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Biomedical subjects

A B Fleischer

Publications and source records attributed to A B Fleischer.

At least 19 recordsLinked to original sources
PubMed1996

Disease severity measures in a population of psoriasis patients: the symptoms of psoriasis correlate with self-administered psoriasis area severity index scores.

Because of the difficulty and expense of objectively measuring psoriasis severity, very little information exists on the severity of psoriasis in populations. We determined severity in a psoriasis patient population using the validated self-administered psoriasis area and severity index (SAPASI). This population consisted of 578 university dermatology clinic psoriasis patients, and data were analyzed from 317 (55%) questionnaire respondents. The majority of our sample was women (57%), and non-Caucasians represented a larger portion (8 %) in our sample compared with some previous studies. In our population, the reported frequencies of skin and joint symptoms were as follows: pruritus (95 %), skin burning (81 %), joint pain (69%), arthritis (51%), and psoriatic arthritis (20%). The SAPASI was significantly associated with severity of pruritus, burning, joint pain, and psoriatic arthritis. There was a significant negative correlation between the number of treatments employed and the SAPASI. This study provides results of a detailed measurement of the severity of psoriasis in a psoriasis patient population and relates this severity to population characteristics.

Adolescent↗
PubMed1996

The self-administered psoriasis area and severity index is valid and reliable.

The self-administered psoriasis area and severity index (SAPASI) is a structured instrument for measuring the severity of psoriasis. This study examines the validity, reliability, and responsiveness of the SAPASI. Trained personnel performed a psoriasis area and severity index (PASI) assessment on the same day a SAPASI was obtained from 80 subjects. The validity of the SAPASI was demonstrated using the PASI as the standard (r2 = 0.59, p = 0.0001). Significant correlations were found between SAPASI and PASI for body surface area (r = 0.62-0.75), erythema (r = 0.39), induration (r = 0.24) and scale (r = 0.38). Test-retest reliability was assessed in 19 subjects with repeated evaluations within 2 d. Correlations between the first and second SAPASI scores (r = 0.82) were highly significant (p = 0.0001). Inter-rater reliability of SAPASI body surface area measurements among five raters was very high (intraclass correlation coefficient R = 0.953). The SAPASI was responsive to changes in severity over time as demonstrated by correlation with changes in PASI scores (r = 0.63, p = 0.0002). We conclude that this structured patient self-report instrument facilitates quantitative assessment of psoriasis.

Evaluation Studies as Topic↗
PubMed1996

An assessment of potential problems of home phototherapy treatment of psoriasis.

Very little has been reported about how patients use home ultraviolet B (UVB) phototherapy. A survey of thirty-one patients who were prescribed a home UVB phototherapy unit to treat psoriasis was performed as a pilot study of home UVB phototherapy usage; twenty-two patients responded. Generally, respondents reported home UVB phototherapy to be very helpful for their psoriasis. We conclude that home UVB is an effective and appropriate treatment for many patients with psoriasis, but screening and education of candidates for home UVB phototherapy is important to ensure compliance with the treatment program.

Adolescent↗
PubMed1994

Low-dose methotrexate treatment in elderly patients with bullous pemphigoid.

BACKGROUND: Various treatments have been used for elderly patients with bullous pemphigoid. The most common is moderate-dose to high-dose prednisone, either alone or in combination with other oral or topical agents. OBJECTIVE: The aim of this study was to evaluate the efficacy of low-dose methotrexate as a steroid-sparing agent in patients with bullous pemphigoid. METHODS. A retrospective chart review of 34 patients with bullous pemphigoid seen from 1989 through the first half of 1993 was conducted. The diagnosis of bullous pemphigoid was confirmed by direct or indirect immunofluorescence microscopy, or salt-split skin sections. Eight of 34 elderly (> 60 years old) patients with therapy-resistant bullous pemphigoid received low-dose weekly methotrexate (average, 5 to 10 mg) in combination with oral prednisone. RESULTS: Patients who received combination therapy required significantly lower (p < or = 0.02) doses of prednisone to control their disease at 1 month compared with baseline doses. CONCLUSION: In this elderly patient population the side effect profile of the methotrexate was acceptable and well tolerated. We therefore recommend methotrexate and low-dose corticosteroid as first-line combination therapy for selected elderly patients with bullous pemphigoid.

Administration, Oral↗
PubMed1994

Office-based physician services provided by dermatologists in the United States in 1990.

Published epidemiologic data regarding dermatologic practice may no longer be current. The National Ambulatory Medical Care Survey conducted in 1990 provides a comprehensive assessment of ambulatory medical practice including patient demographics, chief and secondary complaints, diagnoses, and drug treatments prescribed. Many specialties including dermatology were represented in the sampling technique. The database was reviewed for descriptive aspects of visits to dermatologists surveyed. Using standardized weighting techniques, we estimated the total number of physician visits. Dermatologists had an estimated 24.0 million patient encounters in 1990. Dermatologists treated a disproportionately large number of female and younger patients. After adjusting for their proportion of the population, Asians and Whites had greater numbers of dermatologic encounters than Blacks and Native Americans. Patients had two or more complaints 27.2% of the time, and received two or more diagnoses 28.9% of the time. The most common complaints accounting for 49.7% of visits included "pimples," "rash," "discoloration," "skin lesion," "wart," and "skin growth." The most common diagnoses, accounting for 52.7% of all encounters, were acne, keratosis, wart, dermatitis or eczema, benign neoplasm, and malignant neoplasm. This paper presents demographic information, chief and secondary complaints, and chief and secondary diagnoses of patients visiting dermatologists in the United States in 1990. Whites and Asian or Pacific Islanders have increased utilization of services compared with Blacks and Native Americans or Eskimos; this disparity correlates with median family income.

Adolescent↗
PubMed1994

Patient measurement of psoriasis disease severity with a structured instrument.

The Psoriasis Area and Severity Index (PASI) is used by dermatologic investigators to assess psoriasis disease severity. PASI measures are time-consuming and require trained personnel. We developed and evaluated a structured PASI-like instrument for self-measurement of psoriasis disease severity for use in future large-scale epidemiologic studies. The instrument consisted of a silhouette of a body for patients to shade in affected areas and of three modified visual analog scales for recording the redness, thickness, and scaliness of an average lesion. The resulting "patient PASI" score was compared to investigator PASI measurements in 43 patients with mild to severe psoriasis. Patients and investigator also recorded a subjective global severity score. The patient PASI score was highly predictive of the investigator PASI score (r2 = 0.71, p < 0.0001) and the investigator global score (r2 = 0.37, p < 0.0001). The patient global score was also predictive of the investigator PASI (r2 = 0.18, p < 0.0053) and the investigator global score (r2 = 0.10, p < 0.044), but these relationships exhibit wide predicted confidence intervals. Following the initial evaluation by 18.4 +/- 9.1 d of therapy, one-way t tests for paired samples (pre and post) showed significant improvements in the patient PASI (p < 0.003) and investigator PASI (p < 0.05). We conclude that although patients' overall scores may not allow for accurate prediction of clinical disease severity in a single individual, this structured instrument facilitates prediction of psoriasis disease severity in a population.

Adult↗
PubMed1994

Bacillary angiomatosis in an immunocompetent child: the first reported case.

Bacillary angiomatosis, an infectious process associated with Rochalima spp., was thought until recently to be restricted to HIV-infected or otherwise immunosuppressed patients. In 1993, bacillary angiomatosis was reported in several immunocompetent adults. An extensive literature review failed to find references to bacillary angiomatosis in immunocompetent children. We describe a 6-year-old female who presented with a single, rapidly growing, friable, erythematous papule on her neck. Histologic examination of a biopsy specimen confirmed the diagnosis of bacillary angiomatosis. The patient was otherwise healthy, and her physical examination was normal. Laboratory studies, including HIV serology, were normal. The patient was treated with six weeks of oral erythromycin without evidence of recurrence. We present and discuss the implications of the first case of bacillary angiomatosis in an immunocompetent child.

Angiomatosis, Bacillary↗
PubMed1994

Dermatologic services provided to children and adolescents by primary care and other physicians in the United States.

To determine the frequency and types of pediatric dermatologic problems encountered by primary care physicians, dermatologists, and other physicians, we examined data from the 1990 National Ambulatory Medical Care Survey, a continuing study of physician practice in the United States. In 1990, 163.3 million physician office visits were made by patients 18 years of age or younger for all diagnoses; of these, 126.2 million were to primary care physicians. Among visits to these providers, a primary, secondary, or tertiary cutaneous concern or diagnosis was recorded in 12.3 million visits (9.7%). Of these patients with a primary cutaneous concern, 68% of visits were made to primary care physicians, 21% to dermatologists, and 10% to other physicians. For encounters in which primary care physicians reported a primary dermatologic diagnosis (9.6 million visits, 7.6%), the majority of diagnoses (86-93%) were in one of five categories: skin infections, dermatitis, parasitic infestations, acne, or urticaria. This analysis demonstrates the great frequency with which cutaneous disease occurs in ambulatory medicine, and reinforces the importance of dermatologic education in the training of primary care physicians.

Acne Vulgaris↗
PubMed1994

Microscopic artifact found during examination of the skin: plant hair of Viburnum dentatum.

Examination of skin specimens with microscopic techniques requires differentiation of pathogenic structures from artifact. While preparing potassium hydroxide preparations for fungal identification or immersion oil preparations for scabies identification, we have recently seen several examples of a bizarre stellate or cruciform plant structure. These artifactual particles were identified as plant hairs from Viburnum dentatum, or arrowwood. Clinicians and laboratory technicians should be aware of this artifact in order to interpret microscopic skin specimens appropriately.

Adolescent↗
PubMed1993

Tanning facility compliance with state and federal regulations in North Carolina: a poor performance.

BACKGROUND: Little is known about the compliance of commercial tanning facilities with regulations governing their operation. We inspected some tanning parlors to assess the degree to which they follow federal and North Carolina state regulations. METHODS: An inspection of 32 tanning facilities was conducted between March and May 1991 as part of an ongoing effort to educate tanning parlor operators and proprietors about UV light safety. Compliance with each of 21 distinct state and federal requirements was recorded for each facility. RESULTS: Only 1 of 32 facilities was in complete compliance with both state and federal regulations. The number of infractions ranged from none to 21 (mean [+/- SD] 7.1 +/- 4.1). Nineteen percent of facilities had timers that were not within the required +/- 10% accuracy level. Twenty-two percent also had timers that did not meet Code of Federal Regulations standards. The estimated proportion of the total light output in the UVB spectrum ranged from 0.5% to 5.0% (mean 4.25% +/- 0.95%). CONCLUSIONS: These limited data suggest that many commercial tanning establishments are not uniformly compliant with regulations. Although we cannot extrapolate these findings to other states, we anticipate that facilities in states with less rigorous regulations than North Carolina have similar or inferior safety profiles.

Beauty Culture↗
PubMed1993

Pruritus in the elderly: management by senior dermatologists.

BACKGROUND: Pruritus in older patients is common, yet remains a challenge for clinicians. By virtue of their years of experience and older age, senior dermatologists may have developed opinions and approaches that are insightful. METHODS: A random sample of board-certified dermatologists older than 64 years of age was surveyed by a written anonymous questionnaire to assess their opinions, diagnostic approaches, and treatments of pruritus and xerosis in the older adult. RESULTS: The 63 respondents whose surveys were analyzed believe the most common cause of generalized pruritus in the elderly is xerosis. Of those respondents who believe laboratory evaluation is necessary for generalized pruritus in this population, a complete blood cell count and a multichemistry panel were the most frequently ordered tests. Treatment regimens and products recommended were highly variable and included topical emollients, corticosteroids, and others. The most common systemic agent employed was hydroxyzine hydrochloride, followed by corticosteroids, doxepin, diphenhydramine, and terfenadine. Various topical, physical, and miscellaneous treatments were recommended. CONCLUSION: This study provides a glimpse into the diagnostic and therapeutic approaches of senior dermatologists.

Administration, Oral↗
PubMed1993

A survey of attitudes, beliefs, and behavior regarding tanning bed use, sunbathing, and sunscreen use.

BACKGROUND: Although cosmetic tanning and unprotected solar exposure are common, little is known about general attitudes, beliefs, and behavior regarding sunbathing, sunscreen use, and tanning salon use. OBJECTIVE: We sought to determine the frequency of UV exposure in a select sample and to assess the knowledge and beliefs of the effects of UV irradiation. METHODS: A written, anonymous questionnaire was distributed to a sample of 477 persons in a shopping mall, at a social gathering, and on a vacation cruise ship. The instrument explored demographic information, sunscreen use, sunbathing habits, tanning bed use, and cutaneous solar effects. RESULTS: Forty-two percent of respondents seldom or never used sunscreen, and 33% sunbathed at least once a week. Although the three sample populations differed in education, sunbathing habits, sunscreen use, and tanning bed use, they were equally informed about UV light hazards. Compared with those who had not used tanning beds, tanning bed users were more likely to be female and more knowledgeable about the long-term effects of UV. Tanning beds were most commonly used in tanning or hair salons, (mean 23 +/- 7 minutes at 2.3 +/- 1.1 times per week). Reported positive psychologic sequelae from tanning bed use were more common than negative physical sequelae. At least 10% would continue to use tanning beds if these were proved to cause skin cancer. CONCLUSION: In this select sample, sunbathing and tanning bed use were common. No group surveyed universally practiced sun protection and avoidance. Clientele of tanning beds may be aware of the damaging effects of the sun, but may not be aware that tanning bed use is associated with skin damage.

Adolescent↗
PubMed1993

Porphyria cutanea tarda in the setting of renal failure. Response to renal transplantation.

BACKGROUND: Porphyria cutanea tarda (PCT) and similar vesiculobullous disorders have been described with increased frequency in patients with chronic renal failure undergoing long-term hemodialysis. Descriptions of over 20 cases of hemodialysis-related PCT have appeared in the literature. The precise cause of PCT in chronic renal failure is unknown, and the treatment of PCT occurring in this setting is complex and often ineffective. OBSERVATIONS: We describe a patient who developed hemodialysis-related PCT, which, in this patient, was refractory to various treatment modalities. This patient eventually went on to receive a renal transplant and all symptoms of PCT resolved with normalization of urinary porphyrin levels. CONCLUSIONS: We propose that in PCT refractory to the currently available treatment modalities occurring after the development of chronic renal failure, renal transplantation is indicated as a potentially efficacious therapy.

Adult↗