Steven R Feldman

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

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Publications (838)2025.25 Total impact

  • Michael E Farhangian · Karen E Huang · Steven R Feldman · Alan B Fleischer ·

    Pediatric Dermatology 11/2015; DOI:10.1111/pde.12716 · 1.02 Impact Factor
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    ABSTRACT: Objectives: The objectives of the study were to evaluate and compare medication adherence associated with acne drugs in children and adolescents with acne vulgaris. Methods: Data from MarketScan Medicaid enrollees with acne vulgaris were included if patients were ages 6 to 17 years on the index date, had at least one acne-related medication claim, and were enrolled in Medicaid during January 2004 to December 2007. The adherence rate was measured using the medication possession ratio. The medication possession ratio was dichotomized to categorize patients as adherent (≥0.8) or nonadherent (<0.8). Multivariate logistic regressions were used for analyses of the medication possession ratio. Results: Of 20,039 eligible patients, 2,860 patients were children and 17,179 patients were adolescent. Approximately 6.96% of children and 16.75% of adolescents had at least one acne-related medication refill. The mean adherence rate to acne medication was significantly different between children (0.22) and adolescents (0.32). In addition, only 3.71% of children were adherent to acne medication while 13.38% of adolescents were adherent. After controlling for covariates, adolescents were 2.06 times more likely to get an acne-related medication refilled and were 2.40 times more likely to be adherent to acne-related medication. The analyses also showed that acne-related medication adherence was associated with the patient's characteristics and acne medication type. Conclusion: Neither patient population was considered adherent to acne-related medications, nor was there a significant difference between the two patient populations. This study also revealed that medication type is a contributing factor towards adherence. Health care providers should strive to educate patients on the importance of medication adherence.
    Pediatric Dermatology 11/2015; DOI:10.1111/pde.12713 · 1.02 Impact Factor
  • Dane Hill · Steven R Feldman ·

    11/2015; DOI:10.1001/jamadermatol.2015.3951
  • Jaclyn A Smith · Swetha Narahari · Dane Hill · Steven R Feldman ·
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    ABSTRACT: Introduction: Acne is a common skin condition of the pilosebaceous units that affects the young and old, ranges from moderate to severe, and can be treated with an array of options. Topical retinoids are the initial treatment for acne due to their ability to treat comedones, the starting point of acne. Areas covered: Tazarotene is a topical retinoid available as a cream, gel, and foam. Tazarotene 0.1% foam was FDA approved in 2012 for the treatment of acne in patients ages 12 and over and is the first foam topical retinoid on the market. Phase I and III trials support the efficacy and safety of tazarotene foam for acne. Expert Opinion: The foam vehicles may increase compliance and satisfaction in some patients, and since retinoids are commonly first line acne treatments, this novel topical retinoid foam may be a useful option for some acne patients.
    Expert Opinion on Drug Safety 11/2015; DOI:10.1517/14740338.2016.1117605 · 2.91 Impact Factor
  • Hossein Alinia · Lucy Lan · Sandy Kuo · Karen E Huang · Sarah L Taylor · Steven R Feldman ·
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    ABSTRACT: Background: Rosacea patients commonly employ nonprescription therapies. The authors' aim was to understand rosacea patients' perceptions of over-the-counter products, complementary and alternative medicine, and homeopathic therapies. Method: A public, online discussion forum comprising 3,350 members and 27,051 posts provided a source of 346 posts on patient perceptions on alternative rosacea treatments. Results: Three major themes of nonprescription treatment were identified-motivation for use, patient-provider discussions, and experience with these treatments. Perceived medication failure, barriers to treatment, and distrust of physicians drive patients to seek nonprescription therapies. Still, patients prefer to consult a physician on incorporating nonprescription therapies into treatment. Complementary and alternative medicine natural products (19.4% of posts), complementary and alternative medicine practices (16.5%), and homeopathic medicine (3.8%) were commonly discussed. Conclusion: Physicians have an opportunity to be a trusted source of information on the strengths and weaknesses of skin care products and other complementary treatments for rosacea.
    Journal of Clinical and Aesthetic Dermatology 11/2015; 8(10):30-4.
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  • Nicole C Rouse · Michael E Farhangian · Brooke Wehausen · Steven R Feldman ·
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    ABSTRACT: Given its chronicity and impact on quality of life, psoriasis is a costly disease. As new and better treatments are developed, the cost of treating psoriasis has risen. In this drug profile, the authors discuss ustekinumab, its pharmacokinetics, safety profile, and direct and indirect costs to determine its cost-efficacy. The authors searched PubMed with specific search phrases for clinical trials investigating this issue over 5 years. Eleven articles analyzed cost-effectiveness of ustekinumab, and the references of these articles were included. Studies limited to 12 weeks reported that ustekinumab may not be cost-effective as it has high cost per injection and is costly when loading doses are required. Studies that went beyond 12 weeks documented that, with ustekinumab's infrequent dosing, it is cost-effective during the maintenance period.
    Expert Review of Pharmacoeconomics & Outcomes Research 10/2015; DOI:10.1586/14737167.2015.1102634 · 1.67 Impact Factor
  • Toral S Vaidya · Kathryn L Anderson · Steven R Feldman ·
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    ABSTRACT: Background: Though psoriasis is chronic and recurring, current options can help many patients achieve good disease control.New treatments could provide greater improvement in objective disease, but it is not clear that there is room for improving subjective outcomes, particularly for patients who are already "well-controlled." Objective: To analyze treatment satisfaction of well-controlled patients with psoriasis in two patient populations of very different disease severity. Methods: Patients with well-controlled psoriasis on topicals (mild psoriasis) only or on biologics (moderate-to-severe psoriasis) were queried by telephone about perceptions of disease control, improvement level, overall treatment satisfaction, and consideration for trying new treatments. Satisfaction scores and feedback were analyzed to assess treatment type and satisfaction level associations. Results: The majority of patients, regardless of disease severity, would consider trying new treatments for psoriasis, though patients with mild psoriasis were less satisfied with their disease control, level of improvement, and overall treatment. Patient feedback revealed widespread treatment dissatisfaction, non-adherence, and inconvenience. Limitations: The patient population was from one university setting. Conclusion: 16% of patients with psoriasis meet study definition for "well-controlled" disease. Less than 20% of these well- controlled patients with psoriasis are satisfied with their current level of control and clearance and would not consider trying new treatments, suggesting the majority of well-controlled patients, regardless of disease severity, still have unmet needs. Strongerpatient-physician communication may contribute to patient-based, comprehensive care in concordance with a health system that isheaded towards financial incentives for better patient satisfaction.
    Dermatology online journal 10/2015; 21(9).
  • Sean McGregor · Michael E Farhangian · Steven R Feldman ·
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    ABSTRACT: Introduction: Current treatment options for moderate-to-severe atopic dermatitis (AD) are limited and have potentially dangerous side effects. Dupilumab is a novel monoclonal antibody that was recently studied in adult patients with moderate-to-severe AD. Dupilumab inhibits interleukin-4 (IL-4) and interleukin-13 (IL-13) signaling and was previously found to be effective in asthma. Considering that both AD and asthma are Th2 cell-mediated inflammatory processes, it is reasonable to suspect that dupilumab would be beneficial in AD.` Areas covered: This article is a review of the one major clinical trial that assessed the efficacy of dupilumab in patients with AD. Its goal is to provide a comparison to the current modalities for the treatment of AD and expert insight regarding future studies. Expert opinion: The results of this study are a significant therapeutic advancement. Dupilumab was shown to provide a mean percent change in Eczema Area and Severity Index score of -74% ± 3.6, in addition to, statistically and clinically significant reductions the severity, symptomatology, and morbidity associated with AD. However, the small sample size makes it difficult to assess the magnitude of this effect. As a result, dupilumab will likely be reserved for cases of severe AD unresponsive to traditional modalities.
    Expert Opinion on Biological Therapy 10/2015; 15(11):1-4. DOI:10.1517/14712598.2015.1076388 · 3.74 Impact Factor
  • Steven R Feldman · Yang Zhao · Lizheng Shi · Mary Helen Tran ·
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    ABSTRACT: Background: Previous studies demonstrated substantial economic and comorbidity burden associated with psoriasis (PsO) before biologics were available. Biologics have changed PsO treatment paradigms and potentially improved patient outcomes. There is a need to reassess the economic and comorbidity burden of PsO in the biologic era. Objective: To compare the prevalence of comorbidities, health care resource utilization, and costs between moderate-to-severe PsO patients and demographically matched controls. METHODS: Adults aged 18-64 years with at least 2 PsO diagnoses (ICD-9-CM code 696.1) were identified in the OptumHealth Reporting and Insights claims database from January 2007 to March 2012. Moderate-to-severe PsO patients were identified as those receiving ≥ 1 systemic therapy or phototherapy during the 12-month study period following the index date (randomly selected date after the first PsO diagnosis). Controls were free of PsO and psoriatic arthritis (PsA) and were matched 1:1 with PsO patients on age, gender, and geographic region. All patients had at least 12 months of continuous enrollment after the index date. Selected comorbidities, medication use, all-cause health care utilization, and costs were compared between PsO patients and controls. Multivariate regression models were performed to examine the association between PsO and selected comorbidities, medication use, and health care costs and utilization, adjusting for demographics, index year, insurance type, and other comorbidities. Odds ratios (ORs) were reported for any medication use, hospitalization, emergency room visit, and outpatient visit, and incidence rate ratios (IRRs) were reported for the number of medications filled. Adjusted cost differences between PsO patient and controls were also estimated. RESULTS: A total of 5,492 matched pairs of moderate-to-severe PsO patients and controls were selected, with a mean age of 47.6 years and 55.5% of patients being male. PsO patients were significantly more likely to have most of the comorbidities examined, with the top 3 most common in both groups being hyperlipidemia (33.3% vs. 27.3%), hypertension (32.8% vs. 23.5%), and diabetes (15.8% vs. 9.7%). Compared with controls, PsO patients were more likely to have any medication filled (OR = 27.5) and had more distinct number of prescription medications (IRR = 2.1; both P less than 0.01). PsO patients were more likely to have any inpatient admission (OR = 1.3), emergency room visit (OR = 1.3), and outpatient visit (OR = 29.3; all P less than 0.01). PsO patients also incurred significantly higher total, pharmacy, and medical costs (adjusted annual costs differences: $18,960, $13,990, and $3,895 per patient, respectively; all P less than 0.01) than controls. CONCLUSIONS: Compared with PsO- and PsA-free controls, moderate-to-severe PsO patients were more likely to have selected comorbidities and higher health care utilization and costs.
    09/2015; 21(10):874-888.
  • Toral S Vaidya · Robin S Lewallen · Steven R Feldman ·
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    ABSTRACT: Psoriasis is closely associated with cardiovascular comorbidities.(1) Poor adherence can affect both psoriasis outcomes and the effectiveness of treatment for cardiovascular comorbidities. We discuss a case of psoriasis medication non-adherence resulting in admission to the dermatology inpatient service for erythrodermic psoriasis. Administration of the patient's prescribed home anti-hypertensive regimen on admission resulted in a severe hypotension requiring transfer to the medical intensive care unit. This case illustrates the role of poor adherence in an erythrodermic flare of psoriasis; this case also illustrates how new-onset regimented adherence, in a formerly non-adherent patient, may result in life-threatening iatrogenic disease.
    Journal of Dermatological Treatment 09/2015; DOI:10.3109/09546634.2015.1087462 · 1.67 Impact Factor
  • Michael E Farhangian · Amy J McMichael · Karen E Huang · Steven R Feldman ·
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    ABSTRACT: Background: Alopecia Areata (AA) is a non-scarring alopecia that affects millions of Americans, however the way it is treated and which patients seek treatment is not well characterized. Objective: To better understand how AA was being treated in the United States, what type of patients are seen for AA, and what physicians treated them. Methods: We analyzed data from the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2001 to 2010. We tabulated patient characteristics, the physicians who treated AA and what treatments were prescribed for AA. Results: There were an estimated 2.6 million outpatient visits for AA. Patients with AA were most commonly treated by a dermatologists (84.8%). Patients were most commonly treated with topical and injected corticosteroids (61.0%) followed by minoxidil (5.9%) and topical tacrolimus (5.7%). Males made fewer visits per 1,000 capita compared to females (P=0.01). Limitations: The NAMCS and NHAMCS do not record severity of disease data. Conclusions: Topical and injected corticosteroids are the mainstay of treatment for AA, however the use of steroid sparing agents such as minoxidil is low. Despite no studies demonstrating efficacy, topical tacrolimus was used almost as frequently as minoxidil. J Drugs Dermatol. 2015;14(9):1012-1014.
    Journal of drugs in dermatology: JDD 09/2015; 14(9):1012-4. · 1.45 Impact Factor
  • Dane Hill · Steven R Feldman ·

    Journal of Dermatological Treatment 09/2015; DOI:10.3109/09546634.2015.1090054 · 1.67 Impact Factor
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    ABSTRACT: Atopic dermatitis affects a substantial number of children, many of whom seek initial treatment from their pediatrician or other primary care provider. Approximately two-thirds of these patients have mild disease and can be adequately managed at the primary care level. However, recent treatment guidelines are written primarily for use by specialists and lack certain elements that would make them more useful to primary care providers. This article evaluates these recent treatment guidelines in terms of evaluation criteria, treatment recommendations, usability, accessibility, and applicability to nonspecialists and integrates them with clinical evidence to present a streamlined severity-based treatment model for the management of a majority of atopic dermatitis cases. Because each patient's situation is unique, individualization of treatment plans is critical as is efficient communication and implementation of the plan with patients and caregivers. Specifically, practical suggestions for individualizing, optimizing, implementing, and communicating treatment plans such as choosing a moisturizer formulation, avoiding common triggers, educating patients/caregivers, providing written treatment plans, and scheduling physician follow-up are provided along with a discussion of available resources for patients/caregivers and providers. Copyright © 2015 by the American Academy of Pediatrics.
    PEDIATRICS 08/2015; 136(3). DOI:10.1542/peds.2014-3678 · 5.47 Impact Factor
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    ABSTRACT: Patients with psoriasis (PsO) suffer from a variety of symptoms. Tools are needed to assess psoriasis symptoms from the patient’s perspective.
    08/2015; DOI:10.1016/j.jdds.2015.07.004
  • Kathryn L. Anderson · Karen E. Huang · William W. Huang · Steven R. Feldman ·
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    ABSTRACT: Background/PurposeOne reason phototherapy use is lacking in the United States may be inadequate phototherapy education during dermatology training. The purpose of this study was to estimate the level of dermatology resident training with prescribing phototherapy and to see if inadequate education may be contributing to the underuse of phototherapy in the US.MethodsA questionnaire was developed to assess resident education and comfort with prescribing phototherapy from the resident perspective. Botulinum toxin and radiation therapy training were used as positive and negative controls, respectively. Responses were tabulated and comparisons made using Fisher's exact test and Cochran-Armitage Trend Test.Results88 residents responded. 42% and 81% of respondents reported not receiving didactic education on prescribing in-office and home phototherapy, respectively, compared to 13% for botulinum toxin and 91% for radiation therapy. 29% and 76% reported not being comfortable prescribing in-office and home phototherapy, respectively, compared to 36% for botulinum toxin and 91% for radiation therapy. Phototherapy education satisfaction was positively correlated with comfort of prescribing, and comfort prescribing was positively correlated with actual prescribing of phototherapy.Conclusions Training for prescribing phototherapy is lacking. Augmenting phototherapy training may help make home phototherapy more accessible for patients.This article is protected by copyright. All rights reserved.
    Photodermatology Photoimmunology and Photomedicine 08/2015; 31(6). DOI:10.1111/phpp.12195 · 1.26 Impact Factor
  • T. Mudigonda · K.E. Huang · S.R. Feldman ·

    Journal of Clinical and Aesthetic Dermatology 08/2015; 8(8).
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    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 · 1.67 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; 73(3). DOI:10.1016/j.jaad.2015.06.004 · 4.45 Impact Factor
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Publication Stats

14k Citations
2,025.25 Total Impact Points


  • 1998-2015
    • Wake Forest School of Medicine
      • Department of Dermatology
      Winston-Salem, North Carolina, United States
  • 2014
    • East Tennessee State University
      جونسون سيتي، تينيسي, Tennessee, United States
  • 1993-2014
    • Wake Forest University
      • • Department of Dermatology
      • • School of Medicine
      • • Department of Psychology
      • • Department of Psychiatry and Behavioral Medicine
      Winston-Salem, North Carolina, United States
    • Medical University of South Carolina
      • Department of Dermatology
      Charleston, SC, United States
  • 2012
    • University of Michigan
      Ann Arbor, Michigan, United States
  • 2011
    • University of Chicago
      Chicago, Illinois, United States
  • 2010
    • University of Notre Dame
      • College of Science
      Indiana, PA, United States
  • 1997-2010
    • Winston-Salem State University
      Winston-Salem, North Carolina, United States
  • 2008-2009
    • University of North Carolina at Greensboro
      • Department of Public Health Education
      Greensboro, North Carolina, United States
  • 2007
    • Ohio University
      Athens, Ohio, United States
    • University of Virginia
      • Department of Dermatology
      Charlottesville, Virginia, United States
  • 2005-2007
    • The Ohio State University
      • Division of Pharmacy Practice and Administration
      Columbus, Ohio, United States
    • Loyola University Medical Center
      Maywood, Illinois, United States
  • 2004
    • 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
  • 2002
    • Sunnybrook Health Sciences Centre
      • Department of Medicine
      Toronto, Ontario, Canada
    • University of California, San Francisco
      • Department of Dermatology
      San Francisco, California, United States
  • 2001-2002
    • Bristol-Myers Squibb
      New York, New York, United States
    • Georgetown University
      Washington, Washington, D.C., United States