title: Heterogeneity in the treatment of moderately severe scalp psoriasis in Scotland - results of a survey of Scottish health professionals.
abstract: BACKGROUND
  Scalp psoriasis is a chronic recalcitrant condition. An aging literature for topical treatments used in clinical practice and no treatment guidelines means there is no current gold standard for its management in Scotland. There are no Scottish data on the resources and costs of treatment of the scalp psoriasis patient.
  
  
  OBJECTIVE
  Conduct a survey of Scottish healthcare professionals to understand how patients are typically managed to support the development of a model estimating the cost-effectiveness of a new treatment for moderately severe scalp psoriasis in Scotland.
  
  
  METHODS
  Experts from primary and secondary care were invited to participate in an interview programme to collect information on the management of scalp psoriasis in Scotland. This was further informed by Scottish prescribing statistics. Simple descriptive statistics were performed.
  
  
  RESULTS
  Forty-three healthcare professionals (33 from primary care and ten in secondary care) completed the survey which illuminated national prescribing statistics. While an overall 72% response rate was achieved, representation from five of 14 Health Boards was not available. There was significant variation in stated patient pathways but some common themes. Most patients were treated initially with coal tar preparations and shampoos, then often progressing to topical potent corticosteroids. There was no consensus on the order patients might receive topicals thereafter although if referred for specialist review they would typically have been treated with three topicals in primary care first. Treatment in secondary care comprised application of topicals available in primary care or alternative preparations with nurse assistance to improve compliance. Phototherapy and systemic agents were not given to patients with scalp psoriasis alone. Study limitations are not considered to impact on the study observations.
  
  
  CONCLUSIONS
  There was a large variety in first-, second- and third-line agents in primary care in scalp psoriasis although our interview programme and prescribing data confirmed which treatments were most frequently prescribed. Treatment heterogeneity reflects the limitations in current therapies, paucity of evidence-based effectiveness data and lack of clinical guidelines. Experts agreed 'current standard practice' in Scotland was best described as an average across five plausible treatment pathways.
authors.affiliation: Banchory Group Practice, Banchory, Scotland.
authors.forename: Douglas R W
authors.initials: DR
authors.lastname: Smith
authors.forename: Julia M
authors.initials: JM
authors.lastname: Bottomley
authors.forename: Merran
authors.initials: M
authors.lastname: Auland
authors.forename: Peter
authors.initials: P
authors.lastname: Jackson
authors.forename: Judith
authors.initials: J
authors.lastname: Sharp
mesh_terms: D000293:Adolescent; D000328:Adult; D000369:Aged, 80 and over; D000465:Algorithms; D003362:Cost-Benefit Analysis; D003625:Data Collection; D058005:General Practitioners / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data; D011565:Psoriasis / Q000150:complications / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D012536:Scalp Dermatoses / Q000150:complications / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D012606:Scotland / Q000453:epidemiology; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D054928:Validation Studies as Topic; D055815:Young Adult