Wake Forest Study: Dermatologists Provide Better, Cheaper Care For Fungal Skin Disease

July 01, 1998

WINSTON-SALEM, N.C.--Should you see a specialist for athlete's foot? You should if you want the infection cleared up faster and at less cost, according to researchers at the Wake Forest University School of Medicine.

Researchers at the school's Department of Dermatology found that family doctors, internists and other non-dermatologists were far more likely than dermatologists to prescribe less-effective yet more costly medications for athlete's foot and other fungal skin disease.

The study has implications not only for the public, but for health maintenance organizations that typically limit access to specialists in the belief that it reduces costs.

The results of the study, funded by Westwood-Squibb Pharmaceuticals, were published today (July 1) in the Journal of the American Academy of Dermatology.

Alan Fleischer, M.D., associate professor of dermatology, and others based their conclusion on an analysis of visits to doctors for fungal skin infections as recorded in the National Ambulatory Medical Care Survey for 1990-1994.

The survey recorded 4.1 million visits to doctors for fungal skin infections during those five years. Of those 4.1 million visits, 82 percent of the visits were to doctors other than dermatologists.

The data showed that 34.1 percent of the non-dermatologists prescribed drugs that combined cortisone with anti-fungal agents, compared with just 4.8 percent of the dermatologists.

This treatment is less effective than the single agents, such as Lotrimin (made by Schering Corp.), Nizoral (Janssen Pharmaceutica Inc), Lamisil (Sandoz Pharmaceuticals Corp.) and Exelderm (Westwood-Squibb), that the overwhelming number of dermatologists prescribed, Fleischer said.

"The cortisone keeps the anti-fungal drug from working as effectively," he said. "It doesn't completely cancel it out but it does, to some degree, cancel it out." Other studies have shown failure rates of 45 percent for combination drugs, compared with just 8 percent for single agents.

The combination drugs cost more, too. Fleischer estimated that the combination drugs cost the nation's health care system $10.3 million to $24.9 million during the five years studied, depending on the drug prescribed. And this conservative estimate does not include the cost of additional office visits and prescriptions that would have been required in cases where the combination agent did not clear up the infection.

Roughly two-thirds of the visits to non-dermatologists were to family or general practitioners. They prescribed combination agents in 29 percent of the visits. Visits to internists accounted for about a sixth of the visits to non-dermatologists. They prescribed combination agents 51 percent of the time.

Fleischer conjectured that the doctors prescribing combination agents may do so because these drugs would seem to fit the symptoms.

"With some fungal infections there is a great amount of inflamation and irritation of the skin, and the patient has itching and burning," Fleischer said. These doctors may prescribe combination agents so that the cortisone can relieve the inflamation, not realizing that it negates the anti-fungal drug.

"The reason there's inflamation," Fleischer said, "is there's an infection, and the best way to treat the infection is to treat the infection, rather than the inflamation that results from the infection."

The study has important implications for HMOs, which, to reduce costs, typically require that patients first be seen by a primary care doctor, Fleischer said.

"What we are interested in are cost-effective outcomes for patients--that is, getting a patient to disease resolution quickly and efficiently.

"It might be assumed that treatment of skin disease is very straightforward, and that there are only two creams and you use Cream A or Cream B. But in fact, the recognition that there may very well be differences between how specialities manage skin diseases is very important. And this is just one piece of the puzzle that helps us understand what some of these differences are."

Contact: Robert Conn or Jim Steele at 336-716-4587
-end-


Wake Forest Baptist Medical Center

Related Infection Articles from Brightsurf:

Halving the risk of infection following surgery
New analysis by the University of Leeds and the University of Bern of more than 14,000 operations has found that using alcoholic chlorhexidine gluconate (CHG) halves the risk of infection in certain types of surgery when compared to the more commonly used povidone-iodine (PVI).

How plants shut the door on infection
A new study by an international team including University of Maryland scientists has discovered the key calcium channel responsible for closing plant pores as an immune response to pathogen exposure.

Sensing infection, suppressing regeneration
UIC researchers describe an enzyme that blocks the ability of blood vessel cells to self-heal.

Boost to lung immunity following infection
The strength of the immune system in response to respiratory infections is constantly changing, depending on the history of previous, unrelated infections, according to new research from the Crick.

Is infection after surgery associated with increased long-term risk of infection, death?
Whether experiencing an infection within the first 30 days after surgery is associated with an increased risk of another infection and death within one year was the focus of this observational study that included about 660,000 veterans who underwent major surgery.

Revealed: How E. coli knows how to cause the worst possible infection
The discovery could one day let doctors prevent the infection by allowing E. coli to pass harmlessly through the body.

UK study shows most patients with suspected urinary tract infection and treated with antibiotics actually lack evidence of this infection
New research presented at this week's European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Amsterdam, Netherlands (April 13-16, 2019) shows that only one third of patients that enter the emergency department with suspected urinary tract infection (UTI) actually have evidence of this infection, yet almost all are treated with antibiotics, unnecessarily driving the emergence of antimicrobial resistance.

Bacteria in urine doesn't always indicate infection
Doctors should think carefully before testing patients for a urinary tract infection (UTI) to avoid over-diagnosis and unnecessary antibiotic treatment, according to updated asymptomatic bacteriuria (ASB) guidelines released by the Infectious Diseases Society of America (IDSA) and published in Clinical Infectious Diseases.

Subsidies for infection control to healthcare institutions help reduce infection levels
Researchers compared three types of infection control subsidies and found that under a limited budget, a dollar-for-dollar matching subsidy, in which policymakers match hospital spending for infection control measures, was the most effective at reducing the number of hospital-acquired infections.

Dengue virus infection may cause severe outcomes following Zika virus infection during pregnancy
This study is the first to report a possible mechanism for the enhancement of Zika virus progression during pregnancy in an animal model.

Read More: Infection News and Infection Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.