Showing papers by "Steven R. Feldman published in 1997"

The economic impact of psoriasis increases with psoriasis severity

Abstract: Background: Psoriasis treatments are known to be costly, but little is known about the financial impact of psoriasis and the way in which it relates to the severity of the disease. Objective: This study was performed to obtain an estimate of the treatment costs faced by patients with psoriasis. Methods: A total of 578 anonymous mail surveys were distributed to patients with psoriasis; 318 surveys were returned (55%). Psoriasis severity was assessed with the previously validated Self-Administered Psoriasis Area Severity Index (SAPASI). Results: The total and out-of-pocket expenses to care for psoriasis were correlated with psoriasis severity ( r = 0.26, p = 0.0001). There were no sex ( p = 0.9) or racial ( p = 0.4) differences in total expenditures. Severity was correlated with how bothersome to the patient was the cost of treatment ( r = 0.30, p = 0.0001), the time required for treatment ( r = 0.38, p = 0.0001), and the time lost from work ( r = 0.23, p = 0.0001). Lower quality of life at work and in money matters also correlated with severity of psoriasis. Higher family income was associated with less time spent caring for psoriasis and less interference with work around the home. Conclusion: As expected, the expenses caring for psoriasis are greater for patients with more severe disease. These costs and other financial implications are associated with lower quality of life for patients with more severe psoriasis. (J Am Acad Dermatol 1997;37:564-9.)

The physical, psychological and social impact of psoriasis.

Abstract: Psoriasis is a chronic, disabling skin disease affecting up to 2 percent of the population. Little is known about how physical, psychological and social features of the illness interact to create a negative impact. In this article, a biopsychosocial model of the impact of psoriasis is described, and results from a survey of 317 psoriasis patients are presented. The types of functional disability, psychological distress and disease-related stressors are described for highly strained patients (i.e. those with disease-related suicidal ideation) and compared with less strained patients (i.e. those without suicidal ideation). As predicted by the model, significantly more disability, psychological distress and disease-related stressors are found among highly strained patients. Logistical regression analysis revealed that strain is more strongly associated with disability, distress and disease-related stress level than with disease severity. Implications for research and clinical interventions are discussed.

Adult pityriasis rubra pilaris: A 10-year case series

Abstract: Background: Pityriasis rubra pilaris (PRP) often has a devastating impact on the lives of patients. Descriptions of its histopathologic features are not uniform. Finding a successful therapy can be challenging. Objective: Our purpose was to examine the histopathologic features and response of patients to our standard therapy of an oral retinoid and concomitant or later addition of low-dose weekly methotrexate. Methods: A retrospective chart review was done on 24 patients with PRP seen from March 1986 to March 1996. Biopsy specimens from 19 patients were reexamined. Telephone follow-up was conducted to determine maintenance of remission. Results: All patients had the adult acquired form of PRP. Biopsy specimens from nine patients were characterized by prototypical findings of PRP, while the others included both typical and other features. Twenty-two patients were treated with either isotretinoin, 40 mg twice daily, or etretinate, 25 to 75 mg/day. Six patients with more disabling involvement had low-dose weekly methotrexate ranging from 5 to 30 mg started concurrently. Five patients had weekly methotrexate added at a later time. Seventeen patients showed 25% to 75% response after 16 weeks of therapy. All patients whose skin cleared maintained their remission. Conclusion: Initial oral retinoid plus concurrent or later low-dose weekly methotrexate resulted in 25% to 75% improvement of PRP in 17 of 24 patients after 16 weeks of therapy. Some of the atypical features seen in biopsy specimens emphasize the importance of clinical and histopathologic correlation in establishing the diagnosis.

Procedures for skin diseases performed by physicians in 1993 and 1994 : Analysis of data from the National Ambulatory Medical Care Survey

Abstract: Background: The provision of ambulatory dermatologic procedural care is not well characterized. Objective: Our purpose was to determine the frequency that different cutaneous procedures are performed by different physician specialties and the diagnoses corresponding to these procedures. Methods: Outpatient dermatologic procedures recorded in the 1993 and 1994 National Ambulatory Medical Care Survey were analyzed. To define dermatologic procedures and diagnoses, the International Classification of Diseases diagnosis and procedure codes were identified that related to the skin and subcutaneous tissues. Sampling weights were applied to achieve the nationally representative estimates. Results: During 1993 and 1994, an estimated 37 million dermatologic procedures were performed. Most were performed by dermatologists (69%) and by family and general practice physicians (15%). A single procedure, "Other local excision or destruction of lesion or tissue of skin and subcutaneous tissue," constituted 65% of all of the dermatologic procedures. UV light treatments, ambulatory microscopic examination of skin specimens, and acne surgical procedures were performed almost exclusively by dermatologists. Most skin biopsies (82%) and excision/destruction procedures (71%) were performed by dermatologists. Actinic keratoses and viral warts accounted for 25% of all cutaneous dermatologic diagnoses treated. Conclusion: Dermatologists have far more experience performing skin biopsies and excision/destruction procedures than other physicians. Cost containment efforts that deny coverage for treatment of actinic keratoses and viral warts would affect a significant portion of cutaneous procedures. (J Am Acad Dermatol 1997;37:719-24.)

The most common dermatologic problems identified by family physicians, 1990-1994.

Abstract: Background and objectives Because all family physicians see numerous patients with dermatologic complaints, their education in skin disorders is important. Data are needed to help program directors know which areas of dermatology deserve the most time and emphasis. This study determined what types of skin problems family physicians most commonly diagnose. Methods Study researchers analyzed National Ambulatory Medical Care Survey data from 1990 to 1994 for dermatologic diagnoses. We then compared physicians specializing in family practice and its related fields (general practice, family practice sports medicine, and family practice geriatrics) with dermatologists and other physicians. Results The most common skin disorders diagnosed by family physicians were dermatitis (16.4% of all diagnoses), pyoderma (13.7%), wart (8%), tinea infection (5.4%), and epidermoid cyst (5.1%). The top 10 most common diagnoses accounted for 65% of all skin-related diagnoses, and the top 20 most common diagnoses accounted for 81.8%. Family physicians more commonly saw patients for infectious processes, infestations, and insect bites, while dermatologists were more likely to see patients for psoriasis, alopecia, and rosacea. Conclusions Skin disorders diagnosed by family physicians differ considerably from those diagnosed by dermatologists. Because dermatologists do much of the dermatology teaching of family practice residents, it is important to recognize these dissimilarities to place emphasis on the proper areas of study. Some common or serious conditions, such as psoriasis and melanoma, are not often diagnosed by family physicians and also deserve attention in family practice training programs.

Increasing utilization of dermatologists by managed care: An analysis of the National Ambulatory Medical Care Survey, 1990–1994

Abstract: Patients with managed care are less likely to see dermatologists for skin problems than are patients with traditional insurance. Through 1992, increase in the demand for treatment of skin problems reduced the effect of managed care on dermatologists. We assessed the continued impact of managed care on visits to dermatologists. Skin disease visits from the National Ambulatory Medical Care Survey were analyzed for the years 1990–1994. We found that demand for treatment of skin problems did not rise between 1992 and 1994, but demand for dermatologists' services within the managed care sector more than doubled. In 1994 patients with HMO/prepaid insurance with skin disease were just as likely to see a dermatologist as were patients with commercial insurance. Mean visit duration for skin problems was 19% longer for nondermatologists than for dermatologists ( p

Intermittent, short term use of methotrexate for exacerbations of psoriasis

Abstract: The Correspondence Section serves as a forum for opinion exchange about subjects of general interest such as dermatoiogic training, relations between dermatologists and pharmaceutical houses, governmental control of dermatology and medical practice in general, peculiarities of dermatology related to geographic, climatic, or racial factors, the flow of information and publications, as well as other concerns the readership might have. Contributions are welcome and should conform to the usual format for correspondence. Manuscripts will undergo standard editorial procedures. Submit all correspondence to Mauricio Goihman-Yahr, md,phd, Editor, Jet International M-154, PO Box 020010, Miami, FL 33102.