Featured Research

from universities, journals, and other organizations

Evaluation of pediatric psoriasis outpatient health care delivery finds some treatment variability

Date:
September 19, 2011
Source:
JAMA and Archives Journals
Summary:
Most outpatient visits for pediatric psoriasis in the United States are made by white children ages 8 years and older and are made to dermatologists and pediatricians, but the treatment approach may differ by physician specialty and patient age, according to a new study.

Most outpatient visits for pediatric psoriasis in the United States are made by white children ages 8 years and older and are made to dermatologists and pediatricians, but the treatment approach may differ by physician specialty and patient age, according to a report published Online First by Archives of Dermatology, one of the JAMA/Archives journals.

According to background information in the article, approximately 2.5 percent of the U.S. population is affected by psoriasis, including 1 percent of children from birth to 18 years. In one-third of patients, the first signs and symptoms appear by the age of 20 years. Clinicians consider disease severity, presentation and distribution of lesions, patient age and the presence of concurrent conditions in determining treatment. For mild, localized cases in the pediatric population, topical medications are generally used, with phototherapy and systemic medication usually utilized for more complex cases. "Management of psoriasis in children can be challenging," write the authors, "owing to a paucity of data and lack of standardized guidelines specific to the pediatric population."

Sinae A. Vogel, B.S., from the University of California, San Francisco School of Medicine, and colleagues conducted a retrospective, cross-sectional investigation of data from the National Ambulatory Medical Care Survey. The authors examined outpatient-visit data from dermatologists and nondermatologists from 1979 to 2007 (except the periods 1982-1984 and 1987-1988, when data were not collected) for pediatric visits (children ages 0 to 18 years) with a diagnosis of psoriasis. The researchers tabulated the frequency of medications in the database and assigned them to three categories: topical corticosteroid, topical noncorticosteroid and systemic. Corticosteroids were further assigned a relative potency value from one (super potent) to seven (very weak).

In total, an estimated 3.8 million pediatric psoriasis visits occurred during the 28-year interval, with a median (midpoint) of 123,420 visits per year. Nearly two-thirds of patients visited dermatologists for the condition (63 percent); 17 percent of psoriasis visits were made to pediatricians and 14 percent were made to internists. Equal numbers of visits were made by male and female patients, 93 percent of whom were white. Patients ages 13 to 18 years made 47 percent of the visits, children ages 8 to 12 years made 35 percent of the visits and those ages 0 to 7 years made 18 percent of the visits.

The most commonly prescribed medications were topical corticosteroids, and the potency levels of these medications appeared equal in younger and older children. Overall, and in both younger and older age groups, the most commonly prescribed medication was the topical corticosteroid betamethasone. Dermatologists and internists most commonly prescribed high-potency steroids, and pediatricians most commonly prescribed the topical immunosuppressant tacrolimus. The top 20 most-prescribed medications by dermatologists did not include topical calcineurin inhibitors (medications that prevent inflammation), and the top 20 most-prescribed medications in any age group did not include systemic antipsoriatic agents.

"This study confirms that pediatric psoriasis visits are frequent and represent a substantial burden of disease in the United States, validating the social, economic, and medical impact of this disease," write the authors. They note the age differences in office visits for the condition as well as the trends in medication usage, and are particularly concerned about the frequency of strong corticosteroid use in patients younger than 8 years. "In our experience, the highest potency topical corticosteroids are not commonly needed for psoriasis in young children," the researchers state.

Such trends appear to point to a need for treatment guidelines that address the condition in children. "The current state-of-the-art care for pediatric psoriasis is based primarily on experience and expert consensus," and some clinicians may not be anticipated to change even if standardized treatment guidelines existed, write the authors. "As such, education of our dermatology and nondermatology colleagues about unique clinical and treatment aspects of pediatric psoriasis, rather than guidelines alone, may decrease the treatment gap by creating more comfortable, safe, and effective use of topical and systemic regimens for children with psoriasis."


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Journal Reference:

  1. Sinae A. Vogel; Brad Yentzer; Scott A. Davis; Steven R. Feldman; Kelly M. Cordoro. Trends in Pediatric Psoriasis Outpatient Health Care Delivery in the United States. Archives of Dermatology, 2011; DOI: 10.1001/archdermatol.2011.263

Cite This Page:

JAMA and Archives Journals. "Evaluation of pediatric psoriasis outpatient health care delivery finds some treatment variability." ScienceDaily. ScienceDaily, 19 September 2011. <www.sciencedaily.com/releases/2011/09/110919164006.htm>.
JAMA and Archives Journals. (2011, September 19). Evaluation of pediatric psoriasis outpatient health care delivery finds some treatment variability. ScienceDaily. Retrieved July 28, 2014 from www.sciencedaily.com/releases/2011/09/110919164006.htm
JAMA and Archives Journals. "Evaluation of pediatric psoriasis outpatient health care delivery finds some treatment variability." ScienceDaily. www.sciencedaily.com/releases/2011/09/110919164006.htm (accessed July 28, 2014).

Share This




More Health & Medicine News

Monday, July 28, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Deadly Ebola Virus Threatens West Africa

Deadly Ebola Virus Threatens West Africa

AP (July 28, 2014) West African nations and international health organizations are working to contain the largest Ebola outbreak in history. It's one of the deadliest diseases known to man, but the CDC says it's unlikely to spread in the U.S. (July 28) Video provided by AP
Powered by NewsLook.com
$15B Deal on Vets' Health Care Reached

$15B Deal on Vets' Health Care Reached

AP (July 28, 2014) A bipartisan deal to improve veterans health care would authorize at least $15 billion in emergency spending to fix a veterans program scandalized by long patient wait times and falsified records. (July 28) Video provided by AP
Powered by NewsLook.com
Two Americans Contract Ebola in Liberia

Two Americans Contract Ebola in Liberia

Reuters - US Online Video (July 28, 2014) Two American aid workers in Liberia test positive for Ebola while working to combat the deadliest outbreak of the virus ever. Linda So reports. Video provided by Reuters
Powered by NewsLook.com
Traditional African Dishes Teach Healthy Eating

Traditional African Dishes Teach Healthy Eating

AP (July 28, 2014) Classes are being offered nationwide to encourage African Americans to learn about cooking fresh foods based on traditional African cuisine. The program is trying to combat obesity, heart disease and other ailments often linked to diet. (July 28) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins