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A 28 Year Rewind: Patterns in Health Care Delivery for Pediatric Psoriasis (1979-2007)

A recent study published in the Archives of Dermatology demonstrates varying treatment patterns over time within institutions which treat pediatric psoriasis.  Researchers went further in this study to find specific patterns in health care practices for children with psoriasis from 1979 through 2007.  


Using data from the National Ambulatory Medical Care Survey (NAMCS), the authors obtained and analyzed psoriasis treatment data from dermatologists and non-dermatologists over a 28 year period.  Record information included reason for visit, diagnoses, provided services, prescribed medications, referrals and demographic. 


Most young patients were white (92.8%) and gender did not vary (50% male, 50% female).  Forty-seven percent of visits were for children 13-18 years old, 35% were 8-12 years and 18% were 0-7 years.  The following comprises the highlights from this 28 year rewind on pediatric psoriasis:


A Look Back: Medications & Patient Age

0-8 years

1. Most listed treatment: topical betamethasone

2. Second-most listed treatment: topical calcineurin inhibitor tacrolimus, topical vitamin D analog calcipotriene

The potency of the topical corticosteroids prescribed were equal to that of the older children.


9-18 years

1. Most listed treatment: topical betamethasone

2. Second-most listed: topical corticosteroids fluocinonide (high-potency), fluocinolone (low-potency)


A Look Back: Medications & History

+ Topical corticosteroids usage increased from 1979 to 2007

+ Over-the-counter medication usage declined over the 28 year period

+ Few noncorticosteroid topical agents were prescribed from 1986 to 1995

+ From 1995 onward nonsteriodal topical agents were increasingly prescribed

+ It was only until after 2000 that prescriptions for biologic agents were written


The data collected confirms the frequency of psoriasis-related visits in the pediatric population and indicates that treatment varies among physician and age groups.  With the suggested increase in the risk of comorbid conditions in children with psoriasis, a discussion on specific treatment guidelines is warranted.  The authors found that different management approaches were based on the different practices, whether the physician treating was a dermatologist or nondermatologist. 


It is suggested that due to the variation in practice, it would be most helpful to educate pediatricians and dermatologists on all aspects of pediatric dermatology, rather than just releasing a set list of guidelines.  For a disease that burdens so many children in the United States, the creation of a comprehensive and effective regimen for the safe and efficient treatment of pediatric psoriasis is a needed change.


Source: Archives of Dermatology

[image by Faceme]


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