Steven R Feldman

Wake Forest School of Medicine, Winston-Salem, North Carolina, United States

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Publications (797)1990.45 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Cryosurgery is a common treatment modality for many dermatological conditions; however, the extent to which it is used and by which medical specialties is not well characterized. To determine the rates of cryosurgery use over time, the top dermatoses treated by cryosurgery, patient demographics and the rate at which practitioners used cryosurgery. We used the National Ambulatory Medical Care Survey (NAMCS) from 1993 to 2010 in order to quantify the use of cryosurgery in outpatient offices. For visits where cryosurgery was utilized, the leading diagnoses, treating physician specialties, and patient ages were tabulated. Cryosurgery was most commonly used for treating actinic keratoses (48% of visits), seborrheic keratoses (25% of visits) and verrucae (21% of visits). Dermatologists performed 82% of all cryosurgeries, followed by family/internal medicine physicians (13.6%) and pediatricians (2.8%). The use of cryosurgery for these dermatoses has increased over time (p < 0.0001), especially in patients over the age of 65 years. Physicians in offices with health maintenance organization-based practices were more likely to utilize cryosurgery. Since NAMCS data are cross-sectional, we are unable to determine whether patients tried and failed other treatments. As the baby boomer generation ages, the demand for cryosurgery will likely further increase.
    Journal of Dermatological Treatment 07/2015; DOI:10.3109/09546634.2015.1054780 · 1.76 Impact Factor
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    ABSTRACT: Safety profiles of systemic biologic agents for the treatment of psoriasis and psoriatic arthritis (PsA) encompass a wide spectrum of adverse events. To date, no uniform evidence-based guidelines exist regarding screening and monitoring patients who are undergoing biologic therapy. We sought to identify studies evaluating screening and monitoring tests in the treatment of psoriasis and PsA with systemic biologic agents, and to propose evidence-based practical guidelines. The MEDLINE database was searched to identify data on risks associated with adalimumab, etanercept, infliximab, and ustekinumab. Articles were reviewed and graded according to methods developed by the US Preventative Services Task Force. Evidence was strongest (grade B) for tuberculosis screening. Interferon-gamma release assay was preferable to tuberculin skin testing. Among known hepatitis B virus carriers, the evidence grade was C for monitoring liver function tests and viral load. This study was limited by the lack of high-quality controlled trials evaluating screening and monitoring tests in patients treated with biologic agents. Baseline tuberculosis testing remains the only screening test with strong evidence to support its practice. Other screening and monitoring tests commonly performed in patients who are taking biologic agents are supported only in certain clinical settings or lack evidence to support or recommend against their practice. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.
    Journal of the American Academy of Dermatology 07/2015; DOI:10.1016/j.jaad.2015.06.004 · 5.00 Impact Factor
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    ABSTRACT: Melanoma is a common, potentially deadly disease but is curable if caught early. A specimen of a pigmented lesion must capture the entire width and depth of the lesion to evaluate the lesion's size, symmetry, and circumscription. Saucerization shaving, punching, and excision biopsy are 3 techniques that can be used to achieve a satisfactory specimen. Physicians should have a low threshold to biopsy a suspicious atypical pigmented lesion, but acceptable specimens are key in following through with an accurate diagnosis. © Copyright 2015 by the American Board of Family Medicine.
    The Journal of the American Board of Family Medicine 07/2015; 28(4):523-5. DOI:10.3122/jabfm.2015.04.150043 · 1.85 Impact Factor
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    ABSTRACT: Clinical models are invaluable in studying wound healing. Challenges in studying human wounds include heterogeneity of patients and wounds, as well as prolonged study time, resulting in high costs. Animal models are an efficient method to study wound healing, but often lack correlation with human acute wound healing. Human wound models can be created using sharp instruments, suction, acids, heat and cold. In this observational study, we propose a practical human acute wound model where partial thickness wounds are induced by cryosurgery to create wounds that could facilitate wound healing research and development. METHODS: On forearms of 8 healthy adult volunteers, freeze injuries were induced using liquid nitrogen spray delivered onto a target area of a 1 cm circular opening at a distance from the cryo-device to the skin of 0.5-1 cm. Several freeze-thaw time cycles were implemented by administering pulses ranging from 3 to 12 seconds. Clinical evaluation was performed at a 24-hour follow-up period. Blister roofs were histologically analyzed by a blinded dermatophathologist. Clinical assessment of time to heal was determined. RESULTS: Freeze-times greater than 5 seconds caused a majority of subjects to develop blisters, and freeze-times greater than 8 seconds resulted in uniform blister formation. Consistent histology of full thickness necrotic epidermis with intact detached basement membrane with minimal acute neutrophilic inflammatory infiltrate was observed in all blister specimens examined. The 8-second freeze-time group had a time to heal of 13-14 days, while the 12-second freeze-time group required 3 weeks to heal. After healing, an area of hypopigmented skin and slightly hypertrophic scarring remained. DISCUSSION: This novel cryo-induced wound model is a potential simple, efficient and reliable model for studying the dynamic processes involved in acute wound healing and to aid in the development of new wound healing therapies. identifier: NCT01253135. J Drugs Dermatol . 2015;14(7):734-738.
    Journal of drugs in dermatology: JDD 07/2015; 14(7):734-738. · 1.32 Impact Factor
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    ABSTRACT: Treatment adherence is a ubiquitous challenge in medicine, particularly in the adolescent population with chronic disorders. Web-based adherence interventions may be particularly useful in adolescents, due to their familiarity with and frequent use of the Internet. To review web-based interventions used to improve adherence to medication in adolescent patients with chronic disorders. A PubMed search was performed for full-text, English, clinical trials in adolescents using keywords "adherence" or "compliance", "Internet" or "web", and "treatment" from inception until November 2014. Articles were selected if they involved using the Internet to provide support to adolescents to help improve their adherence to treatment, excluding those focused on solely providing medical services through the Internet and articles focusing on preventative care, rather than treatment of an illness. Fourteen studies were found concentrating on chronic adolescent disorders. Interventions included online surveys, physician chat lines, monitoring programs, and interactive programs. All interventions experienced either greater improvement in adherence or another disease control measure or no statistically significant difference compared with the control group (in-clinic visits). Few clinical trials studying web-based interventions to improve adherence in adolescents were found. Due to not having one standard outcome measured in all of the studies, it was also difficult comparing the effectiveness of the interventions. Web-based interventions play a role in improving adherence in adolescents with chronic disorders by being more time saving and cost effective compared with in-clinic visits. Further research focusing on adherence interventions using the Internet is necessary to determine the ideal ways of utilizing the Internet to improve adherence in adolescents with chronic disorders.
    Adolescent Health, Medicine and Therapeutics 06/2015; 6. DOI:10.2147/AHMT.S56065
  • Palak K Patel, Caleb R King, Steven R Feldman
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    ABSTRACT: Biological drugs are large, complex glycoprotein molecules produced in living organisms. Revolutionary treatments for many conditions, biologics used in dermatology will face patent expiration, opening opportunities for competitive versions. Biologic drugs are so complex such that it is impossible to reproduce them exactly. Biosimilars are designed to be highly similar, though not identical, to the innovator product. Because biosimilars are not exact replicates of innovator biologics, guidelines have suggested that biosimilars should be considered as unique therapeutic interventions, requiring unique names and physician notification prior to substitution. However, because biologics can never be replicated exactly, even innovator biologics have inherent batch-to-batch variability; when the second batch of innovator products were released, physicians began prescribing non-identical variants of biologics to their patients, accepting the possibility of variation in clinical effects. Unlike the variants in innovator products, biosimilars will provide clinical trial data demonstrating similar clinical effects, though there will always be some degree of uncertainty in how much clinical impact will be result from the variation in both innovator and biosimilar products. How biosimilars are approved and how we use biosimilars will need to balance considerations of cost and development time with the possibility of variation in biological response.
    Journal of Dermatological Treatment 06/2015; DOI:10.3109/09546634.2015.1054782 · 1.76 Impact Factor
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    ABSTRACT: Topical retinoids are first-line treatment options for acne vulgaris. These drugs, however, produce varying degree of cutaneous irritation within the first few weeks of treatment. Our purpose was to examine differences in tolerability of topical retinoids and assess whether these differences would be clinically meaningful. A PubMed search was performed for sources on topical retinoids in acne vulgaris treatment. Thirty-four clinical studies were analyzed. Thirteen studies had statistically significant results on tolerability of retinoid based on retinoid, vehicle, concentration, or skin type. All studies classified most of skin reactions as mild-moderate. Large differences in the number of dropouts due to irritation were not identified. Irritation studies did not show a high frequency of clinically significant irritation with topical retinoids. We anticipate that the large variation in patient use of topical retinoids would likely account for more variation in response than differences between drug formulations. © The Author(s) 2015.
    Journal of Cutaneous Maedicine and Surgery 06/2015; DOI:10.1177/1203475415591117 · 0.71 Impact Factor
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    ABSTRACT: Health care workers suffer from musculoskeletal disorders at a significantly higher rate than workers in other industries. Consequently, a growing demand for patient handling devices to reduce worker injury has evolved. This article reviews the literature regarding interventions designed to reduce injuries among health care workers. A PubMed search was conducted using the terms "occupational health [Mesh Terms] patient lifting." Fourteen articles were identified that assessed interventions to improve worker safety. Of the 14 articles, 7 discussed technological interventions, 4 educational approaches, and 3 policy change. All three types of interventions were generally effective at improving worker safety, with the ideal intervention consisting of elements of all three types. Although adopting a new intervention may be expensive, the reduction in workers' compensation costs associated with injured nurses can easily outweigh the costs of interventions. © 2015 The Author(s).
    06/2015; 63(6):267-275. DOI:10.1177/2165079915580038
  • Imran Aslam, Steven R Feldman
    Southern medical journal 06/2015; 108(6):325-331. DOI:10.14423/SMJ.0000000000000294 · 1.12 Impact Factor
  • Michael E Farhangian, Steven R Feldman
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    ABSTRACT: The five biologic agents approved for the treatment of psoriasis-etanercept, infliximab, adalimumab, ustekinumab, and secukinumab-have been transformative in the clinical management of severe forms of the disease. However, a significant number of patients fail to respond to these agents or experience a loss of efficacy over time, which may be attributable to the development of antidrug antibodies (ADAs). Increasing evidence, primarily in the context of rheumatoid arthritis or other chronic inflammatory diseases, suggests that concomitant administration of methotrexate may prevent or diminish the development of ADAs, thereby improving response rates. However, methotrexate is infrequently coadministered with biologic agents in patients with psoriasis, and the potential benefits of this strategy in the context of psoriasis are largely unexplored. In this review, we discuss clinical studies regarding the development and consequences of antibodies targeting biologic agents used in the treatment of psoriasis and present key findings describing the potential role of methotrexate as an inhibitor of immunogenicity. We also discuss clinical considerations pertaining to the use of methotrexate as a tool to reduce immunogenicity, and encourage further investigation into potential techniques to optimize this treatment approach in patients with psoriasis.
    American Journal of Clinical Dermatology 05/2015; DOI:10.1007/s40257-015-0131-y · 2.52 Impact Factor
  • Michael E Farhangian, Steven R Feldman
    Southern medical journal 05/2015; 108(5):298-9. DOI:10.14423/SMJ.0000000000000283 · 1.12 Impact Factor
  • To Heal the Skin: The Heroes Behind Discoveries in Dermatology, Edited by Stuart Maddin, Eileen Murray, 05/2015: chapter 20: pages 141-148; Linacre's Books., ISBN: 978-0-9685848-4-2
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    ABSTRACT: There is a reported global decrease in the number of clinical trials conducted in recent years. We aimed to determine if this declining trend can be extrapolated to dermatologic clinical trials. METHODS: We conducted a query of for dermatologic clinical trials from 2009 to 2013 for 6 common skin conditions: acne, psoriasis, rosacea, eczema and atopic dermatitis, actinic keratosis, and skin cancer. Results were sorted by condition and number of study subjects. This study did not involve any participants apart from the researchers. RESULTS: Although there is an increasing trend in the number of trials performed annually, the results were not significant ( P =.08). The average number of patients per study has not significantly changed ( P =.12), but there was a significant increase in the number of large studies (201+ subjects) conducted over time ( P =.002). Although there was significant variation based on dermatologic condition studied (global statistic P=.01), only skin cancer demonstrated a significant change in the number of studies registered annually (β=10.6 studies/year, P =.04). CONCLUSIONS AND RELEVANCE: The sky does not appear to be falling, at least not yet, with regard to continued development of treatments for patients with skin disease. J Drugs Dermatol. 2015;14(5):497-500.
    Journal of drugs in dermatology: JDD 05/2015; 14(5):497-500. · 1.32 Impact Factor
  • Journal of Cutaneous Maedicine and Surgery 05/2015; 19(3):201-2. DOI:10.1177/1203475415576427 · 0.71 Impact Factor
  • H Alinia, S R Feldman
    British Journal of Dermatology 05/2015; 172(5):1194-5. DOI:10.1111/bjd.13766 · 4.10 Impact Factor
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    ABSTRACT: Onychomycosis is a common progressive infection of the nails that may result in remarkable morbidity. Although there are a variety of treatments available for fungal nail infections with different efficacy and safety profiles, there are limited reports on the ways in which physicians use these treatments or the frequency with which they prescribe them. In this retrospective study, major trends in the prescription and use of antifungal agents for treatment of onychomycosis in the United States were evaluated using data from the National Ambulatory Medical Care Survey. Results showed that current treatment and trends in use of drugs for onychomycosis in the United States are in accordance with recommendations in current guidelines.
    Cutis; cutaneous medicine for the practitioner 05/2015; 95(5):E15-E21. · 0.59 Impact Factor
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    ABSTRACT: Understanding skin cancer incidence is critical for planning prevention and treatment strategies and allocating medical resources. However, owing to lack of national reporting and previously nonspecific diagnosis classification, accurate measurement of the US incidence of nonmelanoma skin cancer (NMSC) has been difficult. To estimate the incidence of NMSC (keratinocyte carcinomas) in the US population in 2012 and the incidence of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in the 2012 Medicare fee-for-service population. This study analyzes US government administrative data including the Centers for Medicare & Medicaid Services Physicians Claims databases to calculate totals of skin cancer procedures performed for Medicare beneficiaries from 2006 through 2012 and related parameters. The population-based National Ambulatory Medical Care Survey database was used to estimate NMSC-related office visits for 2012. We combined these analyses to estimate totals of new skin cancer diagnoses and affected individuals in the overall US population. Incidence of NMSC in the US population in 2012 and BCC and SCC in the 2012 Medicare fee-for-service population. The total number of procedures for skin cancer in the Medicare fee-for-service population increased by 13% from 2 048 517 in 2006 to 2 321 058 in 2012. The age-adjusted skin cancer procedure rate per 100 000 beneficiaries increased from 6075 in 2006 to 7320 in 2012. The number of procedures in Medicare beneficiaries specific for NMSC increased by 14% from 1 918 340 in 2006 to 2 191 100 in 2012. The number of persons with at least 1 procedure for NMSC increased by 14% (from 1 177 618 to 1 336 800) from 2006 through 2012. In the 2012 Medicare fee-for-service population, the age-adjusted procedure rate for BCC and SCC were 3280 and 3278 per 100 000 beneficiaries, respectively. The ratio of BCC to SCC treated in Medicare beneficiaries was 1.0. We estimate the total number of NMSCs in the US population in 2012 at 5 434 193 and the total number of persons in the United States treated for NMSC at 3 315 554. This study is a thorough nationwide estimate of the incidence of NMSC and provides evidence of continued increases in numbers of skin cancer diagnoses and affected patients in the United States. This study also demonstrates equal incidence rates for BCC and SCC in the Medicare population.
    04/2015; DOI:10.1001/jamadermatol.2015.1187
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    ABSTRACT: Treatment adherence plays a large role in chronic dermatologic diseases and may play an important role in the outcomes of patients with cutaneous lupus erythematosus (CLE). We sought to gauge what is currently known about adherence to topical and oral medications in patients with CLE. A review of MEDLINE was performed using a combination of the phrases "adherence", "compliance", "lupus", and "cutaneous". Studies were hand searched and prospective and cross-sectional studies evaluating medication adherence in patients with CLE and systemic lupus erythematosus (SLE) were included. Only two articles explored adherence in patients with CLE, while 17 articles discussed treatment adherence in patients with SLE. Depression was consistently cited as detrimental to adherence. The impact that race, ethnicity, and education has on adherence is unclear. Three studies noted a clear connection between adherence and disease activity, while two others did not. Few studies investigated methods that have improved adherence to treatment which have showed promise. Much of what we know about adherence to medication in patients with lupus is limited to SLE. Although cutaneous symptoms are among the most common manifestations of SLE, cutaneous disease is often managed at least in part with topical agents, and adherence to topical treatment was not assessed in any of the articles, though one study investigated sunscreen usage in patients with CLE. Understanding adherence in patients with CLE may help contribute to better CLE treatment outcomes.
    04/2015; 5(2). DOI:10.1007/s13555-015-0075-4
  • Journal of Dermatological Treatment 04/2015; DOI:10.3109/09546634.2015.1034082 · 1.76 Impact Factor

Publication Stats

12k Citations
1,990.45 Total Impact Points


  • 1998–2015
    • Wake Forest School of Medicine
      • Department of Dermatology
      Winston-Salem, North Carolina, United States
  • 1989–2014
    • Wake Forest University
      • • Department of Dermatology
      • • School of Medicine
      • • Department of Psychology
      • • Department of Psychiatry and Behavioral Medicine
      Winston-Salem, North Carolina, United States
  • 2011–2013
    • University of Michigan
      • Department of Clinical, Social, and Administrative Sciences
      Ann Arbor, MI, United States
    • University of Chicago
      Chicago, Illinois, United States
    • University of Georgia
      • Department of Clinical and Administrative Pharmacy
      Athens, GA, United States
  • 2012
    • University of South Florida
      • Department of Dermatology and Cutaneous Surgery
      Tampa, FL, United States
  • 2010
    • State University of New York Upstate Medical University
      Syracuse, New York, United States
    • University of Notre Dame
      • College of Science
      Indiana, PA, United States
  • 1997–2010
    • Winston-Salem State University
      Winston-Salem, North Carolina, United States
  • 2009
    • Wright State University
      Dayton, Ohio, United States
    • University of California, Davis
      • School of Medicine
      Davis, CA, United States
  • 2004–2009
    • University of North Carolina at Greensboro
      • • Department of Public Health Education
      • • Department of Psychology
      Greensboro, North Carolina, United States
    • University of North Carolina at Chapel Hill
      North Carolina, United States
    • Kent State University
      • Department of Geography
      Kent, Ohio, United States
    • Beth Israel Deaconess Medical Center
      • Department of Dermatology
      Boston, MA, United States
  • 2008
    • University of Massachusetts Medical School
      Worcester, Massachusetts, United States
  • 2005–2008
    • The Ohio State University
      • Division of Pharmacy Practice and Administration
      Columbus, OH, United States
    • University of Utah
      Salt Lake City, Utah, United States
  • 2007
    • Ohio University
      Athens, Ohio, United States
  • 2006–2007
    • Northeast Ohio Medical University
      Ravenna, Ohio, United States
    • George Washington University
      Washington, Washington, D.C., United States
    • Medical University of South Carolina
      • Division of General Internal Medicine and Geriatrics
      Charleston, SC, United States
  • 2003
    • Mount Sinai School of Medicine
      • Department of Dermatology
      Manhattan, NY, United States
  • 2002–2003
    • Sunnybrook Health Sciences Centre
      • • Division of Dermatology
      • • Department of Medicine
      Toronto, Ontario, Canada
    • University of California, San Francisco
      • Department of Dermatology
      San Francisco, California, United States
    • University of Toronto
      • Department of Medicine
      Toronto, Ontario, Canada
  • 2001–2002
    • Bristol-Myers Squibb
      New York, New York, United States
    • University of Nevada, Las Vegas
      Las Vegas, Nevada, United States
    • Georgetown University
      Washington, Washington, D.C., United States