title: Physicians underutilize topical retinoids in the management of acne vulgaris: analysis of U.S. National Practice Data.
abstract: BACKGROUND
  Topical retinoids are effective in the treatment of acne, yet no current guidelines existed in the literature until recently recommending their use as an integral part of mild to moderate acne treatment.
  
  
  OBJECTIVE
  To assess whether underutilization of topical retinoids occurs in clinical practice.
  
  
  METHODS
  Weighted data on representative office visits with acne vulgaris diagnoses were analyzed using the National Ambulatory Medical Care Survey (NAMCS), from 1990 to 1999.
  
  
  RESULTS
  Of the 54.2 million acne vulgaris visits, retinoids were prescribed at 35.3% visits. Dermatologists prescribed significantly more retinoids than non-dermatologists (39.4%' versus 23%). Dermatology visit was a significant predictor of topical retinoid prescription (RR: 2.27,95% CI: 1.63-3.17). Data suggest that prescribing retinoids for acne has been increasing over the past decade, primarily among dermatologists.
  
  
  CONCLUSIONS
  There is a major difference between suggested treatment guidelines for acne and actual practice in the community. There is distinct under-utilization of topical retinoids for treatment of acne vulgaris by dermatologists and non-dermatologists.
authors.affiliation: Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC 27104, USA. rbalkris@wfubmc.edu
authors.forename: R
authors.initials: R
authors.lastname: Balkrishnan
authors.forename: A B
authors.initials: AB
authors.lastname: Fleischer
authors.forename: S
authors.initials: S
authors.lastname: Paruthi
authors.forename: S R
authors.initials: SR
authors.lastname: Feldman
mesh_terms: D000152:Acne Vulgaris / Q000188:drug therapy*; D000287:Administration, Topical; D000328:Adult; D000704:Analysis of Variance; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012176:Retinoids / Q000008:administration & dosage / Q000627:therapeutic use*; D014481:United States
chemical_list: D012176:Retinoids