Variation in cash price of the generic medications most prescribed by dermatologists in pharmacies across the United States.

BACKGROUND: The United States has the highest drug costs in the world. Consumers complain about large price differences at pharmacies on generic drugs. OBJECTIVE: To evaluate variation in cash prices of generic medications most prescribed in dermatology across different drugstores and states in United States. METHOD: The 11 generic drugs most prescribed by dermatologists according to National Ambulatory Medical Care Survey were assessed. By using Google, the most common used pharmacies in United States were listed, which are located at a random selection of six states. By calling the first available number of each pharmacy in the six states and asking about the generic cash price of the smallest stock size and the most prescribed type, the data were collected. RESULTS: Drug prices varied; the median cumulative price of the 11 medications was highest at Rite Aid ($1226) and lowest at Walmart ($795.34) with 35% difference. The prices at CVS differed by 20% across different states; however, the prices at Walmart, Rite Aid and Walgreens were consistent. New York has the highest and Iowa the lowest prices, especially at CVS, ($1160.79) versus ($931.32). CONCLUSION: There are varieties in the prices for the generic medications in different pharmacies and States.

Rosacea Management.

BACKGROUND: Rosacea is a chronic inflammatory skin condition associated with four distinct subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular. PURPOSE: To review the different kinds of management for all subtypes. METHODS: We divided rosacea management into three main categories: patient education, skin care, and pharmacological/procedural interventions. RESULTS: Flushing is better prevented rather than treated, by avoiding specific triggers, decreasing transepidermal water loss by moisturizers, and blocking ultraviolet light. Nonselective ß-blockers and α2-adrenergic agonists decrease erythema and flushing. The topical α-adrenergic receptor agonist brimonidine tartrate 0.5% reduces persistent facial erythema. Intradermal botulinum toxin injection is almost safe and effective for the erythema and flushing. Flashlamp-pumped dye, potassium-titanyl-phosphate and pulsed-dye laser, and intense pulsed light are used for telangiectasias. Metronidazole 1% and azelaic acid 15% cream reduce the severity of erythema. Both systemic and topical remedies treat papulopustules. Systemic remedies include metronidazole, doxycycline, minocycline, clarithromycin and isotretinoin, while topical remedies are based on metronidazole 0.75%, azelaic acid 15 or 20%, sodium sulfacetamide, ivermectin 1%, permethrin 5%, and retinoid. Ocular involvement can be treated with oral or topical antibacterial. Rhinophyma can be corrected by dermatosurgical procedures, decortication, and various types of lasers. CONCLUSION: There are many options for rosacea management. Patients may have multiple subtypes, and each phase has its own treatment.

Additional evidence that rosacea pathogenesis may involve demodex: new information from the topical efficacy of ivermectin and praziquantel.

Additional evidence that Demodex folliculorum may contribute to the pathogenesis of papulopustular rosacea are new studies of two topical antiparasitic agents. Ivermectin and praziquantel have recently been shown to be effective in decreasing the severity of papulopustular rosacea. These two agents significantly differ in molecular structure, but yield similar antiparasitic mechanisms of action. Higher numbers of Demodex mites are found in the skin of patients with rosacea than in people with normal skin. If Demodex play a role in pathogenesis, then hypersensitivity to the mites, their flora, or their products could explain the observed efficacy of antidemodectic therapy.

Use of the emergency department for dermatologic care in the United States by ethnic group.

OBJECTIVES: The emergency department (ED) is not the ideal setting for dermatologic care, but may be widely used, especially among disadvantaged ethnic minorities. This study was performed to characterize the role of the ED in providing dermatologic care for each racial and ethnic group in the United States. METHODS: We analyzed visits from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 1993 to 2010. Settings (office-based, outpatient department or ED), diagnoses and race/ethnicity were assessed to compare usage of the ED across groups. RESULTS: Usage of the ED for dermatologic conditions increased over time (p < 0.0001). EDs were more often used for dermatologic care of black (18.3%) and Hispanic (10.5%) patients than for white patients (5.9%) and were used most in rural or small metropolitan areas. CONCLUSIONS: Providing better insurance, more dermatologists in rural areas and better dermatologic training for family physicians may help improve care for underserved populations and reduce inappropriate use of the ED.

An emerging treatment: Topical ivermectin for papulopustular rosacea.

Ivermectin shows broad-spectrum anti-parasitic activity. It kills the Demodex mites that reside in the pilosebaceous units of patients with papulopustular rosacea. Ivermectin also has anti-inflammatory effects, it decreases cellular and humoral immune responses. Inflammatory mechanisms appear to play a dominant role in the development of rosacea inflammatory lesions. Additionally, there is some evidence that it shows antimicrobial activity against Myobacterium tuberculosis and Chlamydia trachomatis. The recent clinical studies of ivermectin on rosacea show that it was superior to vehicle in reducing inflammatory lesion counts, and its tolerability was excellent. Ivermectin displays antimicrobial, antiparasitic, antibacterial, and anti-inflammatory activities.