Trends in the use of topical over the counter products in the management of dermatologic disease in the United States.

BACKGROUND: Over the counter (OTC) products play an important role in treating and preventing disease in the U.S. Topical OTCs are widely used but use in dermatology is not well defined. OBJECTIVE: To characterize topical OTC use in the U.S. METHODS: The National Ambulatory Medical Care Survey was queried for physician visits in which topical OTCs were recorded. Physician specialty, patient demographics, and diagnoses were examined and linear regressions were performed to determine trends over time. RESULTS: From 1989 to 2008, there were an estimated 320 million visits documenting topical OTC recommendations; the majority of which were visits to a dermatologist (33.5%). Dermatologists most commonly recommended hydrocortisone (16.9%), benzoyl peroxide (13.3%), and sunscreen (7.4%). Dermatologists were more likely than other providers to use moisturizers in the treatment of dermatologic disease. Overall, topical OTC recommendations by all physicians has decreased over time (p < 0.0001). However, dermatologists' recommendations for moisturizers and sunscreens has increased significantly. CONCLUSION: Topical OTC products have an important role in the prevention and treatment of dermatologic disease. Topical OTC recommendations are decreasing over time whereas their use as complementary components (sunscreen/moisturizers) appears to be increasing. Increased awareness of the utility of these agents may help to improve patient outcomes.

A review of home phototherapy for psoriasis.

BACKGROUND: Phototherapy is a mainstay in the treatment of psoriasis and other photoresponsive dermatoses and home phototherapy has broadened therapeutic options. PURPOSE: To describe the history of home phototherapy, the technological advances in the safety and efficacy of the equipment available, and the associated issues of cost, convenience, adherence, and quality of life. METHODS: We conducted a literature review of home phototherapy, broad-band UVB, narrow-band UVB, and PUVA phototherapy using PUBMED. A Google search of home phototherapy equipment and technology was also undertaken. RESULTS: Technological advances in home phototherapy equipment have allowed for more treatment options and improvements in safety and efficacy. One randomized, controlled trial found results comparable to office-based phototherapy. Home phototherapy is convenient, cost-effective, and associated with better quality of life compared to outpatient phototherapy treatment. One trial found that adherence to home phototherapy regimens was better than to oral retinoids. CONCLUSIONS: Home phototherapy is a well-tolerated, efficacious, economical and patient friendly therapeutic option. Advantages of home phototherapy include improved quality of life, greater convenience, lower cost, and less time lost from work and social activities. Dermatologists should strongly consider home phototherapy as a first-line treatment option for appropriately selected psoriasis patients.

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. PURPOSE: The purpose of this study is to review the use of phototherapy with emphasis on the safety, efficacy, and practical use of home phototherapy. METHODS: A comprehensive Pubmed literature search was done using the keywords NB-UVB, narrowband UVB, BB-UVB, broadband UVB, PUVA, psoralen and UVA, UVA, history of phototherapy, mechanism of phototherapy, phototherapy in dermatology, home phototherapy, and phototherapy for psoriasis. All relevant articles were reviewed. CONCLUSIONS: Home NB-UVB phototherapy can be as safe, effective, and cost-effective as outpatient phototherapy. Further, home UVB is more convenient for patients, has higher patient satisfaction, and a lower treatment burden compared to outpatient phototherapy. Home NB-UVB should be considered as a treatment option for patients eligible for phototherapy.

Tanning as an addictive behavior: a literature review.

BACKGROUND: Recent studies have identified reinforcing properties associated with tanning and suggest a possible physiologic mechanism and addiction driving tanning behavior. OBJECTIVE: This article attempts to synthesize the existing literature on tanning and addiction to investigate possible associations. METHODS: We investigated a variety of substance dependence models to define what constitutes dependence/addiction and to determine how current studies on tanning meet these criteria. RESULTS: In some individuals, tanning has met Diagnostic and Statistical Manual criteria for a substance-related disorder or tanning-modified Cut Down, Annoyed, Guilt, Eye-opener criteria. Trial studies have demonstrated the induction of withdrawal symptoms in frequent tanners. LIMITATIONS: Additional studies are needed to investigate the associated dependency and addiction more fully and to elucidate its similarities to other better-known addictive syndromes. DISCUSSION: Tanning is a problem behavior, both as a health risk and as a possible dependency. Future studies, especially in the area of cognitive mapping and cue-related stimuli are needed. Imaging studies may be important in elucidating whether the same areas of the brain are involved in tanning addiction as in other addictive syndromes.

Recruiting underserved populations to dermatologic research: a systematic review.

Recruitment of participants to dermatologic research studies can be challenging, particularly with historically underserved populations. Recruitment of these groups is essential to ethical, valid, and useful dermatologic research. This article discusses findings from a review of 78 studies that examined factors influencing participation in health research studies with an emphasis on underserved populations, particularly women and ethnic minorities. The most commonly encountered barriers to research participation are mistrust of research, lack of access to research programs, and culturally incompetent research design. Motives to participate in research include receipt of benefit from participation, perceived opportunities to help others, and culturally competent research design. Practical methods for addressing barriers and enhancing research participation include culturally competent research design, community-based recruitment, and easily understandable informed consent. These factors should be considered when recruiting subjects for dermatologic research, especially when recruitment of underserved populations is desired. In addition, the literature demonstrates a paucity of research among rural residents, infants, and children, as well as within clinical dermatologic research.

Ultraviolet tanning addiction.

Behavioral studies of ultraviolet light exposure behavior have provided insight into motivations for tanning, which include not only the desire for a tanned appearance but also the physiologic response to ultraviolet light. Many frequent tanners continue to tan despite knowledge or personal experience of adverse consequences. Efforts to reduce tanning behavior need to account for the interplay between physiologic effects of tanning and psychosocial drives behind tanning behavior.

Dermatologic medication adherence.

Human behavior is directly related to the development of various skin disease conditions and to the effectiveness of skin disease treatment regimens. Adherence research studies have demonstrated abysmal adherence to topical treatment of common skin disorders, opening new opportunities for improving skin disease treatment outcomes. The treatment of skin raises unique issues in environmental exposures, psychosocial human interactions, biology, and pharmacology. The resulting human behaviors and the potential to understand and modify those behaviors through behavioral research studies are exciting and promising.