Steven R Feldman

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

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Publications (881)2091.27 Total impact

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    ABSTRACT: Background: Social media have become outlets for patients to voice opinions and ask questions. Since suffering from rosacea is an isolating experience and the disease is poorly understood, patients use social media to expand their knowledge about the condition. Objective: To understand rosacea patients' online health information seeking habits to obtain a better insight of their educational needs. Methods: Ten percent of posts in online rosacea forum composed of 3350 members and 27 051 posts, discussing patient viewpoints and concern, selected by stratified random sampling. Three hundred and nine queries were directly categorized to patients "seeking advice" by two investigators and qualitatively analyzed. Results: Patients primarily sought advice about treatments (n = 155, 50.1%), triggers (n = 53, 17.1%), diet (n = 48, 15.5%), skin care (n = 37, 11.9%) and special presentations of the disease (n = 22, 7.1%). Questions frequently pertained to adverse effects, efficacy and target of therapy (78, 49, 30 posts, respectively). Conclusion: Proactively providing reliable resources and comprehensive explanations on treatments, triggers, diet and skin care could be helpful in reducing patients' confusion about rosacea and enhancing rosacea patient-physician relationships.
    Preview · Article · Jan 2016 · Journal of Dermatological Treatment
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    ABSTRACT: Background: Many factors affect the depth of electrocoagulation. Objective: To evaluate the effect of current frequency and electrode size on the depth of electrocoagulation. Methods and materials: In this in vitro study, 4 cylindrical electrodes (2, 2.3, 3, and 4 mm) were used to apply 3 electrosurgical currents (0.4, 1.5, and 3 MHz) to bovine liver. Each electrode was placed at different points on the surface of the liver, and energy at various levels and frequencies was delivered to the tissue. Subsequently, cross-sections of the liver were analyzed. Results: Coagulation started at the periphery of the electrode-tissue contact area. With higher energy levels, coagulation spreads to involve the remainder of the contact area. Neither the frequency nor the electrode size had any effect on this coagulation pattern. The frequency of the current also did not show any relation with depth of coagulation; however, there was a direct correlation between the size of the electrode and the depth of coagulation. Conclusion: Larger-tip electrodes provided deeper coagulation compared with finer-tip electrodes.
    No preview · Article · Jan 2016 · Dermatologic Surgery
  • Alyson Snyder · Michael Farhangian · Steven R Feldman
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    ABSTRACT: Atopic dermatitis (AD) is one of the most commonly diagnosed dermatologic conditions in the United States. Topical agents are the mainstay of treatment for AD, and when used correctly, these therapies generally are straightforward and efficacious. However, poor adherence to treatment can prevent patients from achieving disease control. This article provides a review of the literature on patient adherence to topical therapies for AD as well as a discussion of methods to improve patient adherence to treatment in the clinical setting.
    No preview · Article · Jan 2016
  • Tejaswi Mudigonda · William Kaufman · Steven R Feldman
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    ABSTRACT: Severe atopic dermatitis can have an enormous impact on a child and the child's caregivers. Topical corticosteroids can be highly effective, but not all patients respond. If atopic dermatitis does not improve with a topical corticosteroid, poor adherence should be strongly considered as the cause of treatment failure. We report a child with horrendous atopic dermatitis whose disease resolved rapidly in the hospital when therapy was changed to a product that was easier to apply. J Drugs Dermatol. 2016;15(1):114-115.
    No preview · Article · Jan 2016 · Journal of drugs in dermatology: JDD
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    Abraham M. Korman · Dane Hill · Ali Alikhan · Steven R. Feldman
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    ABSTRACT: Psoriasis and depression are commonly associated. Depression has a direct burden on patients and can exacerbate psoriasis by reducing adherence to treatment. The purpose of this paper is to review factors relating to depression in psoriasis patients -sexual dysfunction, suicidal ideation, sleep disturbances, pruritus, stigmatization, and psoriatic arthritis-the impact of depression on adherence, and how to best screen for depression in psoriasis patients. We estimate that the prevalence of depressive symptoms in psoriasis patients is 20-30%, and that these symptoms cause 20-33% of patients to be non-adherent. The current questionnaires used for detecting depression in psoriasis patients are listed, and use of the Patient Health Questionnaire-2 followed by the Patient Health Questionnaire-9 may be a valuable depression screening tool. Management of depression in psoriasis patients is poorly studied, but currently available data are reviewed. Adequate detection and treatment of depression may improve adherence and patient outcomes.
    Preview · Article · Dec 2015 · Expert Opinion on Pharmacotherapy
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    ABSTRACT: Background: Collecting reliable and valid symptom information from patients is critical for assessing psoriasis severity in clinical research. Objective: To evaluate measurement properties of a new patient-reported outcome (PRO), the Psoriasis Symptoms and Signs Diary (PSSD). Methods: One hundred six US patients with moderate-to-severe plaque psoriasis completed two versions of the PSSD [a 24-hour recall (PSSD-24h) and 7-day recall (PSSD-7d)] using a 0-10 numerical rating scale. Reliability (test-retest and internal consistency), validity (convergent, divergent and known-groups), responsiveness, and version equivalence were evaluated. Minimally important difference was estimated. Results: Based on exploratory factor analysis and clinical input, symptom, sign, and total severity scores were established. Internal consistency (Cronbach's alpha ≥ 0.944) and test-retest reliability (intraclass correlation coefficients ≥ 0.824) were acceptable. Correlations with Dermatology Life Quality Index (DLQI) (0.489 to 0.644) indicated convergent validity, while low correlations (< 0.30) with several Short Form (SF)-36 scales indicated divergent validity. PSSD scores differed when patients were categorized by Body Surface Area, DLQI, and Psoriasis Area Severity Index scores. PSSD-24h and PSSD-7d versions were equivalent (Pearson correlations ≥ 0.953). Limitations: PSSD responsiveness should be evaluated in patients receiving treatment. Conclusion: The PSSD is reliable and valid in measuring symptoms/signs of patients with moderate-to-severe plaque psoriasis.
    No preview · Article · Dec 2015 · Journal of Dermatological Treatment
  • Darren Guffey · Steven R Feldman · William W Huang
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    ABSTRACT: Currently no broadly accepted and standardized objective ranking system for dermatology residency programs exist. A new ranking system was recently developed in an attempt to address this issue. However, it remains unclear if the algorithm employed is based on factors that have a tangible impact on the quality of training provided by dermatology residency programs [1]. Our authors surveyed all current dermatology residents in order to investigate the factors that they feel are most important in determining the strength of training provided by a residency program.
    No preview · Article · Dec 2015 · Dermatology online journal

  • No preview · Article · Nov 2015 · Pediatric Dermatology
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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.
    No preview · Article · Nov 2015 · Pediatric Dermatology
  • Dane Hill · Steven R Feldman

    No preview · Article · Nov 2015
  • 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.
    No preview · Article · Nov 2015 · Expert Opinion on Drug Safety
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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.
    No preview · Article · Nov 2015 · Journal of Clinical and Aesthetic Dermatology
  • Source

    Full-text · Dataset · Nov 2015
  • Sara W. Faulks · Steven R. Feldman

    No preview · Article · Nov 2015 · Journal of the American Academy of Dermatology
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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.
    No preview · Article · Oct 2015 · Expert Review of Pharmacoeconomics & Outcomes Research
  • 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.
    No preview · Article · Oct 2015 · Dermatology online journal
  • Steven R. Feldman · Kathryn Anderson

    No preview · Article · Oct 2015 · JAMA Dermatology
  • Steven R. Feldman · Kathryn Anderson

    No preview · Article · Oct 2015 · JAMA Dermatology
  • 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.
    No preview · Article · Oct 2015 · Expert Opinion on Biological Therapy
  • 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.
    No preview · Article · Sep 2015

Publication Stats

16k Citations
2,091.27 Total Impact Points


  • 1998-2015
    • Wake Forest School of Medicine
      • Department of Dermatology
      Winston-Salem, North Carolina, United States
  • 1993-2015
    • Wake Forest University
      • • Department of Dermatology
      • • Department of Psychology
      Winston-Salem, North Carolina, United States
    • Medical University of South Carolina
      • Department of Dermatology
      Charleston, SC, United States
  • 2014
    • Harvard Medical School
      Boston, Massachusetts, United States
    • East Tennessee State University
      جونسون سيتي، تينيسي, Tennessee, United States
  • 2012
    • University of Michigan
      Ann Arbor, Michigan, United States
  • 2011
    • University of Chicago
      Chicago, Illinois, 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 Texas Health Science Center at Houston
      • Division of Management, Policy and Community Health
      Houston, Texas, United States
    • University of North Carolina at Chapel Hill
      North Carolina, United States
    • University of Houston
      Houston, Texas, United States
    • Kent State University
      • Department of Geography
      Kent, Ohio, United States
    • Harvard University
      Cambridge, Massachusetts, 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
    • University of Toronto
      Toronto, Ontario, Canada