Trends in pediatric psoriasis outpatient health care delivery in the United States

Abstract

Objective: To characterize patterns of childhood psoriasis health care delivery from 1979-2007.

Design: Retrospective, cross-sectional investigation using National Ambulatory Medical Care Survey data.

Setting: US ambulatory physician offices from 1979 through 2007.

Patients: Children with psoriasis ages 0 (birth) to 18 years.

Main outcome measures: Demographics, physician specialty, and medications prescribed.

Results: There were an estimated 3.8 million visits for psoriasis over the study interval with a median of 123,420 visits per year. Dermatologists saw 63% of patients, pediatricians saw 17%, and internists, 14%. The numbers of visits were equal between sexes but ranged by age group: patients ages 13 to 18 years accounted for 47% of visits, those ages 8 to 12 years for 35%, and those ages 0 to 7 for 18%. Ninety-three percent of patients were white. Topical corticosteroids were the most commonly prescribed medications. Children 0 to 9 years old received equally potent corticosteroids as children 10 to 18 years old. Among all patients, the most prescribed medication was topical betamethasone; among those ages 0 to 9 years, tacrolimus; and among those ages 10 to 18 years, betamethasone. By physician specialty, the most prescribed medications were high-potency steroids for dermatologists and internists, and topical tacrolimus for pediatricians. Topical calcineurin inhibitors were not among the top 20 most prescribed medications by dermatologists, and systemic antipsoriatic agents were not among the top 20 most prescribed medications in any age group.

Conclusions: Over the 28-year interval, outpatient visits for pediatric psoriasis were attended primarily by white children older than 8 years in equal number by sex. Dermatologists and pediatricians saw the majority, and treatment approach differed by physician specialty and patient age. Treatment guidelines for childhood psoriasis may help reduce treatment variability.