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Biomedical subjects

A B Fleischer

Publications and source records attributed to A B Fleischer.

At least 91 records · Page 5Linked to original sources
PubMed1997

The most common dermatologic problems identified by family physicians, 1990-1994.

BACKGROUND AND OBJECTIVES: Because all family physicians see numerous patients with dermatologic complaints, their education in skin disorders is important. Data are needed to help program directors know which areas of dermatology deserve the most time and emphasis. This study determined what types of skin problems family physicians most commonly diagnose. METHODS: Study researchers analyzed National Ambulatory Medical Care Survey data from 1990 to 1994 for dermatologic diagnoses. We then compared physicians specializing in family practice and its related fields (general practice, family practice sports medicine, and family practice geriatrics) with dermatologists and other physicians. RESULTS: The most common skin disorders diagnosed by family physicians were dermatitis (16.4% of all diagnoses), pyoderma (13.7%), wart (8%), tinea infection (5.4%), and epidermoid cyst (5.1%). The top 10 most common diagnoses accounted for 65% of all skin-related diagnoses, and the top 20 most common diagnoses accounted for 81.8%. Family physicians more commonly saw patients for infectious processes, infestations, and insect bites, while dermatologists were more likely to see patients for psoriasis, alopecia, and rosacea. CONCLUSIONS: Skin disorders diagnosed by family physicians differ considerably from those diagnosed by dermatologists. Because dermatologists do much of the dermatology teaching of family practice residents, it is important to recognize these dissimilarities to place emphasis on the proper areas of study. Some common or serious conditions, such as psoriasis and melanoma, are not often diagnosed by family physicians and also deserve attention in family practice training programs.

Clinical Competence↗
PubMed1996

Disease severity measures in a population of psoriasis patients: the symptoms of psoriasis correlate with self-administered psoriasis area severity index scores.

Because of the difficulty and expense of objectively measuring psoriasis severity, very little information exists on the severity of psoriasis in populations. We determined severity in a psoriasis patient population using the validated self-administered psoriasis area and severity index (SAPASI). This population consisted of 578 university dermatology clinic psoriasis patients, and data were analyzed from 317 (55%) questionnaire respondents. The majority of our sample was women (57%), and non-Caucasians represented a larger portion (8 %) in our sample compared with some previous studies. In our population, the reported frequencies of skin and joint symptoms were as follows: pruritus (95 %), skin burning (81 %), joint pain (69%), arthritis (51%), and psoriatic arthritis (20%). The SAPASI was significantly associated with severity of pruritus, burning, joint pain, and psoriatic arthritis. There was a significant negative correlation between the number of treatments employed and the SAPASI. This study provides results of a detailed measurement of the severity of psoriasis in a psoriasis patient population and relates this severity to population characteristics.

Adolescent↗
PubMed1996

The self-administered psoriasis area and severity index is valid and reliable.

The self-administered psoriasis area and severity index (SAPASI) is a structured instrument for measuring the severity of psoriasis. This study examines the validity, reliability, and responsiveness of the SAPASI. Trained personnel performed a psoriasis area and severity index (PASI) assessment on the same day a SAPASI was obtained from 80 subjects. The validity of the SAPASI was demonstrated using the PASI as the standard (r2 = 0.59, p = 0.0001). Significant correlations were found between SAPASI and PASI for body surface area (r = 0.62-0.75), erythema (r = 0.39), induration (r = 0.24) and scale (r = 0.38). Test-retest reliability was assessed in 19 subjects with repeated evaluations within 2 d. Correlations between the first and second SAPASI scores (r = 0.82) were highly significant (p = 0.0001). Inter-rater reliability of SAPASI body surface area measurements among five raters was very high (intraclass correlation coefficient R = 0.953). The SAPASI was responsive to changes in severity over time as demonstrated by correlation with changes in PASI scores (r = 0.63, p = 0.0002). We conclude that this structured patient self-report instrument facilitates quantitative assessment of psoriasis.

Evaluation Studies as Topic↗
PubMed1996

Lower utilization of dermatologists in managed care: despite growth in managed care, visits to dermatologists did not decrease: an analysis of National Ambulatory Medical Care Survey data, 1990-1992.

Growth of managed care and the decline of direct access are two of the major issues confronting dermatology. Previous study has demonstrated that patients in managed care are less likely than patients with indemnity insurance to see a dermatologist for skin problems, and it was predicted that this would result in a slowing in the demand for dermatologist services. To examine whether the changing health-care environment has resulted in fewer visits to dermatologists, we used National Ambulatory Medical Care Survey data from the years 1990-1992 to examine utilization of dermatologist services over a period in which managed care grew by 32%. Patients with HMO/prepaid insurance were less likely to have their skin care provided by dermatologists than patients with commercial insurance (Blue Cross/Blue Shield and other commercial carriers) or Medicare. A reduction in the number of visits to dermatologists was observed among patients with HMO/prepaid insurance despite the growth in HMO/prepaid insurance as a form of payment; when all payors were considered, however, the number of visits to dermatologists increased from the 1989 level, reaching a plateau in 1992. The number of visits for skin disease to all physicians increased from 56.5 million to 63.5 million, whereas the proportion of this care delivered by dermatologists decreased from 39.6% to 37.9%. The overall increase in visits for skin conditions tempered the reduction in demand for dermatology services expected with the growing transition to managed care.

Dermatology↗
PubMed1996

An assessment of potential problems of home phototherapy treatment of psoriasis.

Very little has been reported about how patients use home ultraviolet B (UVB) phototherapy. A survey of thirty-one patients who were prescribed a home UVB phototherapy unit to treat psoriasis was performed as a pilot study of home UVB phototherapy usage; twenty-two patients responded. Generally, respondents reported home UVB phototherapy to be very helpful for their psoriasis. We conclude that home UVB is an effective and appropriate treatment for many patients with psoriasis, but screening and education of candidates for home UVB phototherapy is important to ensure compliance with the treatment program.

Adolescent↗
PubMed1996

Alternative therapies commonly used within a population of patients with psoriasis.

Alternative therapies are known to be employed by dermatology patients. This study investigates the use of alternative medical treatments for psoriasis and the sociodemographic variables, conventional medical treatment, and psoriasis disease severity. Our study population consisted of 578 university dermatology clinic patients with psoriasis and data was analyzed from 317 (55 percent) questionnaire respondents. The majority of our sample were women (57 percent) and nonwhites represented 8 percent of our sample. Psoriasis severity was measured using the validated Self-Administered Psoriasis Area and Severity Index. Alternative medicine was used by 62 percent of respondents. Excluding sunlight and nonprescription tanning equipment, 51 percent used one or more of the remaining alternative therapeutic modalities. The psoriasis severity was worse in those who had tried herbal remedies, vitamin therapy, and dietary manipulation. With the exception of vitamin therapy, we observed no association between the intensity of conventional medical treatment and alternative treatment. The present or prior use of herbal remedies was correlated with the use of vitamin therapy and sunbathing, and dietary interventions were significantly correlated with vitamin therapy. Of the 113 (36 percent) who had used nonprescription tanning equipment for their psoriasis, 68 percent believed this modality was effective. We found that alternative medical therapies were widely utilized by subjects participating in this study. Clinicians need to continue to be aware of nonallopathic remedies employed by their patients to discover useful information about future therapies and to monitor for adverse effects.

Adolescent↗
PubMed1996

Patch testing in an aged population without dermatitis: high prevalence of patch test positivity.

BACKGROUND: Epidermal immune function has been observed to decline in the aged. OBJECTIVE: The purpose of this study was to determine the prevalence and relevance of patch test reactivity in an aged population without dermatitis and compare this with patch test reactivity in healthy younger volunteers. METHODS: Patch testing with the North American Contact Dermatitis Group standard tray was performed on 82 healthy volunteers ranging in age from 68 to 87 years (mean age, 75 years), and the results were compared with those of 41 healthy younger volunteers (mean age, 24 years). A questionnaire regarding cutaneous symptoms was administered to both groups. RESULTS: Thirty subjects in the older population (37%) had one or more positive patch test results compared with 6 members of the control group (15%) (P = .01). Common sensitizers in the older group included balsam of Peru (7[9%]), fragrance (8[10%]), neomycin (6[7%]), nickel (5[6%]), and methylchloroisothiazolinone/methylisothiazolinone (3[4%]). A history of severe pruritus (without dermatitis) was associated with positive patch test results to balsam of peru and nickel. CONCLUSION: A high prevalence of positive patch test results in an aged population without dermatitis was observed. Factors contributing to to the high prevalence of patch test reactivity in the aged population may include cumulative exposure to potential allergens over time, a preserved ability to develop contact allergy, and altered percutaneous absorption. Patch testing in the aged must be interpreted carefully because the results may relate to past rather than present relevance.

Adult↗
PubMed1994

Low-dose methotrexate treatment in elderly patients with bullous pemphigoid.

BACKGROUND: Various treatments have been used for elderly patients with bullous pemphigoid. The most common is moderate-dose to high-dose prednisone, either alone or in combination with other oral or topical agents. OBJECTIVE: The aim of this study was to evaluate the efficacy of low-dose methotrexate as a steroid-sparing agent in patients with bullous pemphigoid. METHODS. A retrospective chart review of 34 patients with bullous pemphigoid seen from 1989 through the first half of 1993 was conducted. The diagnosis of bullous pemphigoid was confirmed by direct or indirect immunofluorescence microscopy, or salt-split skin sections. Eight of 34 elderly (> 60 years old) patients with therapy-resistant bullous pemphigoid received low-dose weekly methotrexate (average, 5 to 10 mg) in combination with oral prednisone. RESULTS: Patients who received combination therapy required significantly lower (p < or = 0.02) doses of prednisone to control their disease at 1 month compared with baseline doses. CONCLUSION: In this elderly patient population the side effect profile of the methotrexate was acceptable and well tolerated. We therefore recommend methotrexate and low-dose corticosteroid as first-line combination therapy for selected elderly patients with bullous pemphigoid.

Administration, Oral↗
PubMed1994

Office-based physician services provided by dermatologists in the United States in 1990.

Published epidemiologic data regarding dermatologic practice may no longer be current. The National Ambulatory Medical Care Survey conducted in 1990 provides a comprehensive assessment of ambulatory medical practice including patient demographics, chief and secondary complaints, diagnoses, and drug treatments prescribed. Many specialties including dermatology were represented in the sampling technique. The database was reviewed for descriptive aspects of visits to dermatologists surveyed. Using standardized weighting techniques, we estimated the total number of physician visits. Dermatologists had an estimated 24.0 million patient encounters in 1990. Dermatologists treated a disproportionately large number of female and younger patients. After adjusting for their proportion of the population, Asians and Whites had greater numbers of dermatologic encounters than Blacks and Native Americans. Patients had two or more complaints 27.2% of the time, and received two or more diagnoses 28.9% of the time. The most common complaints accounting for 49.7% of visits included "pimples," "rash," "discoloration," "skin lesion," "wart," and "skin growth." The most common diagnoses, accounting for 52.7% of all encounters, were acne, keratosis, wart, dermatitis or eczema, benign neoplasm, and malignant neoplasm. This paper presents demographic information, chief and secondary complaints, and chief and secondary diagnoses of patients visiting dermatologists in the United States in 1990. Whites and Asian or Pacific Islanders have increased utilization of services compared with Blacks and Native Americans or Eskimos; this disparity correlates with median family income.

Adolescent↗
PubMed1994

Patient measurement of psoriasis disease severity with a structured instrument.

The Psoriasis Area and Severity Index (PASI) is used by dermatologic investigators to assess psoriasis disease severity. PASI measures are time-consuming and require trained personnel. We developed and evaluated a structured PASI-like instrument for self-measurement of psoriasis disease severity for use in future large-scale epidemiologic studies. The instrument consisted of a silhouette of a body for patients to shade in affected areas and of three modified visual analog scales for recording the redness, thickness, and scaliness of an average lesion. The resulting "patient PASI" score was compared to investigator PASI measurements in 43 patients with mild to severe psoriasis. Patients and investigator also recorded a subjective global severity score. The patient PASI score was highly predictive of the investigator PASI score (r2 = 0.71, p < 0.0001) and the investigator global score (r2 = 0.37, p < 0.0001). The patient global score was also predictive of the investigator PASI (r2 = 0.18, p < 0.0053) and the investigator global score (r2 = 0.10, p < 0.044), but these relationships exhibit wide predicted confidence intervals. Following the initial evaluation by 18.4 +/- 9.1 d of therapy, one-way t tests for paired samples (pre and post) showed significant improvements in the patient PASI (p < 0.003) and investigator PASI (p < 0.05). We conclude that although patients' overall scores may not allow for accurate prediction of clinical disease severity in a single individual, this structured instrument facilitates prediction of psoriasis disease severity in a population.

Adult↗
PubMed1994

Bacillary angiomatosis in an immunocompetent child: the first reported case.

Bacillary angiomatosis, an infectious process associated with Rochalima spp., was thought until recently to be restricted to HIV-infected or otherwise immunosuppressed patients. In 1993, bacillary angiomatosis was reported in several immunocompetent adults. An extensive literature review failed to find references to bacillary angiomatosis in immunocompetent children. We describe a 6-year-old female who presented with a single, rapidly growing, friable, erythematous papule on her neck. Histologic examination of a biopsy specimen confirmed the diagnosis of bacillary angiomatosis. The patient was otherwise healthy, and her physical examination was normal. Laboratory studies, including HIV serology, were normal. The patient was treated with six weeks of oral erythromycin without evidence of recurrence. We present and discuss the implications of the first case of bacillary angiomatosis in an immunocompetent child.

Angiomatosis, Bacillary↗
PubMed1994

Dermatologic services provided to children and adolescents by primary care and other physicians in the United States.

To determine the frequency and types of pediatric dermatologic problems encountered by primary care physicians, dermatologists, and other physicians, we examined data from the 1990 National Ambulatory Medical Care Survey, a continuing study of physician practice in the United States. In 1990, 163.3 million physician office visits were made by patients 18 years of age or younger for all diagnoses; of these, 126.2 million were to primary care physicians. Among visits to these providers, a primary, secondary, or tertiary cutaneous concern or diagnosis was recorded in 12.3 million visits (9.7%). Of these patients with a primary cutaneous concern, 68% of visits were made to primary care physicians, 21% to dermatologists, and 10% to other physicians. For encounters in which primary care physicians reported a primary dermatologic diagnosis (9.6 million visits, 7.6%), the majority of diagnoses (86-93%) were in one of five categories: skin infections, dermatitis, parasitic infestations, acne, or urticaria. This analysis demonstrates the great frequency with which cutaneous disease occurs in ambulatory medicine, and reinforces the importance of dermatologic education in the training of primary care physicians.

Acne Vulgaris↗
PubMed1994

Microscopic artifact found during examination of the skin: plant hair of Viburnum dentatum.

Examination of skin specimens with microscopic techniques requires differentiation of pathogenic structures from artifact. While preparing potassium hydroxide preparations for fungal identification or immersion oil preparations for scabies identification, we have recently seen several examples of a bizarre stellate or cruciform plant structure. These artifactual particles were identified as plant hairs from Viburnum dentatum, or arrowwood. Clinicians and laboratory technicians should be aware of this artifact in order to interpret microscopic skin specimens appropriately.

Adolescent↗