Treatment policy for psoriasis and eczema: a survey among dermatologists in the Netherlands and Belgian Flanders.
Today, many therapies are available for the treatment of psoriasis and eczema. One of the oldest topical therapies is coal tar. Coal tar has been used for decades, but over the past years, the use of coal tar has decreased for several reasons, including the supposed carcinogenicity of coal tar. We investigated the current and past treatment policies for psoriasis and eczema with special emphasis on the use of tar products; a postal survey was conducted among all dermatologists in two European countries: the Netherlands (n = 360) and the Flemish speaking part of Belgium (Flanders) (n = 328). This study was conducted as part of the ongoing LATER-study ("Late effects of coal tar treatment in eczema and psoriasis; the Radboud study"). All practising dermatologists received a questionnaire. Dermatologists were asked to describe their treatment policies in mild/moderate psoriasis, severe psoriasis, mild/moderate eczema and severe eczema. The response rate to the questionnaire was 62.5% for the Dutch dermatologists and 45.7% for the Flemish dermatologists. Almost all dermatologists prescribe topical corticosteroids. In eczema, most of the dermatologists prescribe the recently introduced calcineurin inhibitors (95%). Coal tar is a second choice topical therapy. Dutch dermatologists mainly use tar in the treatment of eczema (72% vs. 48% in Flanders), whereas in Flanders, tar is mainly prescribed in psoriasis (60% vs. 41% in Holland). Flemish dermatologists very frequently prescribe PUVA in psoriasis (93% vs. 63%). Topical treatment, especially topical corticosteroids, is the mainstay in psoriasis and eczema. Coal tar still is an important (second choice) therapy for the topical treatment of psoriasis and eczema, but its use varies from country to country. Despite the carcinogenicity of PUVA, this photochemotherapy is frequently prescribed by dermatologists, mainly in Flanders.
Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre P.O Box 9101, 6500 HB Nijmegen, The Netherlands.
Judith H J
JH
Roelofzen
Katja K H
KK
Aben
Ali J M
AJ
Khawar
Peter C M
PC
Van de Kerkhof
Lambertus A L M
LA
Kiemeney
Pieter G M
PG
Van Der Valk
D001530:Belgium; D002273:Carcinogens; D003033:Coal Tar / Q000009:adverse effects / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003880:Dermatology / Q000379:methods; D004333:Drug Administration Routes; D004485:Eczema / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D009426:Netherlands; D010778:Photochemotherapy / Q000009:adverse effects / Q000706:statistics & numerical data; D010789:Phototherapy / Q000009:adverse effects / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D011364:Professional Practice / Q000706:statistics & numerical data* / Q000639:trends; D011565:Psoriasis / Q000188:drug therapy*; D011795:Surveys and Questionnaires
D002273:Carcinogens; D003879:Dermatologic Agents; D007166:Immunosuppressive Agents; D003033:Coal Tar