title: Factors affecting prescription of ultra-high potency topical corticosteroids in skin disease: an analysis of US national practice data.
abstract: Of the topical preparations available, the ultra-high potency corticosteroids have an important role in treating psoriasis. However, the use of these agents in many other conditions and patient populations may not be appropriate. This study examines the prescribing patterns of Class I topical corticosteroids in patients with skin disease by analyzing data from the National Ambulatory Medical Care Survey (1990-2000). Of the nearly 718 million visits for skin disease, Class I topical corticosteroids were prescribed in nearly 3% of all skin disease-related visits, with prescription rates being highest in psoriasis (22%). The study found greater prescription rates of Class I topical steroids by dermatologists compared to non-dermatologists [Odds Ratio (OR) = 4.39 (95% CI: 2.15, 8.99)]. However, there were also a large number of questionable prescriptions for other conditions, which could be construed as misuse of these medications. Despite limitations and the potential dubious use seen here, Class I topical corticosteroid use is relatively commonplace. Education efforts and novel preparations of Class I agents will help to ensure the best possible care for patients suffering from significant skin diseases like psoriasis.
authors.affiliation: Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1071, USA.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Balkrishnan
authors.forename: Fabian T
authors.initials: FT
authors.lastname: Camacho
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Pearce
authors.forename: Amit S
authors.initials: AS
authors.lastname: Kulkarni
authors.forename: Lori
authors.initials: L
authors.lastname: Spencer
authors.forename: Alan B
authors.initials: AB
authors.lastname: Fleischer
authors.forename: Steven R
authors.initials: SR
authors.lastname: Feldman
mesh_terms: D000279:Administration, Cutaneous; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D003880:Dermatology / Q000706:statistics & numerical data; D004305:Dose-Response Relationship, Drug; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005194:Family Practice / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data; D008297:Male; D009819:Office Visits / Q000706:statistics & numerical data; D010372:Pediatrics / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D011565:Psoriasis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D012871:Skin Diseases / Q000188:drug therapy; D014481:United States / Q000453:epidemiology
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents