Predictors of treatment choices and associated outcomes in actinic keratoses: results from a national physician survey study.

OBJECTIVES: Actinic keratoses (AKs) are common skin lesions with the potential to progress to squamous cell carcinoma. Many effective treatment alternatives exist, yet the reasons for treatment choice have not been explored. This study examined which AK therapy was preferred among dermatologists and primary care physicians (PCPs), as well as potential determinants of therapeutic selection. METHODS: A random national sample of 534 dermatologists and PCPs selected from the American Medical Association database completed AK questionnaires. The final sample included 1184 AK patients treated by dermatologists and 559 AK patients treated and/or referred by PCPs. All analyses were weighted using the survey sampling weights. RESULTS: Patients who had new and recurring lesions as well as patients who had a mean duration of more than a year since the last AK episode treatment (all p<0.05) were more likely to receive pharmacotherapy. Patients being treated by a dermatologist, receiving pharmacotherapy treatment only, and having both new and recurring lesions (all p<0.05) were less likely to have a complete treatment success. CONCLUSIONS: This study identifies several patient and physician factors associated with treatment preference and related outcomes in patients being treated for AK.

Healthcare utilization for acute and chronic diseases of young, school-age children in the rural and non-rural setting.

To determine the most frequently diagnosed conditions among rural and non-rural children age 5 to 9 and assess for environmental influences, data from the National Ambulatory Medical Care Survey (1996-2001) were used to examine frequencies of diagnoses in children age 5 to 9. Separately, we examined rural and non-rural outpatient physician visits in weighted multivariate logistic regression models. Overall, the most frequent diagnosis was routine health check, followed by several acute conditions. When analyzed separately, non-rural children were significantly more likely to visit a physician for routine health check (P = 0.002), asthma (P = 0.005), and acute upper respiratory infection (P = 0.037). Rural counterparts were significantly more likely to be seen for attention deficit disorder (P = 0.000), otitis media (P = 0.017), chronic rhinitis (P = 0.017) and influenza (P = 0.037). Children age 5 to 9 are healthy overall. When illness occurs, it is usually acute. Rural and non-rural, young, school-aged children exhibit many similarities in healthcare utilization, but differences occur. Most surprising is the difference in the diagnosis frequency of attention deficit disorder.

Hyperpigmentation: a review of common treatment options.

Hyperpigmentation disorders are common and include a multitude of forms. They are typically divided into three large categories: dermal, epidermal, or mixed, depending on the site of abnormality. The location of the increased melanin affects treatment options, but therapy within a group is often similar. This paper discusses the treatment modalities, including topical and surgical approaches, available for the different types of hyperpigmentation.

Over-the-counter topical skin products--a common component of skin disease management.

Over-the-counter (OTC) products are widely recommended by physicians and utilized by the public for the treatment and prevention of disease. The use of OTC drugs has been studied extensively, but the patterns of physician recommendations for OTC topical skin products and the characteristics associated with patients receiving such recommendations remain unclear. We aimed to look at patterns of OTC topical skin product recommendations by physician specialty, patient demographics, geographical region, diagnosis, and metropolitan status to determine whether there are differences in the utilization of these products in the treatment of dermatologic conditions. We analyzed office-based physician visits for OTC topical skin product recommendations recorded in the 1995 to 2000 National Ambulatory Medical Care Survey (NAMCS). From 1995 to 2000, there were an estimated 36 million physician recommendations for OTC topical skin products. Although dermatologists were responsible for 53.8% of recommendations, pediatricians had the largest proportion of recommendations per prescription recommendation (OTC/Rx=0.58). Women patients, white patients, patients younger than 20 years, urban residents, and those living in the Southern United States received greater numbers of OTC topical skin product recommendations. Of the leading products recommended, hydrocortisone (27.6%), anti-infectives (23.4%), and moisturizers (13.4%) were the most common. OTC topical skin product recommendations by US physicians are substantial, particularly among dermatologists and primary care physicians. Physician specialty, gender, race, and age appear to be factors associated with those recommendations.

Hyperpigmentation: an overview of the common afflictions.

Hyperpigmentation disorders of the skin are common. Three of the more common forms include melasma, lentigines, and post-inflammatory hyperpigmentation. Significant negative psychological consequences can result. Many therapeutic options exist, though treatment is often difficult, requiring lengthy therapy.

Cutaneous blood flow in dermatomyositis and its association with disease severity.

BACKGROUND: Several studies using nailfold capillary microscopes have demonstrated capillary changes in patients with dermatomyositis (DM); however, no previous study has examined cutaneous blood flow in this disease. PURPOSE: To determine cutaneous blood flow in involved and non-involved skin surfaces of patients with DM and to assess possible correlation with clinical measures of disease severity. METHODS: Using a Laser Doppler perfusion imager, cutaneous blood flow was measured at six targeted sites of involved and apparently non-involved skin of 13 DM patients and the corresponding non-involved sites of 13 healthy controls. Overall disease severity of DM patients was determined by physician's global assessment (PGA), creatinine phosphokinase (CPK) levels, medical research council (MRC) scores, and the DM skin severity index (DSSI). RESULTS: Skin blood flow was significantly elevated in involved vs. non-involved skin of DM patients at all anatomic sites measured: periungual (P=0.001), knuckle (P=0.001), elbow (P=0.013), periorbital (P=0.015), chest (P=0.028), and back (P=0.001). Blood flow was also higher in apparently non-involved skin of DM patients vs. skin of healthy controls at all anatomic sites, although statistical significance was not achieved. A significant negative correlation was observed between the DSSI and blood flow in involved skin of the chest (P=0.003), back (P=0.002), and knuckle (P=0.026). CONCLUSION: DM is associated with significantly increased cutaneous blood flow, even at sites where no erythema is evident. This suggests significant involvement of the skin vasculature in this disease process.