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Biomedical subjects

Steven R Feldman

Publications and source records attributed to Steven R Feldman.

At least 55 records · Page 3Linked to original sources
PubMed2006

Social sensitivity and acne: the role of personality in negative social consequences and quality of life.

BACKGROUND: Acne affects a majority of adolescents and a substantial number of adults. The adverse social impact of acne is well documented. Negative social consequences, however, are likely to be determined by personality features as well as acne severity. PURPOSE: To determine whether a personality trait--dispositional social sensitivity--is associated with the adverse social impact of acne. METHODS: A survey of 479 acne sufferers between the ages of 16 and 62 was conducted in the Piedmont region of North Carolina, United States. Respondents were classified as either high or low social sensitivity and compared on demographic, disease characteristics, and quality of life. Main and interaction effects were evaluated for acne severity and social sensitivity in relation to global and intimate social concerns and social interference. RESULTS: Greater acne severity was significantly associated with poorer social outcomes and quality of life (ps < 0.05). For women, higher social sensitivity was independently associated with poorer outcomes (ps < 0.05), while for men, higher social sensitivity interacted with acne severity and was associated with worse social outcomes and life quality (ps < 0.05). CONCLUSIONS: Acne is a biopsychosocial skin condition. Dispositional social sensitivity is an independent psychological factor associated with poorer social functioning and quality of life. Treatment of the acne patient should consider psychosocial factors as well as biological factors.

Acne Vulgaris↗
PubMed2006

Home ultraviolet B phototherapy: a cost-effective option for severe psoriasis.

The cost of treating severe psoriasis has risen dramatically, and treatment options vary widely in terms of cost and efficacy. However, little information is available on the relative costs of home phototherapy and other long-term management options, specifically in the context of managed care. A payer-perspective cost model was developed to estimate and compare the direct expenditures associated with a 30-year course of various treatments for severe psoriasis. Within two years of treatment initiation, home-administered ultraviolet B phototherapy was less costly than any of the other treatments examined, including methotrexate, psoralen plus ultraviolet A, the retinoid acitretin, and new biologic agents. In addition, the efficacy and safety profile of home ultraviolet B phototherapy make it an excellent choice for extended management.

Acute Disease↗
PubMed2006

Gel vehicles are not inherently more irritating than creams.

BACKGROUND: It has been thought that topical gels are inherently more irritating than topical creams. Nevertheless, the irritancies of topical products are potentially quite variable, and a priori assumptions about relative irritancy of gels versus creams may not be accurate. PURPOSE: To determine whether a metronidazole gel formulation is more or less irritating to the skin compared to metronidazole creams. METHODS: A total of 32 normal, healthy volunteers were tested using irritancy patches with 0.75% metronidazole gel and cream, 1% metronidazole cream, and petrolatum (used as the "negative control"). Blinded observers evaluated the application sites for signs of irritancy. A numerical score was assigned to these irritancy patch sites each day for 21 days, or until significant irritation developed, and cumulative irritancy scores were calculated for the study period. A mixed model of variance analysis was performed. RESULTS: After 21 days of evaluation, analysis of the mean cumulative irritancy scores for each of the agents used showed there to be no statistical difference in irritancy potential between the metronidazole gel and the metronidazole creams. However, the 1% metronidazole cream was significantly more irritating than petrolatum. CONCLUSION: There was no significant difference in the cumulative irritancy potential of cream and gel preparations of metronidazole. The irritancy of topical formulations for treating rosacea should be considered on a case by case basis.

Administration, Cutaneous↗
PubMed2006

Sun protection strength of a hydroquinone 4%/retinol 0.3% preparation containing sunscreens.

BACKGROUND: Dyschromias are common and significantly impact patients' quality of life. Formulas containing hydroquinone 4% are effective in these conditions. Since exposure to ultraviolet radiation (UVR) can worsen disease and complicate treatment, the incorporation of sunscreens can avert this problem. METHODS: We tested the sun protection factor of a hydroquinone formulation (Lustra-Ultra, TaroPharma, Hawthorne, NY) containing avobenzone 3%, and octinoxate 7.5% according to the FDA Sunscreen Monograph on 20 volunteer subjects. We also determined the UVR absorbance spectrum of the preparation. RESULTS: The mean sun protection factor (SPF) of 21.7 satisfied labeling requirements for SPF 20. The formulation exhibited strongest photoprotection near the wavelengths of peak sun burning effectiveness in the UVB region and maintains significant UVR absorbance through the entire UVA region. CONCLUSIONS: Avobenzone 3% and octinoxate 7.5% provide broad spectrum UV protection. Incorporating these sunscreens into a hydroquinone preparation simplifies the treatment regimen while providing significant photoprotection for patients being treated for dyschromia.

Administration, Cutaneous↗
PubMed2006

Predictors of healthcare outcomes and costs related to medication use in patients with acne in the United States.

This study investigated the relationship among health status, costs linked with the treatment of acne in the United States, and other aspects related to medication use. The US Medical Expenditure Panel Survey (MEPS) database was analyzed for a cohort of people with acne. This cross-sectional study obtained costs, demographics, healthcare service utilization, and clinical patient variables from the MEPS database. The EuroQol Group's EQ-5D scores available in MEPS were used for health status information. Multivariate weighted analysis was performed for data for approximately 5 million patients (weighted sample size). Nearly 70% of the patients used some type of medication for acne. Acne-related medication accounted for approximately 36% of the total acne-related annual healthcare costs, with an average of 2 annual acne prescription refills per patient. Increased number of refills of acne-related medications was associated with an improvement in health status (P<.05). Increased physician office-based visits were the only predictors of higher acne-related annual healthcare costs (P<.01). Adherence to acne medications is an important component of better health status. Pharmacologic treatment of acne does not significantly add to acne-related annual healthcare costs.

Acne Vulgaris↗
PubMed2006

Clobetasol propionate for psoriasis: are ointments really more potent?

BACKGROUND: Clobetasol propionate is the most common topical therapy used for psoriasis in the US. Conventional dermatologic wisdom is that ointment preparations provide the highest potency (due to their occlusive nature and moisturizing ability) and are best suited for psoriasis. However, patients often find application of ointment to be messy, raising concerns about both short-term and long-term adherence to treatment. This article reviews the current literature and assesses the relative potency of clobetasol propionate ointment compared to other clobetasol propionate preparations in the treatment of psoriasis. Relevant literature was identified by PubMed and Google searches. We included studies of psoriasis that reported the percentage of subjects that achieved desired efficacy endpoints, as well as studies that reported the subjects' mean change in symptoms from baseline. We excluded studies conducted before 1980 and those that allowed concomitant treatments. OBSERVATIONS: Efficacy rates ranged from 17% to 80% for the different vehicles: ointment, solution, foam, cream, lotion, shampoo, and emollient. CONCLUSIONS: Clobetasol propionate is a very effective treatment for psoriasis. Ointment preparations have similar efficacy to other preparations in clinical trial situations. In clinical practice, a situation in which patient preferences are more likely to affect compliance, it may be best to choose whichever vehicle patients find preferable.

Administration, Topical↗
PubMed2006

Would elimination of copayments for phototherapy decrease the cost of treating psoriasis with systemic biologics? A cost analysis.

Phototherapy is a proven treatment method for the treatment of psoriasis, yet is typically underutilized because of the frequency of physician visits and copayments required for each session (typically 2-5 treatments/wk). Injectable biologic therapies are effective but costly. The objective of this study was to explore how changes in copayment strategies for phototherapy may affect biologic usage. Published estimates of the cost of phototherapy and biologic treatment were used to determine the costs of these treatments to patients and insurers. With an estimated patient copayment of $30 per office visit and a pharmacy copayment of $50 per month, the $1,800 annual patient expense for phototherapy far exceeds the estimated out-of-pocket expenses for etanercept, alefacept, and efalizumab ($840, $405, and $780, respectively). The estimated annual costs to MCOs ranged from $3,008 for phototherapy, to $20,300 for etanercept. Copayments for phototherapy may be shifting patients toward biologic treatment, which is more convenient but more costly to managed care plans.

Cost Sharing↗
PubMed2006

Nonlaser UVB-targeted phototherapy treatment of psoriasis.

Nonlaser localized narrowband (290-315 nm) UVB phototherapy was tested in 10 subjects with localized psoriasis. Treatments were given 2 to 3 times weekly. Four patients did not complete the planned 25-treatment course. Of the remaining 6 patients, all reached greater than 90% clearing of their disease. Localized nonlaser UVB phototherapy is another option for the treatment of localized psoriasis.

Adult↗
PubMed2005

Cutaneous symptoms of dermatomyositis significantly impact patients' quality of life.

BACKGROUND: Dermatomyositis affects visible skin and causes disease symptoms that can affect patients' quality of life (QOL). METHODS: In all, 71 patients with dermatomyositis or dermatomyositis sine myositis completed two QOL measures (the Skindex-16 and the Dermatology Life Quality Index) and a visual analog scale for pruritus. Disease severity was assessed by Physician's Global Assessment. RESULTS: The mean Dermatology Life Quality Index score was 10.7 and the mean Skindex-16 score was 51.1. Itching contributed to impact on both the Dermatology Life Quality Index and Skindex-16. Females reported worse QOL. LIMITATIONS: The effect of treatment on quality of life was not assessed in these analyses. CONCLUSION: QOL impairment in dermatomyositis is greater than in other skin conditions including psoriasis and atopic dermatitis. Pruritus is an important treatable factor that significantly impacts QOL for patients with dermatomyositis.

Adolescent↗
PubMed2005

Limited availability of psoriasis and phototherapy care: an analysis of advertisements.

Because the number of dermatologists remains stable, patients with medical dermatologic conditions such as psoriasis may find it increasingly difficult to access dermatological treatment. Measuring the competition in the marketing of dermatologic care may provide insight into the availability of dermatology services. The purpose of this study was to determine to what extent dermatologists are using the Yellow Pages to advertise to patients with psoriasis. We performed a quantitative and qualitative assessment of dermatologists' Yellow Pages advertisements in small cities and the ten largest metropolitan regions in the country. Per capita, more advertisements were found in smaller markets than larger markets and a higher percentage was descriptive rather than just a name, address and phone number. Cosmetic and surgical advertisements were more common than psoriasis ads in both markets. Cosmetic ads were more prevalent in larger markets. In all regions, psoriasis and psoriasis treatment ads were least common. These findings raise the concern that incentive structures in the United States healthcare system do not adequately support delivery of dermatologic care for psoriasis. Efforts to promote psoriasis care should be encouraged.

Advertising↗
PubMed2005

Spanish dermatological vocabulary used by Mexican workers.

Spanish is the second most common language spoken in the United States. Physicians can expect a growing population of patients who speak Spanish as their primary language. The purpose of this study was to develop a glossary of Spanish dermatological vocabulary commonly used by Mexican workers. Dermatologic terms were gathered from transcripts of in-depth interviews with 31 Latino farmworkers in North Carolina. Participants were asked to name and define words related to skin irritations. Farmworkers provided several definitions of some terms, and several Spanish equivalents exist for specific English words. This glossary is a supplement to other resources for learning medical Spanish and expands health care professionals' knowledge of dermatology-related Spanish vocabulary.

Dermatology↗
PubMed2005

Treatments for mild-to-moderate recalcitrant plaque psoriasis: expected clinical and economic outcomes for first-line and second-line care.

The cost effectiveness of treatments for psoriasis has been evaluated previously by several different investigators. Such evaluations should be updated as new products or data become available. To this end, a comparison of expected treatment-related clinical and economic outcomes is undertaken from the payer perspective using a disease-intervention model, decision analyses, and newly emergent information. The model is based on academy guidelines and recommended clinical practice. Model inputs (clinical and cost data) are culled from the medical literature and advisory clinical assessment surveys. Comparable therapies are various topical pharmacotherapies and phototherapies, including the 308-nm excimer laser (XTRAC, PhotoMedex, Montgomeryville, PA). Analytic results indicate that clinical and economic outcomes are influenced by treatment selections but are muted by the rotational nature of treatment regimens. Multiple analyses are required to reveal individual product performance. On the basis of these analyses, the addition of the 308-nm excimer laser to the rotational mix of treatments commonly utilized as second-line therapies for mild-to-moderate plaque psoriasis is expected to add incremental clinical benefit for patients without incremental cost for payers, because the laser can replace both more costly and less costly alternatives for appropriately selected patients who require a different therapeutic modality to maintain or improve their responsiveness.

Administration, Topical↗
PubMed2005

Members of the national psoriasis foundation: more extensive disease and better informed about treatment options.

OBJECTIVE: Patient advocacy groups such as the National Psoriasis Foundation (NPF) serve as representatives of those affected by disease and provide information about the condition. Our objective was to assess the extent to which NPF members differ from nonmember patients with psoriasis in their knowledge and use of therapies. PARTICIPANTS: Using random-digit dialing, we identified and interviewed patients with psoriasis in the general US population. Randomly selected NPF members were also interviewed. MAIN OUTCOME MEASURES: Multivariate logistic regression models were used to estimate differences (odds ratios and 95% confidence intervals) in demographic and clinical characteristics and in awareness and use of therapies between members and others diagnosed as having psoriasis. RESULTS: Of 601 individuals with psoriasis identified from the general population survey, 185 provided a second interview and were defined as nonmembers. We interviewed 289 randomly selected members of the NPF. Although members were significantly older and wealthier and had more extensive disease, they reported the disease to be significantly less of a burden and were more satisfied with therapy than others affected. Compared with nonmembers, members were significantly more likely to have heard of and used most of the 10 therapies assessed. However, the proportion of respondents who were aware of a therapy and who also used it did not differ between groups. CONCLUSION: Members of the NPF are better informed and more satisfied with available treatment options than nonmember affected patients.

Cost of Illness↗
PubMed2005

Topical tacrolimus ointment combined with 6% salicylic acid gel for plaque psoriasis treatment.

BACKGROUND: While oral tacrolimus is effective for the treatment of psoriasis, tacrolimus ointment has shown only spotty efficacy in the treatment of plaque psoriasis. The efficacy of tacrolimus ointment for the treatment of facial and intertriginous psoriasis suggests that if tacrolimus penetration can be increased, the ointment could be used for effective treatment of plaque psoriasis. OBJECTIVE: To assess whether tacrolimus ointment is an effective psoriasis treatment when used in a combination regimen with the penetration-enhancer salicylic acid. METHODS: A total of 30 adult subjects with generally symmetrical plaque-type psoriasis were randomized to treatment with 6% salicylic acid gel plus vehicle or 6% salicylic acid gel plus 0.1% tacrolimus ointment in a 12-week left-right comparison study. The primary outcome was the difference between tacrolimus- and vehicle-treated target lesions in the change in the sum of erythema, scale, and thickness scores from baseline to end of treatment. RESULTS: A total of 24 subjects completed the trial. Combination treatment with tacrolimus ointment or vehicle plus salicylic acid gel was well tolerated. There was greater improvement of the sum score in the tacrolimus plus salicylic acid-treated target plaques than in the vehicle plus salicylic acid-treated plaques at weeks 1, 2, and 8 (P<.05). The efficacy of this regimen was confirmed by investigator and subject global assessments of plaque severity. CONCLUSIONS: The combination of 0.1% tacrolimus ointment and 6% salicylic acid gel is an effective treatment for psoriasis. Although the results reported herein are from a small exploratory study, the magnitude of the effect was sufficiently large as to be detectable with statistical significance (P<.05).

Administration, Topical↗
PubMed2005

Incidence rates, costs, severity, and work-related factors of occupational dermatitis: a workers' compensation analysis of Oregon, 1990-1997.

UNLABELLED: Objectives To extend and update past research on occupational dermatitis by examining recent workers' compensation claims data. DESIGN: Retrospective analysis of workers' compensation claims from Oregon (1990-1997). SETTING: All dermatitis-related workers' compensation claims were merged with US census data to estimate rates of dermatitis by age, sex, occupation, and industry. Associated claim costs and disability times were also calculated from these data. PARTICIPANTS: All individuals with accepted dermatitis claims (N = 611) were included in the analyses. MAIN OUTCOME MEASURES: The overall claim rates of individuals by age, sex, industry, and occupation were estimated. Total costs and average disability time were computed. Monthly patterns of dermatitis claims were examined. RESULTS: The average claim rate of occupational dermatitis was estimated to be 5.73 per 100 000 workers (95% confidence interval, 5.66-5.80). Statistically significant differences (P<.001) in claim rates by age, sex, industry, and occupation were found. More than 47% of all claimants had 1 year of job tenure or less. Employees in the farming, forestry, and fishing occupations and industries had significantly higher claim rates compared with employees in other occupations. The average cost per claim was $3552, and the average disability time was 23.9 days. Some temporal trends in claim rates were observed. CONCLUSIONS: Occupational dermatitis remains a significant problem in workplace settings. In addition, certain types of occupations and industries seem to be particularly affected by occupational dermatitis. Interventions may be particularly valuable for workers with little job tenure.

Adolescent↗
PubMed2005

The prevalence of psoriasis in African Americans: results from a population-based study.

BACKGROUND: Psoriasis is a common disease with substantial effects on quality of life. The prevalence of psoriasis in African Americans has been previously reported as rare. However, there have been no population-based studies to assess the prevalence and burden of psoriasis in African Americans. OBJECTIVE: We sought to measure the prevalence and burden of psoriasis in African Americans compared with Caucasians. METHODS: Patients were randomly selected from the United States population and were asked standard demographic questions. Patients who reported a physician diagnosis of psoriasis were asked additional questions related to quality of life. RESULTS: The total sample included 27,220 individuals of which 21,921 were Caucasian and 2443 were African American. The prevalence of psoriasis was 2.5% in Caucasian patients and was 1.3% in African American patients. African Americans had an approximately 52% reduction in the prevalence of psoriasis compared with Caucasians ( P < .0001). African Americans and Caucasians had similar impacts on quality of life and treatment satisfaction based on single global questions. CONCLUSION: Although psoriasis is less common in African Americans than in Caucasians, it is not rare in either demographic and carries a substantial burden in both groups.

Black or African American↗