UV-B phototherapy is a highly effective and relatively safe treatment for psoriasis, limited by the inconvenience and cost of office-based treatment. Home phototherapy offers greater convenience, but the safety and efficacy of its use outside the physician’s office has not been well studied. The purpose of this study is to provide a preliminary assessment of home-based narrowband UV-B phototherapy plus low-dose acitretin for moderate to severe psoriasis.

Classification of Exogenous Factors Contributing to the Itch Response

Abstract:  Symptoms of atopic dermatitis are often affected by environmental irritants. Modulation of potential irritants may benefit such symptoms. The purpose of this study was to evaluate the impact of a novel silklike bedding fabric for persons with mild to moderate atopic dermatitis. Participants with mild to moderate atopic dermatitis were provided a bedsheet set. Eczema Area and Severity Index and Investigator Global Assessment were the primary outcome measures. Visual Analog Scale for itch and a quality of life were also evaluated. The Wilcoxon signed rank test indicated a significant decrease in severity, with the Investigator Global Assessment score decreasing from 2.05 to 1.74 at week 8 (p = 0.03), the Eczema Area and Severity Index decreasing from 2.63 at baseline to 2.19 (p = 0.014), and the itching score decreasing from 3.97 to 3.00 (p = 0.010). An increase in the study‐specific quality of life index was also observed, changing from −0.08 (no change in quality of life) to 1.23 (some improvement) (p < 0.0001). Atopic dermatitis is commonly recalcitrant to therapy and synthetic silklike bed linens may have value as another option for the treatment of this disease. This pilot study demonstrated promising results that warrant confirmation in controlled clinical studies.