The pattern of topical corticosteroid prescribing in the United States, 1989-1991

Background: Topical corticosteroids are widely used in the treatment of skin diseases. These preparations vary greatly in potency. They are available in both brand name and generic formulations, as well as in combination products. Objective: Our purpose was to determine the pattern of topical corticosteroids prescribing in the United States and the relation of patient and prescriber attributes to the type of corticosteroid preparation prescribed. Methods: Data from the 1989 to 1991 National Ambulatory Medical Care Survey were used to estimate the number of visits with a topical corticosteroid preparation prescribed and to identify prescribers with specific characteristics. Results: In the United States, topical. corticosteroids are prescribed or recommended at an average of 14 million visits per year to office-based health practitioners. Forty percent of these visits were to dermatologists, Dermatologists were 3.9 times more likely to prescribe very high potency steroids than were other physicians. Physicians other than dermatologists were 8.4 times more Likely than dermatologists to prescribe combination agents containing moderate- or high-potency topical corticosteroids and an antiinfective agent. Conclusion: The pattern of topical corticosteroid prescribing is substantially different for dermatologists and other physicians. These differences may reflect differences in severity or complexity of the disease or differences in prescribing habits. The importance of these differences to the outcome of treated patients is not established.