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R S Stern

Publications and source records attributed to R S Stern.

At least 19 recordsLinked to original sources
PubMed1999

Top cited authors in dermatology: a citation study from 24 journals: 1982-1996.

BACKGROUND: One measure of the impact of a medical article is how often it is cited in other articles. Many authors of articles published in dermatologic journals are seldom, if ever, cited while other authors are often cited. OBJECTIVE: To identify the 25 authors whose publications in the dermatology literature were most often cited. DESIGN: We obtained a citation database from the Institute for Scientific Information. From this database we separately quantified the total number of citations for each author and the total number of citations to first authors of original articles. SETTING: Dermatology journals. SUBJECTS: All authors of papers published in 24 dermatology journals between 1981 and 1996. INTERVENTION: None. MAIN OUTCOME MEASURE: Number of citations. RESULTS: If all articles irrespective of the author's listing (eg, first or second) are counted, the top 25 cited authors in the dermatology literature from 1981 to 1996 were cited between 1480 and 4706 times. If only citations and articles of which an author was the first listed author are counted, the top 25 authors were cited between 400 and 813 times. Only 4 authors were among the top 25 cited authors by both criteria. CONCLUSIONS: A relatively small proportion of all authors account for a high proportion of all citations of the dermatologic literature. The most frequently cited first authors of original articles were different in 84% of cases from the most often cited authors of all papers irrespective of the individuals placement in the authorship listing.

Authorship↗
PubMed1998

Photocarcinogenicity of drugs.

A number of commonly used medications including quinolone antibiotics, psoralens and various tetracycline derivatives are photosensitizers. These chemicals enhance the erythema response to sunlight. The effect of such exposures on cancer risk has only been quantified in humans for oral psoralen photochemotherapy (PUVA). The experience of a cohort of 1380 patients followed for more than 20 years who received PUVA therapy for the treatment of psoriasis documents that long-term high dose exposure to PUVA greatly increases the risk of squamous cell carcinoma. After 15 years, the risk of melanoma is also increased among high dose patients. With PUVA therapy, an agent which is immunosuppressive in the skin, induces psoralen DNA adducts, is genotoxic and mutagenic. Substantially increased risk is only observed after many purposeful exposures to ultraviolet and this drug. These data suggest that at least some photosensitizing chemicals can substantially increase the risk of skin cancer in humans, but long-term multiple exposures appear to be necessary for a clinical meaningful increase of risk.

Follow-Up Studies↗
PubMed1998

Oral psoralen and ultraviolet-A light (PUVA) treatment of psoriasis and persistent risk of nonmelanoma skin cancer. PUVA Follow-up Study.

BACKGROUND/METHODS: The treatment of psoriasis with high-dose exposure to oral psoralen and ultraviolet-A light (i.e., PUVA) substantially increases the risk of cutaneous squamous cell cancer, but not of basal cell cancer, within a decade of beginning treatment. To assess the persistence of cancer risk among individuals treated with PUVA, including those who discontinued therapy long ago and those without substantial exposure to other carcinogens, we prospectively studied a cohort of 1380 patients with psoriasis who were first treated during the period from January 1, 1975, through October 1, 1976, and evaluated risk factors associated with the development of cutaneous squamous cell cancers and basal cell cancers after 1985. RESULTS: From 1975 through 1996, 237 patients developed 1422 cutaneous squamous cell cancers. From 1986 through 1996, 135 (12.5%) of 1081 patients without a prior squamous cell cancer developed 593 such tumors. From 1975 through 1997, 247 patients developed 1042 basal cell cancers; these patients included 151 individuals with a first basal cell cancer after 1985. Among those without a squamous cell or a basal cell cancer in the first decade of the prospective study, a strong dose-related increase in the risk of squamous cell cancer was observed in the subsequent decade (adjusted relative risk [> or =337 treatments versus <100 treatments] = 8.6; 95% confidence interval = 4.9-15.2). Risk of basal cell cancer was substantially increased only in those patients exposed to very high levels of PUVA (> or =337 treatments). CONCLUSIONS: High-dose exposure to PUVA is associated with a persistent, dose-related increase in the risk of squamous cell cancer, even among patients lacking substantial exposure to other carcinogens and among patients without substantial recent exposure to PUVA. Exposure to PUVA has far less effect on the risk of basal cell cancer. The use of PUVA for psoriasis should be weighed against the increased cancer risk.

Administration, Oral↗
PubMed1998

Risk of squamous cell carcinoma and methoxsalen (psoralen) and UV-A radiation (PUVA). A meta-analysis.

OBJECTIVE: To assess the risk of squamous cell carcinoma (SCC) and the relation of dose to risk among groups of patients with psoriasis exposed to psoralen-UV-A (PUVA). DATA SOURCES: Four electronic databases were searched from 1984 to 1998. STUDY SELECTION: In addition to the PUVA Follow-up Study, we included all English-language studies from the United States and Europe with at least 150 patients enrolled, who were followed up for at least 5 years as identified from our bibliographic search. DATA EXTRACTION: A custom-designed questionnaire was used to extract data from each of the articles. For each study, if possible, we determined the incidence of basal cell carcinomas and SCCs and the incidence rate ratio of SCC among patients exposed to low-dose (we defined as < 100 treatments or 1000 J/cm2) compared with high-dose PUVA (> 200 treatments or 2000 J/cm2). Exact methods were used to calculate the incidence rate ratios. DATA SYNTHESIS: In addition to our study, we identified and reviewed 8 other studies. Overall, the incidence among patients exposed to high-dose PUVA was 14-fold higher than among patients with low-dose exposure (95% confidence interval, 8.3-24.1); a greater dose-dependent increase in risk than that observed in the PUVA Follow-up Study. CONCLUSION: Although the incidence of SCC reported among groups of PUVA-treated patients followed up for at least 5 years varies greatly, compared with the risk in low-dose patients, long-term high-dose exposure to PUVA was consistently observed to significantly increase the risk of SCC in all studies reviewed.

Carcinoma, Squamous Cell↗
PubMed1998

Consensus workshop on the toxic effects of long-term PUVA therapy.

The possibility that there is an increased risk of melanoma in patients with psoriasis treated with psoralen-UV-A (PUVA) therapy has raised concern on the part of physicians and patients about the long-term safety of this treatment. In response to this concern, the National Psoriasis Foundation sponsored a workshop at which invited participants with expertise in PUVA therapy, psoriasis treatment, melanoma and nonmelanoma skin cancer, and epidemiological and clinical trials were asked to develop a consensus on the following 3 issues: the risk of long-term adverse effects of PUVA therapy with emphasis on nonmelanoma and melanoma skin cancer; the guidelines for physicians and patients for selection and use of PUVA therapy with consideration of the risk-benefit ratio of this treatment compared with the risk-benefit ratios of alternative treatments; and the directions for further evaluation of the long-term effects Of PUVA therapy.

Humans↗
PubMed1998

Managed care and the treatment of skin disease, 1995. Continued growth and emerging dominance.

OBJECTIVE: To document changes in type of financing for office-based visits for the treatment of common skin conditions and to dermatologists. DESIGN: Data from a national survey of visits to office-based practitioners conducted by the National Center for Health Statistics were used. The stratified sampling technique permits estimation of the total number of office visits with specific characteristics in the United States. SETTING: A national probability sample of visits to office-based practitioners occurring in 1995. SUBJECTS: In 1995, 36,875 visits were sampled. Of these, 2121 were for common skin problems to any physician and 1886 were visits for any reason to dermatologists. MAIN OUTCOME MEASURES: The distribution source of payment and presence of managed care arrangements for office visits for common skin problems and to dermatologists. INTERVENTION: None. RESULTS: In 1995, preferred provider and health maintenance organizations provided payment for 34% of all ambulatory care and 38% of office visits for common skin complaints. CONCLUSION: Managed care is already the dominant mechanism of payment for the treatment of skin disease for many patient groups and in many areas of the country. Preferred provider organizations are much more likely to employ dermatologists to provide care of common skin problems than are health maintenance organizations. If the recent trends continue, by year 2000 most patients seen by dermatologists will be seen under the auspices of managed care systems.

Dermatology↗
PubMed1998

HIV-positive patients differ from HIV-negative patients in indications for and type of UV therapy used.

BACKGROUND: Treatments using UV, UVB, or oral psoralen and UVA (PUVA) have been advocated for the care of HIV-infected persons with skin diseases. Concerns about the safety of these treatments exist. OBJECTIVE: We attempted to determine the characteristics of HIV infected persons receiving UV therapy and establish the reasons for and type of treatment administered. METHODS: During two 2-week periods, we prospectively ascertained basic information on all patients treated at 40 phototherapy clinics and detailed clinical information on patients known to be infected with HIV. RESULTS: We identified 3716 persons receiving UV therapy, including 311 known to be infected with HIV. When compared with patients not known to be infected with HIV, HIV-positive patients were significantly more likely to be treated with UVB rather than PUVA and were more likely to be treated for pruritic conditions rather than psoriasis. CONCLUSION: There were great variations in the relative reliance on UVB and PUVA among centers. There appears to be no agreement as to which type of UV therapy is optimal for patients infected with HIV. Most patients known to the treating clinician to be HIV positive are in the advanced stages of HIV disease. The number of persons with less advanced HIV disease receiving treatment remains unquantified but may be even more clinically important.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Psoriasis.

Explore the source record for details and available documents.

Diagnosis, Differential↗
PubMed1997

Malignant melanoma in patients treated for psoriasis with methoxsalen (psoralen) and ultraviolet A radiation (PUVA). The PUVA Follow-Up Study.

BACKGROUND: Photochemotherapy with oral methoxsalen (psoralen) and ultraviolet A radiation (PUVA) is an effective treatment for psoriasis. However, PUVA is mutagenic, increases the risk of squamous-cell skin cancer, and can cause irregular, pigmented skin lesions. We studied the occurrence of melanoma among patients treated with PUVA. METHODS: We prospectively identified cases of melanoma and documented the extent of exposure to PUVA among 1380 patients with psoriasis who were first treated with PUVA in 1975 or 1976. Using incidence data, we calculated the expected incidence of melanoma in this cohort and compared it with the observed incidence. Using regression models, we assessed the risks of melanoma associated with a long time (> or = 15 years) since the first treatment and with a large number of PUVA treatments (> or = 250). RESULTS: From 1975 through 1990, we detected four malignant melanomas, about the number expected in the overall population (relative risk, 1.1). From 1991 through 1996, we detected seven malignant melanomas (relative risk, 5.4; 95 percent confidence interval, 2.2 to 11.1). The risk of melanoma was higher in the later period than in the earlier one (incidence-rate ratio, 3.8) and higher among patients who received at least 250 PUVA treatments than among those who received fewer treatments (incidence-rate ratio, 3.1). CONCLUSIONS: About 15 years after the first treatment with PUVA, the risk of malignant melanoma increases, especially among patients who receive 250 treatments or more.

Adult↗
PubMed1997

The impact of psoriasis on the quality of life of patients from the 16-center PUVA follow-up cohort.

BACKGROUND: The impact of psoriasis on the quality of life of patients is likely to be principally related to alterations in individual appearance and consequent psychosocial disability. Quantifying the impact of psoriasis and related changes from therapy would help in the selection of optimal management. OBJECTIVE: Our purpose was to evaluate the impact of psoriasis on patients with severe disease who have had photochemotherapy (PUVA). METHODS: In 1979 we interviewed 877 of 988 still participating patients who were enrolled in 15 of 16 centers in the PUVA Follow-up Study. We determined the impact of psoriasis on quality of life with a questionnaire that had been modified to incorporate measures of impairment that are likely to be affected by cutaneous disease. RESULTS: Psoriasis had substantial impact on the quality of life. Women were more likely than men to report impairment in quality of life dimensions. The impact of disease decreased with increasing age. Moderate to high relative impact on total quality of life was more often reported by patients who had recently used UVB phototherapy than by those using PUVA or methotrexate. CONCLUSION: Psoriasis has a substantial impact on the quality of life. This impact seems to decrease with increasing age. Use of specific treatments are also associated with the extent to which psoriasis affects quality of life.

Aged↗
PubMed1997

Noncutaneous malignant tumors in the PUVA follow-up study: 1975-1996.

There is concern about possible association between PUVA treatment and an increased risk of noncutaneous cancer. An alteration in the risk of cancer among persons with psoriasis has also been postulated. To test this hypothesis, for nearly two decades we have prospectively followed 1380 patients who first began PUVA treatment for psoriasis in 1975-1976. We compare the risk of noncutaneous cancer in our cohort with that expected based on general population incidence rates. The overall risk of noncutaneous cancer was nearly identical to that expected in general population. For three separate sites, we noted significant increases: thyroid cancer (RR = 3.57, 95% CI = 1.16-8.34), breast cancer (RR = 1.81, 95% CI = 1.19-2.64), and central nervous system neoplasms (RR = 2.80, 95% CI = 1.13-5.57). Since 1987, however, the risk of central nervous system neoplasms has not been elevated (RR = 0.00, 95% CI = 0.00-3.35) and the relative risk of breast cancer was lower than in the prior decade and not statistically significant. There was no association between higher levels of exposure to PUVA and the risk of any of these cancers. We did not detect any significant increase in the risk of lymphoma or leukemia. Our study does not support the hypothesis that long-term PUVA treatment increases the risk of noncutaneous cancer.

Adult↗
PubMed1997

Risk of serious cutaneous disorders after initiation of use of phenytoin, carbamazepine, or sodium valproate: a record linkage study.

Clinical and epidemiologic evidence suggest serious cutaneous reactions to antiepileptic drugs are more likely to occur during the first few months of use. However, studies have quantified risk for these reactions by including all users and their entire duration of use in denominator estimates possibly underestimating the risk. The objective of this study was to measure risk of serious cutaneous reactions in new users of phenytoin, carbamazepine, or valproic acid. We identified serious cutaneous reactions that included hospitalization and occurred within 60 days of the first or second prescription for new users of each study drug in the Saskatchewan Health data files. To classify outcome diagnoses, a dermatologist reviewed hospital discharge summaries. In 8,888 new phenytoin users there were eight serious cutaneous reactions. These included two probable and two possible cases of hypersensitivity syndrome, yielding a risk of 2.3 to 4.5 per 10,000 for this syndrome. There were six serious cutaneous reactions in 9,738 new carbamazepine users. These included one probable case and four possible cases of hypersensitivity syndrome, yielding a risk of 1 to 4.1 per 10,000 for this syndrome. There were no confirmed serious cutaneous diagnoses in 1,504 new valproate users. During the first few weeks of initiating therapy with phenytoin or carbamazepine, the clinician should be aware of the uncommon but not rare possibility that a cutaneous eruption could evolve into a significantly more serious reaction.

Adolescent↗
PubMed1996

Acne therapy. Medication use and sources of care in office-based practice.

BACKGROUND AND DESIGN: This study quantifies visits to office-based physicians for the treatment of acne from 1980 through 1991 and describes treatments prescribed. Data were collected from the National Ambulatory Medical Care Survey, a multistage probability survey conducted in 1980, 1981, 1985, 1989, 1990, and 1991, and were used to estimate visits with specific characteristics. Of 276 689 visits sampled in these surveys, 3075 included a diagnosis of acne and 2678 were principally for acne. RESULTS: Visits for acne as a primary complaint decreased from 7.5 million per year in 1980 and 1981 to 5.4 million per year in 1989 to 1991. The proportion of visits to physicians other than dermatologists increased 2.1-fold from 1980 and 1981 to 1989 through 1991. Differences in the rate of prescribing oral antibiotics between dermatologists and nondermatologists narrowed from 1980 to 1991. Of drugs available throughout the study, topical tretinoin had the greatest increase in usage. Oral isotretinoin was more often prescribed at visits for men than for women. The proportion of acne visits at which isotretinoin was prescribed was comparable for dermatologists and nondermatologists. CONCLUSIONS: Acne remains one of the most frequent reasons for visiting dermatologists. By 1991, nondermatologists provided 23% of care for this disease. From 1980 to 1991, the pattern of prescribing medications for acne by dermatologists and nondermatologists became more alike. Demand for dermatologists' services for acne treatment is decreasing.

Acne Vulgaris↗