Psoriasis treatment in the United States at the end of the 20th century.
BACKGROUND
Psoriasis presents many management complexities. A cornerstone of therapy has been topical corticosteroids, although over the past 10 years there have been many additions to the medication armamentarium. Furthermore, various combination regimens and approaches have been advocated.


OBJECTIVE
We sought to characterize various patterns of psoriasis health care delivery and the changes associated with these patterns from 1990 to 2001.


METHODS
Visits for psoriasis were identified using National Ambulatory Medical Care survey data, a representative survey of visits to physician offices in the United States. We determined basic demographic characteristics, specialty of the physician provider and medications listed at these visits over the 1990-2001 interval.


RESULTS
There were more than 13.5 million visits for psoriasis during the 12-year study period. Dermatologists were responsible for the majority of the visits over the study interval (82%) although there was an overall decline in the proportion of psoriasis visits to dermatologists. As a category, the most common medications used for psoriasis were topical steroids. Topical calcipotriene was the single-most listed medication. There was no observed use of non-corticosteroid topical agents at visits to non-dermatologists. Non-dermatologists were as likely as dermatologists to list a systemic medication at a visit as well as use a systemic as monotherapy.


CONCLUSIONS
In conclusion, the primary topical therapies for psoriasis remain clobetasol and calcipotriene. The decreasing role of dermatologists in the treatment of psoriasis is probably a complex issue, but may relate in part to the difficulty of obtaining access to dermatology care.
Pearce
Daniel J
DJ
Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1071, USA.
Stealey
Katherine H
KH
Balkrishnan
Rajesh
R
Fleischer
Alan B
AB
Feldman
Steven R
SR
D000287:Administration, Topical; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D002117:Calcitriol / Q000031:analogs & derivatives / Q000627:therapeutic use; D002990:Clobetasol / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004363:Drug Utilization / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D011565:Psoriasis / Q000188:drug therapy* / Q000453:epidemiology; D014221:Triamcinolone / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology
D000305:Adrenal Cortex Hormones; D003879:Dermatologic Agents; C055085:calcipotriene; D014221:Triamcinolone; D002990:Clobetasol; D002117:Calcitriol; D008727:Methotrexate