High-potency Topical Corticosteroids Research Articles

High-potency steroid use in children with vitiligo: A retrospective study

Data on efficacy and safety of treatments in children with vitiligo are limited. We sought to describe the clinical outcomes and safety of children with vitiligo treated with high-potency topical corticosteroids. Clinical improvement and laboratory data were retrospectively analyzed in 101 children (0-18 years) with vitiligo treated with moderate- to high-potency topical corticosteroids. Of patients, 64% (45 of 70) had repigmentation of the lesions, 24% (17 of 70) showed no change, and 11% (8 of 70) were worse than at the initial presentation. Local steroid side effects were noted in 26% of patients at 81.7 +/- 44 days of follow-up. Cortisol levels were abnormal in 29% of patients (21 of 73). Two children with low cortisol levels were given the diagnosis of steroid-induced adrenal suppression. Children with normal and abnormal cortisol levels were not significantly different by sex, age of onset, potency of the corticosteroid use, or family history. However, children with head and/or neck affected areas were 8.36 times more likely to have an abnormal cortisol level compared with children affected in other body areas (RR 95% confidence interval: 1.19, 58.60, P = .003, n = 72). Of patients, 8% (6 of 74) had an abnormal thyrotropin test result. The retrospective design of this study presents inherent limitations. Moderate- to high-potency topical corticosteroids are efficacious in children with vitiligo, but may be associated with systemic absorption.

Líquen escleroso e atrófico: relato de dois casos de apresentação atípica

O líquen escleroso e atrófico é doença crônica da pele que se apresenta clinicamente de forma variada. Pode acometer mulheres e, menos freqüentemente, homens e crianças, sendo a área mais afetada a região anogenital. Há forte associação com doenças auto-imunes, e estudos imunogenéticos têm revelado associação com o HLA DQ7. Raramente acomete áreas extragenitais; entretanto, os autores relatam dois casos da doença, com localizações atípicas (extragenitais) e fazem uma abordagem terapêutica distinta. O uso tópico de corticoterapia de alta potência é relatado, porém, com riscos; enquanto agentes imunomoduladores tópicos são descritos com boa resposta clínica e com menor risco de atrofia.

Lichen Sclerosus of the Lip

Lichen sclerosus is a chronic inflammatory mucocutaneous disorder predominately affecting prepubertal girls and postmenopausal women. Isolated lichen sclerosus affecting the oral mucosa is exceedingly rare. Only 13 patients with biopsy-proved isolated oral disease have been reported in the literature. We report a 10-year-old Caucasian girl with a well-demarcated 1.5 cm x 1.2 cm atrophic white plaque with a violaceous border and focal telangiectases on the right inferior vermillion lip, extending on to the labial mucosa. No other cutaneous surfaces, including genitalia, were involved. Incisional biopsy of the plaque on the lip revealed a patchy lichenoid infiltrate of lymphocytes associated with sclerosis of the papillary dermis and a thinned epidermis consistent with a diagnosis of lichen sclerosus. Treatment with a short course of high potency topical corticosteroids likely prevented the progression of this lesion.

Efficacy of anti-IgE therapy in patients with atopic dermatitis

Efficacy of anti-IgE therapy in patients with atopic dermatitis

Corticosteroids: Options in the era of steroid-sparing therapy

Topical corticosteroids remain the most commonly used topical treatments for inflammatory dermatoses, including psoriasis and atopic dermatitis. Topical corticosteroids are available in a variety of vehicles-creams, ointments, lotions, gels, and, more recently, foam. The vehicle used can substantially affect the individual agent's clinical action, potency, and acceptability to the patient. Moreover, some vehicles are better suited for specific body areas. Selection of the appropriate product should be determined by area of usage, physician experience, cost, and patient preference, particularly regarding vehicle. Although topical corticosteroids are associated with several side effects, including skin atrophy, telangiectases, purpura, and striae formation, appropriate usage can minimize these occurrences. Judicious use includes short-term, appropriate application as initial monotherapy or in combination strategies with other therapeutic agents that ideally possess complementing mechanisms of action. Examples include pulsing with high-potency topical corticosteroids and combination regimens with other topical agents such as topical calcineurin inhibitors, calcipotriene, or tazarotene. Appropriate education of patients and caregivers alike will facilitate the optimal use of these medications.

Vesiculo-erosive Oral Mucosal Disease—Management with Topical Corticosteroids: (1) Fundamental Principles and Specific Agents Available

Vesiculo-erosive diseases of the oral mucosa pose a major challenge in oral medicine, because they are chronic, painful, and interfere with the daily activities and quality of life of the patients, including disturbing eating, drinking, talking, and personal relationships. Many are autoimmune diseases, and corticosteroid therapy is currently central to their treatment. These diseases present with inflammation and alterations to epithelial integrity, through cell and/or humoral immunity-mediated attack on epithelial-connective tissue targets. Until recently, despite their serious adverse effects, it was necessary to prescribe systemic corticosteroids to control severe erosive oral diseases. Now, however, many of these diseases can be controlled by high-potency topical corticosteroids, which have proved to be highly efficacious and to cause fewer adverse effects compared with systemic corticosteroids. Nevertheless, although topical corticosteroids are still the most widely used drugs in the practice of oral medicine, the scientific body of evidence for their use in the oral cavity is virtually non-existent, and therefore many of the protocols followed are, of necessity, drawn from experience of their use in a dermatological setting. This review aims to set out the key aspects of the use of topical corticosteroids in oral medicine. The issues covered include the indications and basic rules for their use, the types of corticosteroids, the drug selection, and the specific formulations.

The effect of two skin cleansing systems on moderate xerotic eczema*1

Background Moderate xerotic eczema, characterized by stratum corneum desquamation, erythema, and pruritis is a common condition that can be induced or worsened by skin cleansing. Traditional dermatologic therapy includes the use of emollients, medium or high potency topical corticosteroids, and a change in bathing habits. Objective To investigate the effect of two cleansing systems: a synthetic detergent bar soap applied with a cotton washcloth and a petrolatum-delivering body wash applied with a polyethylene puff as part of a topical treatment approach to moderate xerotic eczema. Method Sixty patients with moderate xerotic eczema were enrolled in a 4-week investigator-blinded study. Half were randomly treated with a strong topical corticosteroid cream (0.05% fluocinonide) and a traditional cleansing system consisting of a synthetic detergent bar soap applied with a washcloth. The remaining patients were treated with a weaker, medium strength topical corticosteroid cream (0.1% triamcinolone acetonide) and a novel cleansing system consisting of a petrolatum-delivering body wash applied with a polyethylene puff. Dermatologist investigator evaluations and patient self-assessments were conducted at baseline, 2 weeks, and 4 weeks. Results Patients using the novel petrolatum-delivering body wash and polyethylene puff cleansing system and the lower potency corticosteroid cream demonstrated significantly greater clinical improvement than those patients using the traditional cleansing system of a synthetic detergent beauty bar and washcloth system and the higher potency corticosteroid cream after both 2 and 4 weeks of treatment. Conclusion The cleansing system of a petrolatum-delivering body wash delivered by a polyethylene puff may be useful as a cleanser for patients with moderate xerotic eczema.

The effect of two skin cleansing systems on moderate xerotic eczema

Background Moderate xerotic eczema, characterized by stratum corneum desquamation, erythema, and pruritis is a common condition that can be induced or worsened by skin cleansing. Traditional dermatologic therapy includes the use of emollients, medium or high potency topical corticosteroids, and a change in bathing habits. Objective To investigate the effect of two cleansing systems: a synthetic detergent bar soap applied with a cotton washcloth and a petrolatum-delivering body wash applied with a polyethylene puff as part of a topical treatment approach to moderate xerotic eczema. Method Sixty patients with moderate xerotic eczema were enrolled in a 4-week investigator-blinded study. Half were randomly treated with a strong topical corticosteroid cream (0.05% fluocinonide) and a traditional cleansing system consisting of a synthetic detergent bar soap applied with a washcloth. The remaining patients were treated with a weaker, medium strength topical corticosteroid cream (0.1% triamcinolone acetonide) and a novel cleansing system consisting of a petrolatum-delivering body wash applied with a polyethylene puff. Dermatologist investigator evaluations and patient self-assessments were conducted at baseline, 2 weeks, and 4 weeks. Results Patients using the novel petrolatum-delivering body wash and polyethylene puff cleansing system and the lower potency corticosteroid cream demonstrated significantly greater clinical improvement than those patients using the traditional cleansing system of a synthetic detergent beauty bar and washcloth system and the higher potency corticosteroid cream after both 2 and 4 weeks of treatment. Conclusion The cleansing system of a petrolatum-delivering body wash delivered by a polyethylene puff may be useful as a cleanser for patients with moderate xerotic eczema.

Management of autoimmune skin disorders in the elderly.

Senescence of the skin immunological system may explain why the elderly population has an increased susceptibility to certain autoimmune skin disorders. These disorders are characterised by the production of either antibodies that react with host tissue or immune effector T cells that are autoreactive. Bullous pemphigoid is the most common autoimmune blistering disease in the elderly. Although oral corticosteroids are the best established therapy, high-potency topical corticosteroids are very useful as initial treatment and, in the elderly, should be used instead of oral prednisolone wherever possible. Pemphigus is a chronic blistering disease of which there are two main subtypes: vulgaris and foliaceous. Paraneoplastic pemphigus is a unique clinical, histological and immunologically distinct autoimmune mucocutaneous disease which tends to be relentlessly progressive. Lichen sclerosus presents specific complications and a small but definite increased risk of squamous cell carcinoma in elderly patients. It is important to be aware of practical issues such as the difficulty in applying topical corticosteroids, the mainstay treatment of this condition. Dermatomyositis is an autoimmune systemic disorder where the skin and muscles are the most commonly affected organs. Tumour-associated disease occurs more commonly in elderly patients and has a poorer prognosis. Management of the disease includes sunscreens, topical or systemic corticosteroids, antimalarials, oral immunosuppressants or intravenous immunoglobulins. It is important to bear in mind that old age modifies the management of skin diseases because of physical and social circumstances as well as the unwanted adverse effects of medications. Polypharmacy results in an increased risk of drug interactions and, therefore, drug regimens need to be kept as simple as possible. Drug-induced autoimmune skin eruptions are common amongst the elderly and usually resolve when the offending drug is discontinued.

Cost-effectiveness analysis of tacrolimus ointment versus high-potency topical corticosteroids in adults with moderate to severe atopic dermatitis

Background: Few cost-effectiveness analyses have been conducted on topical therapies for atopic dermatitis. Objective: We sought to compare cost-effectiveness of high-potency topical corticosteroids (HPTCs) and tacrolimus ointment for the treatment of moderate to severe atopic dermatitis for patients who are not responsive to or not well controlled with mid-potency topical corticosteroids. Methods: A Markov model represented the cyclic nature of atopic dermatitis. Clinical outcomes were derived from published literature. “Efficacy” was defined as disease-controlled days on which patients experienced a greater than 75% improvement in their disease. Resource use and changes in management were on the basis of opinions of a physician panel; secondary treatment was an oral antibiotic with topical corticosteroids. Sensitivity analyses were conducted for all variables. Results: The model was sensitive to duration of continuous treatment with HPTCs. HPTCs, when limited to 2-week treatment cycles, were associated with the highest total costs ($1682 per year) and the least efficacy (185 disease-controlled days). HPTCs in 4-week treatment intervals and tacrolimus ointment were similar in total costs and efficacy ($1317 vs $1323 for 194 vs 190 disease-controlled days, respectively). Although primary drug costs were higher for patients treated with tacrolimus ointment, patients treated with regimens of HPTCs incurred higher secondary drug costs. Conclusion: In the base case analyses, tacrolimus ointment was more cost-effective than HPTCs administered in 2-week treatment cycles, and similar in cost-effectiveness to 4-week cycles of HPTCs. (J Am Acad Dermatol 2003;48:553-63.)

Lichen sclerosus of the vulva in women: assessment, diagnosis, and management for the nurse practitioner.

To describe the etiology, clinical manifestations, assessment, and management of vulvar lichen sclerosus (LS) in women. Selected research and clinical articles in professional journals and online websites, peer review, educational technical bulletin from professional organization and the authors' professional clinical experiences. Vulvar LS can manifest with varied symptoms that may mimic other common vulvar disorders such as infections. Careful assessment of the vulva and biopsy of any suspicious skin changes are needed for diagnosis and management of vulvar LS. Treatment with high-potency topical corticosteroids may alleviate uncomfortable symptoms and reduce physical changes. Follow-up management is essential to check for progressing problems such as introital stenosis and to assess for skin changes that may indicate vulvar squamous cell carcinoma. Accurate diagnosis and successful management of vulvar LS requires thorough assessment of the genitalia, knowledge of the disorder and appropriate treatment and follow-up management.

A randomized multicentre, parallel group, double-blind, vehicle-controlled study to evaluate the efficacy and safety of 1% SDZ ASM 981 cream in the long-term management of atopic dermatitis in children from 3 months to 23 months of age

SDZ ASM 981 is a novel ascomycin macrolactam derivative developed for the treatment of inflammatory skin disease − especially atopic dermatitis. It specifically inhibits the release of inflammatory cytokines from T cells and has been formulated for topical use as a 1% cream. In order to assess the long-term safety and efficacy in children 3 months to 23 months of age, a multicentre, parallel group, double-blind vehicle-controlled 1-year study has been performed. Thirty-nine investigators in seven countries recruited 250 patients aged between 3 months and 23 months with a diagnosis of atopic dermatitis based on the criteria of Williams et al. These patients were randomized to either 1% SDZ ASM 981 cream [Eldel™ (pimecrolimus)] or corresponding vehicle cream (4 : 1 Elidel™: control allocation), to he applied to all affected areas. Treatment was twice a day according to need. Medium high potency topical corticosteroid was allowed as second-line medication to control refractory flares. After acute control of the flare the patient reverted to study medication to maintain control of the disease. Disease management is defined as controlling atopic dermatitis by treating early signs and symptoms with 1% SDZ ASM cream in order to prevent exacerbation to an extent that treatment with a second-line topical corticosteroid medication is required. Primary efficacy analysis was conducted on the frequency of flares observed. In addition, clinical signs and symptoms were recorded using the Eczema Area and Severity Index (EASI) subject assessment, Investigator's Global Assessment and pruritus severity assessment. Adverse events and local tolerability were also recorded. The Study demonstrated the efficacy of Elidel™ (pimecrolimus) vs. control. There was a statistically significant decrease in the number of flares in the Elidel™ group compared with control. A rapid and sustained improvement in pruritis and a significant reduction in EASI scores were also observed in the Elidel™ group. The requirement for a moderately potent topical steroid in the Elidel™ group was decreased as compared with the control group. Adverse events in both groups were similar with no significant systemic event. Infection − bacterial and viral − including the normal childhood illnesses, was similar in the two groups and application site adverse events were also similar in the two groups.

A Clinical Evaluation of Tazarotene 0.1% Gel, with and without a High- or Mid-High-Potency Corticosteroid, in Patients with Stable Plaque Psoriasis

Background: Several clinical trials have established the benefit of using a topical corticosteroid in conjunction with tazarotene gel in the treatment of plaque psoriasis. However, there is little information comparing the relative benefits of different corticosteroids, or different formulations of corticosteroids, when used adjunctively with tazarotene. Objective: This study was designed to compare the clinical benefits achieved with each of six commonly prescribed high- or mid-high-potency corticosteroid creams and ointments applied in conjunction with tazarotene 0.1% gel in the treatment of patients with stable plaque psoriasis. Methods: A 12-week, multicenter, investigator-masked, randomized, parallel-group study was performed with more than 200 patients who were randomly assigned to regimens of tazarotene 0.1% gel alone, tazarotene plus a high-potency topical corticosteroid (fluocinonide 0.05% ointment, mometasone furoate 0.1% ointment, or diflorasone diacetate 0.05% ointment), or tazarotene plus a mid-high-potency topical corticosteroid (betamethasone dipropionate 0.05% cream, fluticasone propionate 0.005% ointment, or diflorasone diacetate 0.05% cream). All medications were to be applied once daily: corticosteroids in the morning, tazarotene gel in the evening. At assessment visits, physicians made an overall evaluation of the patient's psoriasis and graded global improvement, plaque elevation, scaling, erythema, and pruritus. Patients also rated their treatment in terms of efficacy, tolerability, and satisfaction. Results: The best-performing steroid was betamethasone dipropionate 0.05% cream (a mid-high-potency steroid), followed by mometasone furoate 0.1% ointment (a high-potency steroid) and diflorasone diacetate 0.05% ointment (a high-potency steroid). Maximum improvements were achieved within 8 weeks. The best-tolerated regimen was tazarotene plus mometasone furoate 0.1% ointment and the optimal balance between efficacy and tolerability was achieved with this regimen. Conclusion: Some steroids are considerably more effective than others in optimizing the efficacy and tolerability of tazarotene therapy. With a suitable combination regimen, the duration of initial therapy (before maintenance therapy is started) need not be prolonged.

Oral lichen planus: an update.

Oral lichen planus (OLP) is a chronic autoimmune disease of unknown etiology that affects the skin and mucosae, including the oral cavity. The disease is characterized by lacy, thin white lines on a violaceous background on the oral mucosa, usually on the inside of the cheeks. The disease is also characterized by chronic inflammation and is often associated with severe pain and a burning sensation in the mouth. The etiopathogenesis of lichen planus is complex, with the involvement of T lymphocytes, mast cells, intercellular adhesion molecule-1 (ICAM-1) and major histocompatibility complex class II antigens. The immunologic process results in vacuolar degeneration, lysis of basal cells and, ultimately, liquefaction of the basal cells. The precipitating factors of OLP can be: stress, particular foods, dental plaque, systemic illness and poor oral hygiene. Often no medication is necessary for benign disease. In the case of severe pain and the burning sensation, high potency topical corticosteroids remain the most reliably effective treatment. Other available treatments are topical cyclosporine, tacrolimus, retinoids and other immunosuppressive agents. Systemic corticosteroids may be indicated in patients whose condition is unresponsive to topical corticosteroids. However, OLP remains a challenging disease to treat, in spite of the numerous treatments tried in the patient population.

Management of oral lichen planus.

Lichen planus is a relatively common disorder of the stratified squamous epithelia. Most dental and medical practitioners see patients with lichen planus, but not all are recognized as having the disease. Patients with lichen planus may have concomitant involvement of the disease in multiple sites. Oral lichen planus lesions usually have a distinctive clinical morphology and characteristic distribution, but oral lichen planus may also present a confusing array of patterns and forms, and other disorders may clinically mimic oral lichen planus. The etiopathogenesis of lichen planus appears to be complex, with interactions between genetic, environmental, and lifestyle factors. Much has now been clarified about the etiopathogenic mechanisms involved and interesting new associations, such as with liver disease, have emerged. The management of lichen planus is still not totally satisfactory in all cases and there is as yet no definitive treatment that results in long term remission, but there have been advances in the control of the condition. Amongst the many treatments available, high potency topical corticosteroids remain the most reliably effective, though topical cyclosporine, topical tacrolimus, or systemic corticosteroids may be indicated in patients whose condition is unresponsive to topical corticosteroids.

Prescription of high-potency corticosteroid agents and clotrimazole-betamethasone dipropionate by pediatricians

Family physicians, internists, and pediatricians are more likely to prescribe combination topical antifungal-topical corticosteroid preparations than are dermatologists. One such preparation, clotrimazolebetamethasone dipropionate, can cause atrophy because it has a high-potency corticosteroid component. We analyzed data from the National Ambulatory Medical Care Survey for visits to pediatricians from 1990 to 1994 and isolated visits at which a topical corticosteroid agent or clotrimazolebetamethasone dipropionate was prescribed. Pediatricians rarely prescribed single-agent, high-potency topical corticosteroid agents in managing patients with skin disorders. High-potency corticosteroid agents accounted for 5.0% of topical corticosteroid prescriptions, whereas 56.3% were lowpotency and 38.7% were medium-potency agents. Of the 696,285 mentions of clotrimazole-betamethasone dipropionate, 56.4% (389,920) were for children aged newborn to 4 years; diagnoses were erythematodesquamatous dermatoses, diaper rash, tinea, well-baby visit, and candidiasis. In contrast, for dermatologists nationwide, no drug mention existed for this combination agent for children aged newborn to 4 years over the 5-year study period. Our results show that clotrimazole-betamethasone dipropionate is prescribed inappropriately by pediatricians, especially in the treatment of young children. Pediatricians rarely use high-potency topical corticosteroid agents, but most of their use of clotrimazolebetamethasone dipropionate is in the youngest children, in whom such corticosteroid use is least appropriate. This prescription pattern suggests that some pediatricians may be unaware that clotrimazole-betamethasone dipropionate has a high-potency corticosteroid component.

The management of oral lichen planus.

To review the current literature regarding the medical treatment of oral lichen planus (OLP). PubMed on-line Medline data searches were carried out for the years 1966-1998 to identify reports on therapy of OLP. Single case reports or open trials were included if they covered new therapeutic approaches or suggested significant modifications of known treatment modalities. Review papers were limited to those dealing with the topic. Every paper was critically examined. Because of the great heterogeneity of the response criteria, many data could not be directly compared. Stronger weight was given to therapies that have proven to be effective under placebo-controlled research protocols. Attention was also drawn to potential and effective adverse effects of every drug used. Among the various medications advocated for the treatment of OLP, several lack conclusive findings from adequately controlled trials. Mainly high-potency topical corticosteroids in an adhesive medium appear at present the safest and most efficacious. Adjuvant agents as antimycotics may be useful in topical steroid treatment. Systemic corticosteroids may be occasionally indicated for severe recalcitrant erosive OLP or for diffuse mucocutaneous involvement. Topical cyclosporine should be considered in steroid-unresponsive cases considering that its efficacy in OLP could be related to a systemic effect and its high cost. Classical PUVA therapy seems to have too many side effects; topical application of psoralen is promising but still experimental. Topically and systemically delivered retinoids combined with topical corticosteroids could improve the efficacy of these agents whereas complete remission is difficult to achieve with retinoids alone and they frequently cause adverse effects. Finally, there are only few data concerning the long-term effect of the medical treatments upon the course of OLP and we do not know if therapy influences the malignant evolution of OLP.

Infantile acropustulosis revisited: history of scabies and response to topical corticosteroids.

Infantile acropustulosis (IA) is a condition of young children characterized by recurrent episodes of pruritic vesicles and pustules in an acral distribution. Several reports describe patients with scabies infestation prior to the diagnosis of IA, although the relationship between the two remains unclear. Furthermore, optimal therapy is controversial. We reviewed the history of scabies and response to therapy in 21 patients diagnosed with IA at two institutions between 1983 and 1997. A history of prior treatment for scabies was noted in 14 patients, although only two had mites, feces, or ova detected on microscopic examination for diagnostic verification. All patients were treated with topical corticosteroids (4 with class I, 12 with class II, 3 with class III, 1 with class IV, and 1 with class VI). All 18 patients who returned for follow-up experienced significant improvement or cleared completely with treatment. There were no observed cutaneous or systemic side effects from corticosteroid therapy. We conclude that a history of preceding scabies is common in patients with IA, but often this diagnosis is made without microscopic confirmation. We also demonstrate that mid- to high-potency topical corticosteroids are a safe and effective first-line therapy for patients with IA.

The Leukotriene Antagonist Zafirlukast as a Therapeutic Agent for Atopic Dermatitis

A 42-year-old man presented with a 10-year history of atopic dermatitis that was refractory to treatment with UV light, oral antihistamines, and high-potency topical corticosteroids. On presentation, he denied any other medical problems and was taking no medicines. His condition improved with the use of cyclosporine; however, this regimen was discontinued secondary to transaminitis due to hepatitis C infection, which was treated with interferon alfa. His atopic dermatitis flared after discontinuation of cyclosporine therapy. A physical examination showed erythroderma involving more than 70% of his body surface area approximately 2 weeks after cyclosporine therapy was discontinued.

PGD6 A Managed Care Cost Analysis of the Treatment of Psoriasis

There is little published on the relative costs of treatments in psoriasis. OBJECTIVE: This study was designed to assess patterns of medicationuse, costs, and health care resource utilization among US managed care psoriasis patients. METHODS:Members of 4 HMOs were identified using pharmacy outpatient and hospital claims data for a 1-year period. Patients were selected if they had (1) at least 2 claims for psoriasis (ICD-9 code 696, 696.1, and/or 696.8) or (2) 1 claim for psoriasis and 1 claim for a psoriasis drug or phototherapy. Descriptive data were collected to determine psoriasis drug and therapy use, and total and psoriasis-specific costs. RESULTS:There were 2,868 members with psoriasis identified. The data showed that 47.4% of the patients were on monotherapy and 45% of the patients were on monotherapy and 45% of the patients were on polytherapy, defined as two or more of the psoriasis-specific drugs or therapies. This coincides with recent market evaluatoins of psoriasis therapies. Topical corticosteroids were used by 82% of the patients. Claims for photochemotherapy were made by 9% of members. Eighty percent of patients received therapy from a dermatologist. There were psoriasis-related hospitalizations for 11% of the patients. The median costs for psoriasis-related hospitalizations/patients were $252–$1,383 (range: $40–$18,933). Median total psoriasis-related costs/patient were $155–$170 (range: $0–$24,334). CONCLUSION:High potency topical corticosteroids remain the most commonly used medications for psoriasis. Even though few patients were hospitalized for psoriasis, the high costs of hospitalization made it one of the cost drivers of this condition. Phototherapy procedures, office visits for non-psoriasis-specific diagnoses, and total drug costs for psoriasis were additional cost drivers of psoriasis treatment.