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Biomedical subjects

R S Stern

Publications and source records attributed to R S Stern.

At least 127 records · Page 7Linked to original sources
PubMed1986

Office-based care of dermatologic disease.

From 1974 to 1981 the number of visits to office-based physicians for dermatologic complaints remained relatively constant. During this period, dermatologists increased their share of patients with such complaints from one third to one half. As a result of the growth in the number of practicing dermatologists, the average number of visits per dermatologist fell during this period. Nearly half of all visits to dermatologists in the 1980-1981 period were for one of three diagnoses: diseases of the sebaceous glands (principally acne), warts, and skin tumors. Competition between dermatologists and other physicians for patients with these three diagnoses is likely to increase. Changes in medical practice structure, a projected increase in the number of dermatologists, and an aging population may make it difficult for dermatologists to preserve the volume of patients they currently see.

Acne Vulgaris↗
PubMed1986

Long-term use of psoralens and ultraviolet A for psoriasis: evidence for efficacy and cost savings.

A 7.3-year prospective study of 1,380 patients with psoriasis who were treated with oral methoxsalen (8-methoxypsoralen) and ultraviolet A photochemotherapy (PUVA) revealed that patients who continued on PUVA therapy used inpatient hospital treatment less than one fourth as often as those who had discontinued treatment. Patients who continued to use PUVA therapy also had less extensive psoriasis than did other patients in this cohort who discontinued PUVA therapy. These findings demonstrate that PUVA is an effective outpatient therapy for severe psoriasis. The potential toxicity of PUVA treatment, which was the primary reason that one third of the study patients were concerned about their prolonged or continued treatment, must be balanced against the therapy's apparent effectiveness and relatively low cost.

Adult↗
PubMed1986

Contribution of topical tar oil to ultraviolet B phototherapy for psoriasis.

A bilateral comparison study of twenty-two outpatients with psoriasis assessed clearing experience and remission time on halves of the body to which tar oil and oil vehicle (an emollient) were applied twice daily. In addition, both sides were treated three times a week with suberythemogenic doses of ultraviolet B radiation. Of the eighteen patients who complied with the protocol, fourteen (78%) had clearing. There was no significant difference between body halves with regard to the number of treatments to clearing, the dose of ultraviolet B to clearing, or the remission time (p greater than 0.2, all comparisons). Our data indicate with 95% confidence that using tar oil in conjunction with ultraviolet B phototherapy reduces the average total ultraviolet B dose required for clearing by a maximum of 9%, in comparison with using oil vehicle and ultraviolet B. These findings suggest that there is insufficient evidence for substantial clinical benefit to recommend tar oil use in conjunction with outpatient ultraviolet B phototherapy for psoriasis.

Adult↗
PubMed1986

Effect of continued ultraviolet B phototherapy on the duration of remission of psoriasis: a randomized study.

Phototherapy using sunburn spectrum ultraviolet radiation (UVB) is now a frequently utilized treatment for psoriasis that is extensive or has not responded to topical preparations. Four university centers performed a prospective randomized clinical trial to compare remission times of patients with psoriasis who continued UVB phototherapy after initial clearing with this therapy and patients whose UVB phototherapy was discontinued within 3 weeks of clearing. As assessed by life table methods, the time to flare after initial clearing for patients on UVB maintenance therapy was significantly longer than for patients who discontinued UVB within 3 weeks after initial clearing. Our data suggest that continuing UVB phototherapy after initial clearing contributes to the duration of disease control and is justified for many patients.

Actuarial Analysis↗
PubMed1986

Drug reactions.

Explore the source record for details and available documents.

Bibliographies as Topic↗
PubMed1986

Cutaneous tissue repair following CO2 laser irradiation.

We studied the mechanism of repair following exposure of normal skin to the CO2 laser in a focused mode. Exposed areas were biopsied at 0, 24, 48 h; 1, 2 weeks; 1, 2 1/2 months (pulse width varying from 0.1 to 1.0 s) after irradiation. The initial pattern was a V-shaped zone of cauterized collagen with a central crevice, the depth of which correlated with the total energy applied. The epidermal changes consisted of transepidermal cauterization and basal vacuolar changes lateral to the site of impact. Over a period of 1 week, the wound crevice decreased in depth and width and the central margins of the zone of cauterized collagen approximated. The cauterized collagen was extruded and was noted in the epidermal crust; minimal granulation tissue was present. Biopsies at later time periods showed formation of granulation tissue and retention of small amounts of necrotic collagen; the process of collagen extrusion was largely prevented by suturing. These observations show that dermal contraction and necrotic collagen extrusion are important components of initial tissue repair following limited dermal destruction produced by CO2 irradiation.

Carbon Dioxide↗
PubMed1986

Risk reduction for nonmelanoma skin cancer with childhood sunscreen use.

Exposure to ultraviolet radiation is the principle cause of basal and squamous cell carcinomas of the skin, which are the most frequent tumors occurring in white residents of the United States. Using a mathematical model based on epidemiologic data, we quantified the potential benefits of using a sunscreen with a sun protective factor of 15 and estimate that regular use of such a sunscreen during the first 18 years of life would reduce the lifetime incidence of these tumors by 78%. Additional benefits of sunscreen use during childhood include reduced risk of sunburn, retarding the pace of skin aging, and possible reduction in melanoma risk. We recommend that pediatricians encourage sunscreen use and sun avoidance as a regular part of pediatric preventive health care.

Adolescent↗
PubMed1986

DERM/PHARM. Drug data base for dermatologists.

DERM/PHARM (drugs used in dermatology) is computerized data base that presents drug profiles on the more than 300 drugs used for the treatment of skin disease. This data base can be accessed through DERM/INFONET by members of the American Academy of Dermatology. This data base will be maintained by the Task Force on DERM/PHARM of the Committee on Biomedical Communications of the American Academy of Dermatology.

Drug Therapy, Computer-Assisted↗
PubMed1985

Psoriasis treatment with suberythemogenic ultraviolet B radiation and a coal tar extract.

Forty-nine patients with plaque-type psoriasis were enrolled in a randomized prospective trial that compared the efficacy of outpatient treatment with suberythemogenic doses of ultraviolet B (UVB) radiation administered with a tar oil to treatment with maximally erythemogenic UVB radiation with emollients. Seventeen percent of patients treated with tar oil and 26% of patients treated with maximally erythemogenic UVB failed to adhere to the protocol. Although the tar oil protocol seemed slightly less effective in those with more severe psoriasis, a roughly comparable fraction of patients who adhered to either protocol cleared at least 90% of psoriasis on surfaces exposed to UVB (76% vs 100%). The total dose of UVB to clearing was 44% less for patients treated with tar oil and suberythemogenic UVB. For most patients with moderate psoriasis, suberythemogenic UVB and tar oil is an effective, low-cost, and acceptable outpatient therapy.

Adult↗
PubMed1985

Psoriasis and susceptibility to nonmelanoma skin cancer.

Using data from a national skin cancer survey, we assessed the risk of basal cell and squamous cell carcinoma among patients with psoriasis compared with the general population. For both male and female psoriatic patients, the risk of basal cell carcinoma was significantly elevated (relative risk = 2.2 and 1.7; p less than 0.05, both comparisons). The risk of squamous cell carcinoma was not significantly or substantially different for persons with a history of psoriasis compared with other persons (relative risk = 1.3; p greater than 0.05). The relative risk of basal cell skin cancer among patients with psoriasis was significantly higher even after stratification for factors associated with both psoriasis and cutaneous malignancy, which include fair complexion, exposure to coal tar or pitch, and exposure to radiation. Contrary to long-standing beliefs, our findings support the hypothesis that even after allowing for possible greater exposures to cutaneous carcinogens, the risk of nonmelanoma skin cancer in patients with psoriasis is at least as great as in the general population. Thus persons with psoriasis who are treated with potential carcinogens such as ultraviolet radiation, tar, and oral methoxsalen photochemotherapy merit careful, long-term monitoring.

Adult↗
PubMed1985

Coal tar phototoxicity: characteristics of the smarting reaction.

We examined the properties and ultraviolet exposure parameters of tar smarts in an effort to elucidate the mechanisms involved. We showed that irradiation with 1 minimal smarting dose (MSD) of UVA immediately following tar removal lowered the MSD for 6 h, demonstrated by subsequent challenge with UVA. Following 3 MSDs this "memory" effect was demonstrable for 24 h. The smarting reaction was area dependent--smaller areas of exposure require higher doses of UVA to induce smarting. Smarting followed reciprocity over a 6-fold range of irradiances (2-12.5 mW/cm2) but higher irradiances required higher doses of UVA, perhaps due to a delay in the recognition and reporting of smarting. The smarting reaction and delayed erythema due to UVA and tar were equally blocked by sunscreen.

Adult↗
PubMed1985

Actinic degeneration in association with long-term use of PUVA.

To determine the extent of clinical actinic damage that occurred in association with exposure to oral methoxsalen photochemotherapy (PUVA), dermatologists at 16 university centers assessed the wrinkling, telangiectasia, and altered skin markings on the buttocks and the dorsa of the hands among 1380 patients treated with PUVA. These changes are similar to those seen in skin that is chronically exposed to sunlight. After more than 5 years of prospective study, patients with psoriasis exposed to PUVA showed a significant dose-dependent increase in the prevalence of clinical actinic degeneration of the skin of the buttocks (p less than .05, F-test). The prevalence of moderate or severe change among those patients exposed to high doses of PUVA (more than 160 treatments) was low (11%). The degree of increased clinical actinic degeneration noted on the dorsa of the hands was also significantly related to total exposure to PUVA (p less than .05, F-test). Our findings indicate that long-term PUVA exposure is associated with an increase in clinical actinic degeneration of the skin. However, the magnitude of this increase is small and, after more than 5 years, is of limited clinical consequence to most patients.

Adult↗