MedWire News: There is a long-term trend towards use of more potent psoriasis treatments, say researchers who believe this reflects patients’ desire for improved control of their symptoms.

“A reason that psoriasis management does not meet patient expectation could be because of a discrepancy between physician and patient impression of the impact of psoriasis on quality of life,” say Steven Feldman (Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA) and team.

“However, the observed change in psoriasis management during the past 20 years indicates that dermatologists are starting to recognize this disparity.”

Feldman and co-workers studied 23.9 million visits made to US physicians during 1986–2005.

Topical corticosteroids were the most frequently prescribed drugs overall, but use of mild- and mid-potency drugs declined over time, while use of high-potency corticosteroids increased. Clobetasol, for example, was prescribed fewer than 500,000 times during 1986–1990, but more than 2 million times during 2001–2005.

Corticosteroid use increased over the first 10 years of the study, but levelled off during the later period. This plateau coincided with increased use of topical calcipotriene, systemic therapies such as methotrexate and acitretin, and, in the last 5 years of study, biological therapies.

“It appears that physicians are evolving their management of psoriasis to address patient concerns,” the researchers conclude in the Journal of the American Academy of Dermatology.

“Physicians should be prepared to offer (either directly or through referral) all appropriate psoriasis treatment options.”

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