Steven R Feldman

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

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Publications (585)1403.94 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Vehicle formulation plays a major role in patient adherence to topical psoriasis treatments. The objective of this study was to conduct a preliminary assessment of patient preference for ointment versus topical suspension formulations of calcipotriene 0.005%-betamethasone dipropionate 0.064% for treatment of plaque psoriasis. In our small cohort of 20 participants with mild to moderate plaque psoriasis, the topical suspension formulation was preferred over the ointment, though the difference was not statistically significant (P=.32). Overall, the topical suspension was rated as moderately appealing, while the ointment was rated as slightly appealing (P=.06). Subgroup analyses were limited due to the small sample size. The results of this study may provide clinicians with an alternative topical treatment of plaque psoriasis that provides the benefits of a combination product. In clinical practice, it may be best to offer patients both formulations and they can choose the product that is right for them.
    Cutis. 12/2014; 94(6):304-9.
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    ABSTRACT: The dermatologic conditions that are most commonly encountered by nondermatologists are not well characterized, which can hamper efforts to train them in skin disease management. The purpose of this study was to identify the 20 most common dermatologic conditions encountered by nondermatologic specialties (ie, emergency medicine, family practice, general surgery, internal medicine, otolaryngology, pediatrics). Data from the National Ambulatory Medical Care Survey from 2001 to 2010 were analyzed to evaluate the dermatologic diagnoses made by each specialty during this time period. The most common skin conditions reported by dermatologists were compared to those reported by nondermatologists. Nondermatologists evaluated 52.9% of cutaneous diseases that presented in the outpatient setting. Among each nondermatologic specialty included in the study, only 6 to 10 of the top 20 conditions overlapped with the top 20 conditions reported by dermatologists. This study is a retrospective review of a large database and only included skin conditions that were diagnosed in an outpatient setting. The skin conditions that most frequently presented to nondermatologists differed considerably from those most commonly seen by dermatologists. Because dermatologists often are responsible for training nondermatologists in the diagnosis and management of skin disease, curriculum content should reflect these differences to enhance the efficacy of such training opportunities.
    Cutis. 12/2014; 94(6):285-92.
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    ABSTRACT: Abstract Background: Deep erythema and inflammation after re-epithelialization of superficial wounds is a sign of scar formation. Corticosteroids may prevent scarring by suppression of inflammation and fibroblast activity. Tretinoin may increase the efficacy of corticosteroids in this setting. Objective: To evaluate the efficacy of corticosteroids plus tretinoin for prevention of scars after superficial wounds. Methods: In a retrospective study of patients with superficial partial thickness thermal skin burn, we compared the patients who received clobetasol plus tretinoin after re-epithelialization with patients who did not receive any medication. Clobetasol propionate 0.05% ointment was used twice daily with overnight occlusive dressing in conjunction with twice weekly topical tretinoin 0.05% cream. Results: Among 43 patients who had light pink or no erythema after re-epithelialization and consequently did not receive clobetasol+tretinoin, no scar was developed. Among patients who had deep erythema after re-epithelialization, rate of scar formation was significantly higher in 14 patients who did not receive clobetasol+tretinoin than in 21 patients who received clobetasol+tretinoin (64% and 19% respectively; P=0.01). Conclusion: Clobetasol+tretinoin can significantly decrease the incidence of scar formation in patients with inflammation after re-epithelialization of superficial wounds.
    Journal of Dermatological Treatment 11/2014; · 1.76 Impact Factor
  • Adam S Richardson, Scott A Davis, Steven R Feldman
    Journal of the American Academy of Dermatology 11/2014; 71(5):998-9. · 5.00 Impact Factor
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    ABSTRACT: Actinic keratoses (AKs) are on a continuum of progression to squamous cell carcinoma (SCC). The most common AK treatment modalities are lesion-directed cryosurgery and field-directed therapy with 5-fluorouracil (5-FU); however, side effects can affect patient compliance. This study was performed to determine the efficacy and perceived side effects of combination treatment with cryosurgery and a shortened course of 5-FU cream 0.5% for AK lesions. Sixty participants with AK lesions underwent cryosurgery and were then randomized to apply 5-FU cream 0.5% or comparator cream once daily to the study area for 1 week. Participants were evaluated at weeks 3, 4, 8, and 26. After 8 weeks, treatment with cryosurgery and 5-FU cream 0.5% was more likely to result in complete clearance versus cryosurgery alone; however, no statistical difference was found in the complete clearance of AK lesions in the treatment group compared to cryosurgery alone at 26 weeks, while side effects in the treatment group were decreased. This study demonstrated the benefit of combination treatment of cryosurgery with 1 week of 5-FU compared to cryosurgery alone in clearing AK lesions for 2 months. This study shows promise for future studies with larger sample sizes to illustrate increased efficacy and decreased side effects with combination treatment of AKs with cryosurgery and 5-FU.
    Cutis. 11/2014; 94(5):255-9.
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    ABSTRACT: Objectives Since many physicians feel that they are not allotted enough time to adequately evaluate and effectively provide care for patients, we sought to analyze the average duration of office visits with physicians from 1993 through 2010. Study Design Retrospective analysis of data from the National Ambulatory Medical Care Survey of the National Center for Health Statistics. Methods Data were analyzed to examine the duration of office visits with physicians from 1993 through 2010. The trends for patients visiting primary care physicians and specialists, for a range of patient ages, for visits with and without physician's assistants or nurse practitioners, and for different numbers of diagnoses were all analyzed. Results From 1993 through 2010, reported visit duration increased over time from 17.9 minutes to 20.3 minutes for primary care visits (P < .001) and from 19.0 minutes to 21.0 minutes for specialized visits (P < .001). The increase in visit duration was consistent across different age ranges, for different numbers of diagnoses, and for patients who did and did not have a procedure performed during the visit. Conclusions Contrary to expectations and beliefs, from 1993 to 2010 a trend of a reduction in the average duration of office visits with physicians has not been observed. Visit duration has increased for both primary care physicians and specialists, across all age ranges, and for different numbers of diagnoses.
    The American journal of managed care. 10/2014; 20(10):820-6.
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    ABSTRACT: Atopic dermatitis is a common, chronic inflammatory dermatosis that can affect all age groups. This evidence-based guideline addresses important clinical questions that arise in its management. In this final section, treatments for flare prevention and adjunctive and complementary therapies and approaches are reviewed. Suggestions on use are given based on available evidence.
    Journal of the American Academy of Dermatology 09/2014; · 5.00 Impact Factor
  • JAMA Dermatology 09/2014; · 4.30 Impact Factor
  • Kyle B Bartlett, Scott A Davis, Steven R Feldman
    Journal of the American Academy of Dermatology 09/2014; 71(3):581-582.e2. · 5.00 Impact Factor
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    ABSTRACT: Background: Demand for minimally invasive cosmetic procedures have led to an increased market of available products for facial rejuvenation. Objective: To characterize trends in the usage of aesthetic products, specifically the use of botulinum toxins and dermal fillers, by United States physicians. Methods: Data from the National Ambulatory Medical Care Survey was analyzed from 1993 to 2010 to evaluate the use of dermal fillers and neurotoxins in the United States outpatient setting. The types of physician specialties administering these products and their preferences in products were characterized. Results: There were an estimated 100,000 annual cosmetic visits at which a dermal filler was administered from 1993 to 2010. From 2002 to 2010, there were 140,000 annual cosmetic visits for a dermal filler and 440,000 visits for a neurotoxin. While collagen was the most common filler used over the entire study period, its use declined eight percent annually. Hyaluronic acid fillers were preferred from 2002 to 2010, followed by calcium hydroxylapatite filler, representing 50 percent and 16.1 percent of visits, respectively. The leading neurotoxin was onabotulinumtoxin A, used at 87.1 percent of visits. Dermatologists were the leading specialty for the cosmetic use of both dermal fillers and neurotoxins. Conclusion: Providers' preference for cosmetic products appears to be influenced by their familiarity with them, with products that first came to market, such as the neurotoxin onabotulinumtoxin A and the hyaluronic acid fillers being used most frequently from 2002 to 2010.
    Journal of Clinical and Aesthetic Dermatology 09/2014; 7(9):14-19.
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    ABSTRACT: Patient demographics and operative techniques may contribute to adverse events after surgeries.
    Journal of Cutaneous Medicine and Surgery 09/2014; 18(5):337-40. · 0.71 Impact Factor
  • Farah A Moustafa, Laura F Sandoval, Steven R Feldman
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    ABSTRACT: Rosacea is a chronic inflammatory skin condition that negatively impacts patients' quality of life. We sought to review important aspects of the pathogenesis of rosacea and the role of new treatment options in its management. New, emerging treatments show promise; however, quality randomized controlled trials for many of these drugs are lacking. Brimonidine tartrate is an effective newly approved treatment for erythematotelangiectatic rosacea. Topical oxymetazoline has potential for the treatment of erythematotelangiectatic rosacea, with efficacy described in case reports and randomized controlled trials currently underway. Both oral and topical ivermectin have been studied for the treatment of papulopustular rosacea, both showing benefit; however, only topical ivermectin 1 % cream has been studied in randomized controlled trials. As our understanding of the etiology of rosacea continues to evolve, so will our options for therapeutic interventions. Further studies need to be performed to assess the long-term safety and efficacy of these treatments.
    Drugs 08/2014; 74(13). · 4.13 Impact Factor
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    ABSTRACT: Abstract: The treatment of psoriasis has evolved over the years, with the recent focus largely on the use of biologics and anti-interleukin-17 agents. With treatment options expanding, practitioners and patients may find control of psoriasis more convenient and safer to achieve. In this article, we review the literature on emerging medications for the treatment of psoriasis. Although some of the new medications under development, such as the anti-interleukin-17 agents, are being shown to be very efficacious in the treatment of psoriasis in premarketing trials, more information regarding their long-term use is needed to demonstrate their superiority over available modalities.
    psoriasis: targets and therapy. 08/2014; 2014:4.
  • Journal of drugs in dermatology: JDD 08/2014; 13(8):917-20. · 1.32 Impact Factor
  • Source
    Imran Aslam, Laura F Sandoval, Steven R Feldman
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    ABSTRACT: To review recent literature on the topical treatment of allergic skin diseases to help clinicians make informed evidence-based decisions.
    Current Opinion in Allergy and Clinical Immunology 07/2014; · 3.40 Impact Factor
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    ABSTRACT: Costs associated with psoriasis present a considerable economic burden. A previously published review was lacking comprehensive data on biologics. Therefore, a systematic literature review was performed to gain a comprehensive understanding of the economic burden of psoriasis throughout the world. Studies published in the English language between January 2001 and May 2013 reporting the direct and indirect economic burden of psoriasis were identified from PubMed and conference proceedings. Thirty-five studies from 11 countries met the inclusion criteria. In 2004, the annual total cost (direct and indirect) in the USA alone was approximately US$1.40 billion. Among the European countries, the most recent studies reported an annual total cost per patient of €11,928 in Sweden, €8372 in Italy, €2866-6707 in Germany and CDN$7999 in Canada, based on treatment type. Costs associated with psoriasis are high in many countries, indicating a continued need for treatments that offer good value for money.
    Expert Review of Pharmacoeconomics & Outcomes Research 07/2014; · 1.87 Impact Factor
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    ABSTRACT: Early follow-up visits improve patient adherence, but the actual scheduling behavior of physicians is not known. PURPOSE: To characterize the timing of first follow-up visits in US dermatologic practice. Methods: Patients with a diagnosis of psoriasis, acne, or atopic dermatitis were identified in the 2003-2007 MarketScan Medicaid database. Factors affecting the length of time before first follow-up were assessed using a Cox proportional hazards model. RESULTS: Mean length of time to the first follow-up visit was 153 days for adults and 142 days for children with psoriasis; 151 days for adults and 218 days for children with acne; and 161 days for adults and 209 days for children with atopic dermatitis. Black and those other than white patients were less likely than whites to receive early follow-up in psoriasis and acne, but more likely in atopic dermatitis. Dermatologists were more likely to schedule early follow-up visits than nondermatologists. LIMITATIONS: The database includes only Medicaid patients. The rate of non-attendance at scheduled visits could not be determined. CONCLUSIONS: Most physicians are missing the opportunity to maximize patient adherence by scheduling early follow-up visits. Contact by email or phone may be beneficial for physicians who cannot schedule early follow-up. J Drugs Dermatol. 2014;13(7):833-836.
    Journal of drugs in dermatology: JDD 07/2014; 13(7):833-836. · 1.32 Impact Factor
  • Farah Moustafa, Robin S Lewallen, Steven R Feldman
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    ABSTRACT: Rosacea is a common problem that is underdiagnosed; if left untreated can result in physical disfigurement and emotional distress.
    Journal of the American Academy of Dermatology 06/2014; · 5.00 Impact Factor
  • Scott A Davis, Steven R Feldman, Sarah L Taylor
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    ABSTRACT: Abstract Objectives: The objective of this study was to assess how often St. John's wort (SJW) is prescribed with medications that may interact dangerously with it. Design: The study design was a retrospective analysis of nationally representative data from the National Ambulatory Medical Care Survey. Settings: The study setting was U.S. nonfederal outpatient physician offices. Subjects: Those prescribed SJW between 1993 and 2010 were the subjects. Outcome Measures: The outcome measures were medications co-prescribed with SJW. Results: Twenty-eight percent (28%) of SJW visits involved a drug that has potentially dangerous interaction with SJW. These included selective serotonin reuptake inhibitors, benzodiazepines, warfarin, statins, verapamil, digoxin, and oral contraceptives. Conclusions: SJW is frequently used in potentially dangerous combinations. Physicians should be aware of these common interactions and warn patients appropriately.
    Journal of alternative and complementary medicine (New York, N.Y.) 06/2014; · 1.69 Impact Factor
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    ABSTRACT: Acne is occurring more frequently in younger age groups, but most available treatments are considered off-label in young children. As the epidemiology of acne has changed to include younger children over the past 20 years, neither regulators, pharmaceutical companies, nor clinicians have understood the need or value of obtaining regulatory sanctions for problems physicians have managed using clinical judgment. The objective of this study was to analyze the frequency of off-label acne treatment according to age and other demographic factors. We searched the National Ambulatory Medical Care Survey from 1993 to 2010 for visits in children younger than 12 years of age for the diagnosis of International Classification of Diseases, Ninth Revision, code 706.1. We tabulated leading acne treatments and assessed factors associated with off-label prescribing. Off-label but appropriate acne treatments were used in 29% of acne visits for children younger than 12 years of age. Dermatologists were more likely than pediatricians to prescribe off-label treatment (p < 0.001). The most frequently used off-label treatments were topical retinoids, followed by oral antibiotics. There was no significant trend in the rate of off-label prescribing over time (p = 0.40). Off-label treatment is well within the standard of care for young children with acne. More data on the use of topical retinoids in young children will improve our understanding of their use, which may help optimize treatment outcomes for children with acne.
    Pediatric Dermatology 06/2014; · 1.52 Impact Factor

Publication Stats

7k Citations
1,403.94 Total Impact Points

Institutions

  • 1994–2014
    • Wake Forest School of Medicine
      • • Department of Dermatology
      • • Division of Public Health Sciences
      Winston-Salem, North Carolina, United States
  • 2009–2013
    • University of Michigan
      • Department of Clinical, Social, and Administrative Sciences
      Ann Arbor, MI, United States
    • Wright State University
      Dayton, Ohio, United States
    • Yale University
      New Haven, Connecticut, United States
    • Columbus State University
      Columbus, Georgia, United States
    • University of Maryland, Baltimore
      Baltimore, Maryland, United States
  • 2003–2013
    • Wake Forest University
      • • Department of Dermatology
      • • School of Medicine
      Winston-Salem, North Carolina, United States
    • Mount Sinai School of Medicine
      • Department of Dermatology
      Manhattan, NY, United States
  • 2012
    • University of South Florida
      • Department of Dermatology and Cutaneous Surgery
      Tampa, FL, United States
  • 2011
    • University of North Carolina at Chapel Hill
      North Carolina, United States
    • University of Chicago
      • Section of Dermatology
      Chicago, IL, United States
    • University of Georgia
      • Department of Clinical and Administrative Pharmacy
      Athens, GA, United States
  • 2008–2011
    • Baylor Health Care System
      Dallas, Texas, United States
    • University of Massachusetts Medical School
      Worcester, Massachusetts, United States
    • Geisel School of Medicine at Dartmouth
      Hanover, New Hampshire, United States
    • Harvard Medical School
      • Department of Dermatology
      Boston, MA, United States
  • 2010
    • University of Notre Dame
      • College of Science
      Indiana, PA, United States
    • Wayne State University
      • Department of Dermatology
      Detroit, MI, United States
  • 2009–2010
    • University of California, Davis
      • School of Medicine
      Davis, CA, United States
    • State University of New York Upstate Medical University
      Syracuse, New York, United States
  • 2008–2009
    • University of North Carolina at Greensboro
      • Department of Public Health Education
      Greensboro, North Carolina, United States
  • 2005–2009
    • The Ohio State University
      • Division of Pharmacy Practice and Administration
      Columbus, OH, United States
    • Cincinnati Museum Center
      Cincinnati, Ohio, United States
    • Johns Hopkins Medicine
      Baltimore, Maryland, United States
    • University of Pennsylvania
      • Department of Dermatology
      Philadelphia, PA, 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
  • 2004
    • Kent State University
      • Department of Geography
      Kent, Ohio, United States
    • Beth Israel Deaconess Medical Center
      • Department of Dermatology
      Boston, MA, United States
    • University of Texas Health Science Center at Houston
      • Division of Management, Policy and Community Health
      Houston, TX, United States
  • 2002
    • Mount Sinai Medical Center
      New York City, New York, United States
    • Sunnybrook Health Sciences Centre
      • Department of Medicine
      Toronto, Ontario, Canada
    • Bristol-Myers Squibb
      New York City, New York, United States
  • 2000
    • King Saud University
      • College of Medicine
      Riyadh, Mintaqat ar Riyad, Saudi Arabia
  • 1997
    • Winston-Salem State University
      Winston-Salem, North Carolina, United States