Background and objectives: There are a lot of publications about quality of life in psoriasis showing patients' opinions and demands. However, there are very few regarding dermatologists' opinions and the type of patients visited by them. This is the rationale of this paper. The main objective of this study has been to determine, for the Spanish dermatologists, which is the specific weight of psoriasis patients, out of their total clinical activity. Other objectives have been to know patients characteristics and dermatologist preferences in order to chose one treatment for the first time and in the follow up visits. Subjects and method: Prospective epidemiological study, performed during the first 3 months of 2004 and made through a survey to 720 Spanish dermatologists. The total amount of answers was 634 (88%). The survey was design introducing 15 questions regarding clinical activity related to psoriasis. Results: Six hundred and thirty-four dermatologists answered the questionnaire (53.4% males and 46.6% females). The mean age was 43.3 years-old and they performed their work both private and public. There is a mean of 25 to 30 psoriasis patients per month treated by the dermatologists in their clinics. One fourth of the dermatologists treat a mean of 50 psoriasis patients per month and only 12,5% of the dermatologists treat more than 60 patients per month. For more than 68% of the dermatologists, more than 50% psoriasis patients are referred from primary care physicians; 55% of psoriasis patients are males and 45% are females. The mean age is 42.5 years old. Sixty-five percent of visited patients have more than 10% of total skin affected by psoriasis. Only 7% of surveyed dermatologists mentioned the regular use of validate tools for measuring psoriasis severity. The most important factor to choose a treatment, in the first visit, was psoriasis characteristics (55.4%) and the less important was the drug cost (11.9%). These criteria were repeated in the follow up visits. In the first visit, the most frequent election was topical monotherapy (39.6%) followed by different topical treatments combination (31.7%). During the second visit the most frequent prescribed treatment was topical treatment combination (31.3%) followed by more than two topical drugs (22,1%). Discussion: The high number of patients visited, highlights the psoriasis importance in dermatologists daily practice. The role of primary care physicians, in psoriasis patient referrals to dermatologists, is very important, and the referral criteria (diagnosis confirmation and severity of illness) are optimal. In Spain, topical treatment is the most prescribed by dermatologists. For the dermatologist, drug cost is the less important factor in order to choose a psoriasis treatment. If we take into account, that around 65% of visited patients (based in dermatologists opinion) have more than 10% of body surface area affected by psoriasis, we can corroborate based on conventional criteria, that those patients are affected by moderate-severe psoriasis. Conclusions: This epidemiological study remarks that the favored dermatologist treatment is topical one, even though majority of visited patients are affected by moderate to severe psoriasis.
- Topical treatment