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Differences in genital dermatoses between south Asian and white men
P1901
P1903
A randomized community interventional trial to increase awareness of sun safety: Interim analysis of 1 year of a skin cancer education program Panta Rouhani, University of Miami Miller School of Medicine, Miami, FL, United States; Robert Kirsner, MD, PhD, University of Miami Miller School of Medicine, Miami, FL, United States; Yirael Parmet, PhD, University of Miami Miller School of Medicine, Miami, FL, United States
Differences in genital dermatoses between south Asian and white men Manu Shah, Department of Dermatology, Dewsbury, West Yorkshire, United Kingdom Aim: To assess differences in demographics, presentation, diagnoses, and outcome of male genital dermatoses between South Asian and white males in Dewsbury, West Yorkshire, UK.
Florida has among the most ambient sunlight in the United States. As a result, Florida’s schoolchildren are at increased risk of excessive ultraviolet light exposure, the most important modifiable risk factor for skin cancer. As part of National Institutes of Healthesponsored research, the knowledge, attitudes, and behaviors of third to fifth graders toward sun safety and skin cancer prevention were assessed in a randomized controlled evaluation of a skin cancer education program. More than 5000 students were randomized into two groups by school, one that received the up to 3 years of education with the SunSmart America curriculum and a control group. We have analyzed the first year of education. The students were administered items tapping their knowledge of sun safety and inquiring about their self-reported engagement in sun-safe behaviors. Results of a one-way analysis of variance on the 16 schools showed that third, fourth, and fifth graders in the intervention schools had significantly higher scores on the knowledge scale after exposure to the curriculum than did students in the control schools, who had no exposure to the curriculum (F1, 14 ¼ 5.329; P ¼ .019; F1, 15 ¼ 4.744; P ¼ .024; and F1, 15 ¼ 9.022; P ¼ .005, respectively). Students in intervention schools also obtained a higher overall mean score on the sun-safe behaviors scale than students in the control schools, which was statistically significant (P between .025 and .045). These results indicate that students in all grades exposed to the SunSmart America curriculum for 1 year demonstrate greater knowledge of facts related to skin cancer and its prevention than do students who are not presented the curriculum. Further work will determine whether multiple years of educational intervention will alter knowledge, attitudes and behaviors in elementary school children and produce long-lasting attitudinal and behavioral change.
Background: Dewsbury is a large town of approximately 350,000 people. The racial mix of 82% white and 18% South Asian (Pakistani and Bangladeshi) gives a unique opportunity to study the effect of environment on different populations and differences in disease types. The study population was comprised of 308 consecutive males attending a male genital dermatoses clinic. Results: Thirty-three men were Asian (11.7%) and 275 (89.3%) were white. Asian men were younger at presentation (mean age, 37.3 yrs) than white men (mean age, 44.9 yrs; Wilcoxon rank sum; P ¼.019) and had experienced symptoms for a shorter time (1.87 yrs compared with 3.27 yrs; Wilcoxon rank sum; P ¼.006). Twenty-seven of the Asian men (82%) were circumcised compared with 34 (12%) of the white men (test of equality of proportions; P \.001). The most common presenting symptoms in Asian men were: genital rash (18; 54%), genital lesion (10; 30%), and genital itch (3; 9%). In white males, the most common presenting symptoms were genital rash (131; 54%), genital soreness (39; 14%), genital lesion (34; 12%), and tight foreskin (31; 11%). The most common clinical diagnoses in the Asian group were lichen planus (10; 30%), various benign lesions (7; 21%), eczema (6; 18%), and various forms of balanitis (4; 12%) and psoriasis (4; 12%). The most common diagnoses in the white patients were lichen sclerosus (77; 28%), various forms of balanitis (71; 26%), eczema (34; 12%), and skin lesions (21; 8%). There were only 16 patients with psoriasis (6%) and 15 with lichen planus (5%). Zoon balanitis made up 11% of the white patients’ diagnoses but was not seen in the Asian group. Asian males were more likely to develop lichen planus (P \.001) but less likely to develop lichen sclerosus (P ¼ .002). Conclusions: Asian males presenting to the male genital dermatoses clinic are younger, have symptoms for a shorter amount of time, and are more likely to present with a genital skin lesion than white males. Dermatoses relating to the foreskin are less common in Asian males. Genital lichen planus may be more common in the Asian population.
Commercial support: None identified.
Commercial support: None identified.
P1904
Conclusion: There was significant association between patient’s race and adherence to topical metroidazole. Increase in patients’ health care costs was associated with increasing age and charges paid for prescriptions. Topical metronizole seems quite an affordable option for the Medicaid population.
Does rural dwelling adversely impact stage of melanoma diagnosis of the elderly? Sallyann Coleman King, MD, Emory University Department of Dermatology, Atlanta, GA, United States; Anne Seidler, MD, Emory University Dermatology Department, Atlanta, GA, United States; Emir Veledar, PhD, Emory University Department of Dermatology, Atlanta, GA, United States; Steven Culler, PhD, Emory University School of Public Health, Atlanta, GA, United States; Suephy Chen, MD, MS, Emory University Department of Dermatology, Atlanta, GA, United States Although an earlier stage of disease at melanoma diagnosis correlates with improved survival, melanoma (MM) outcomes have progressively worsened for those over 65 years of age. Those living in rural areas may have reduced access to health care services, and therefore be diagnosed in higher stages of disease. We sought to examine whether elderly living in rural areas were more likely to be diagnosed in higher stages of MM. Data regarding patients (age [67 yrs) diagnosed with MM with staging were analyzed from the Surveillance, Epidemiology, and End ResultsMedicare datasets from 1991 to 1998. Using outpatient visits as a surrogate for health care utilization we evaluated National Claims History records. We included visits 2 years preceding diagnosis. We evaluated severity of comorbidities using the Charlson index. To determine the number of physicians visited, only records with a Healthcare Financing Administration provider specialty number and unique physician identification number were used. Of the 7111 Medicare patients, the mean age at MM diagnosis was 75.9 years, 59% were female, 85% were urban dwelling, and 51% were unmarried. Overall, for those with no comorbidities, the mean number of visits was higher for stage 0 versus stage 4 MM (16.3 vs 14.3; P ¼.07). This trend was not true for those with comorbidities. Rural patients were diagnosed in stage IV more often than urban dwellers (5.27% vs 3.71%). Rural dwellers compared to urban dwellers also had fewer visits (18.21 vs 21.94; P\.0001). Living in rural settings may limit access to medical care as evidenced by the fewer number of medical visits for these patients as compared to urban dwellers. Given our overall finding that patients with stage 0 (vs stage IV) had more outpatient visits, our finding that a higher percentage of our rural population was diagnosed with stage IV disease may indicate that the reduced number of outpatient visits contributed to their diagnosis at later stages. Therefore, rural patients may benefit from scheduled preventive skin exams. Further work needs to be done to compare the effect of urban versus rural dwelling after adjusting for demographics and comorbidities.
Commercial support: None identified.
Commercial support: None identified.
P1902 Medication adherence patterns in Medicaid-enrolled patients with rosacea Sujata Jayawant, MD, Ohio State University, Columbus, OH, United States; Isha Patel, Ohio State University, Columbus, OH, United States; Rajesh Balkrishnan, PhD, Ohio State University, Columbus, OH, United States; Steven R. Feldman, MD, PhD, Wake Forest University School of Medicine, Winston-Salem, NC, United States Objective: The objective of this study was to examine the predictors of medication adherence related to topical metronidazole and total health care costs in rosacea patients. Methods: The study population was comprised of a longitudinal cohort that followed rosacea patients enrolled in North Carolina Medicaid and who were prescribed at least one study medication (topical metronidazole, adapalene, azelaic acid, permethrin, and sulfacetamide). Patients’ demographic characteristics and components of the health care costs for metronidazole patients like the charges paid for metronidazole, total prescription, and nonprescription charges and total charges for the month were examined. Results: One thousand seven hundre and seventy-one (;69%) of the total 2587 rosacea patients had one or more prescriptions for topical metronidazole. Whites comprised 73% of the patients in the study. After controlling for other variables, adherence to metronidazole and health care costs increased with an increase in age (both P \.001). Compared to whites, African American patients were significantly less adherent to metronidazole (P \.001). Compared to whites, African Americans and other races were associated with an 8.6% and 10.3% decrease in total health care costs, respectively (both P \.001). An increase in number of metronidazole refills was not associated with an increase in health care costs.
MARCH 2009
J AM ACAD DERMATOL
AB93
P1903
A randomized community interventional trial to increase awareness of sun safety: Interim analysis of 1 year of a skin cancer education program Panta Rouhani, University of Miami Miller School of Medicine, Miami, FL, United States; Robert Kirsner, MD, PhD, University of Miami Miller School of Medicine, Miami, FL, United States; Yirael Parmet, PhD, University of Miami Miller School of Medicine, Miami, FL, United States
Differences in genital dermatoses between south Asian and white men Manu Shah, Department of Dermatology, Dewsbury, West Yorkshire, United Kingdom Aim: To assess differences in demographics, presentation, diagnoses, and outcome of male genital dermatoses between South Asian and white males in Dewsbury, West Yorkshire, UK.
Florida has among the most ambient sunlight in the United States. As a result, Florida’s schoolchildren are at increased risk of excessive ultraviolet light exposure, the most important modifiable risk factor for skin cancer. As part of National Institutes of Healthesponsored research, the knowledge, attitudes, and behaviors of third to fifth graders toward sun safety and skin cancer prevention were assessed in a randomized controlled evaluation of a skin cancer education program. More than 5000 students were randomized into two groups by school, one that received the up to 3 years of education with the SunSmart America curriculum and a control group. We have analyzed the first year of education. The students were administered items tapping their knowledge of sun safety and inquiring about their self-reported engagement in sun-safe behaviors. Results of a one-way analysis of variance on the 16 schools showed that third, fourth, and fifth graders in the intervention schools had significantly higher scores on the knowledge scale after exposure to the curriculum than did students in the control schools, who had no exposure to the curriculum (F1, 14 ¼ 5.329; P ¼ .019; F1, 15 ¼ 4.744; P ¼ .024; and F1, 15 ¼ 9.022; P ¼ .005, respectively). Students in intervention schools also obtained a higher overall mean score on the sun-safe behaviors scale than students in the control schools, which was statistically significant (P between .025 and .045). These results indicate that students in all grades exposed to the SunSmart America curriculum for 1 year demonstrate greater knowledge of facts related to skin cancer and its prevention than do students who are not presented the curriculum. Further work will determine whether multiple years of educational intervention will alter knowledge, attitudes and behaviors in elementary school children and produce long-lasting attitudinal and behavioral change.
Background: Dewsbury is a large town of approximately 350,000 people. The racial mix of 82% white and 18% South Asian (Pakistani and Bangladeshi) gives a unique opportunity to study the effect of environment on different populations and differences in disease types. The study population was comprised of 308 consecutive males attending a male genital dermatoses clinic. Results: Thirty-three men were Asian (11.7%) and 275 (89.3%) were white. Asian men were younger at presentation (mean age, 37.3 yrs) than white men (mean age, 44.9 yrs; Wilcoxon rank sum; P ¼.019) and had experienced symptoms for a shorter time (1.87 yrs compared with 3.27 yrs; Wilcoxon rank sum; P ¼.006). Twenty-seven of the Asian men (82%) were circumcised compared with 34 (12%) of the white men (test of equality of proportions; P \.001). The most common presenting symptoms in Asian men were: genital rash (18; 54%), genital lesion (10; 30%), and genital itch (3; 9%). In white males, the most common presenting symptoms were genital rash (131; 54%), genital soreness (39; 14%), genital lesion (34; 12%), and tight foreskin (31; 11%). The most common clinical diagnoses in the Asian group were lichen planus (10; 30%), various benign lesions (7; 21%), eczema (6; 18%), and various forms of balanitis (4; 12%) and psoriasis (4; 12%). The most common diagnoses in the white patients were lichen sclerosus (77; 28%), various forms of balanitis (71; 26%), eczema (34; 12%), and skin lesions (21; 8%). There were only 16 patients with psoriasis (6%) and 15 with lichen planus (5%). Zoon balanitis made up 11% of the white patients’ diagnoses but was not seen in the Asian group. Asian males were more likely to develop lichen planus (P \.001) but less likely to develop lichen sclerosus (P ¼ .002). Conclusions: Asian males presenting to the male genital dermatoses clinic are younger, have symptoms for a shorter amount of time, and are more likely to present with a genital skin lesion than white males. Dermatoses relating to the foreskin are less common in Asian males. Genital lichen planus may be more common in the Asian population.
Commercial support: None identified.
Commercial support: None identified.
P1904
Conclusion: There was significant association between patient’s race and adherence to topical metroidazole. Increase in patients’ health care costs was associated with increasing age and charges paid for prescriptions. Topical metronizole seems quite an affordable option for the Medicaid population.
Does rural dwelling adversely impact stage of melanoma diagnosis of the elderly? Sallyann Coleman King, MD, Emory University Department of Dermatology, Atlanta, GA, United States; Anne Seidler, MD, Emory University Dermatology Department, Atlanta, GA, United States; Emir Veledar, PhD, Emory University Department of Dermatology, Atlanta, GA, United States; Steven Culler, PhD, Emory University School of Public Health, Atlanta, GA, United States; Suephy Chen, MD, MS, Emory University Department of Dermatology, Atlanta, GA, United States Although an earlier stage of disease at melanoma diagnosis correlates with improved survival, melanoma (MM) outcomes have progressively worsened for those over 65 years of age. Those living in rural areas may have reduced access to health care services, and therefore be diagnosed in higher stages of disease. We sought to examine whether elderly living in rural areas were more likely to be diagnosed in higher stages of MM. Data regarding patients (age [67 yrs) diagnosed with MM with staging were analyzed from the Surveillance, Epidemiology, and End ResultsMedicare datasets from 1991 to 1998. Using outpatient visits as a surrogate for health care utilization we evaluated National Claims History records. We included visits 2 years preceding diagnosis. We evaluated severity of comorbidities using the Charlson index. To determine the number of physicians visited, only records with a Healthcare Financing Administration provider specialty number and unique physician identification number were used. Of the 7111 Medicare patients, the mean age at MM diagnosis was 75.9 years, 59% were female, 85% were urban dwelling, and 51% were unmarried. Overall, for those with no comorbidities, the mean number of visits was higher for stage 0 versus stage 4 MM (16.3 vs 14.3; P ¼.07). This trend was not true for those with comorbidities. Rural patients were diagnosed in stage IV more often than urban dwellers (5.27% vs 3.71%). Rural dwellers compared to urban dwellers also had fewer visits (18.21 vs 21.94; P\.0001). Living in rural settings may limit access to medical care as evidenced by the fewer number of medical visits for these patients as compared to urban dwellers. Given our overall finding that patients with stage 0 (vs stage IV) had more outpatient visits, our finding that a higher percentage of our rural population was diagnosed with stage IV disease may indicate that the reduced number of outpatient visits contributed to their diagnosis at later stages. Therefore, rural patients may benefit from scheduled preventive skin exams. Further work needs to be done to compare the effect of urban versus rural dwelling after adjusting for demographics and comorbidities.
Commercial support: None identified.
Commercial support: None identified.
P1902 Medication adherence patterns in Medicaid-enrolled patients with rosacea Sujata Jayawant, MD, Ohio State University, Columbus, OH, United States; Isha Patel, Ohio State University, Columbus, OH, United States; Rajesh Balkrishnan, PhD, Ohio State University, Columbus, OH, United States; Steven R. Feldman, MD, PhD, Wake Forest University School of Medicine, Winston-Salem, NC, United States Objective: The objective of this study was to examine the predictors of medication adherence related to topical metronidazole and total health care costs in rosacea patients. Methods: The study population was comprised of a longitudinal cohort that followed rosacea patients enrolled in North Carolina Medicaid and who were prescribed at least one study medication (topical metronidazole, adapalene, azelaic acid, permethrin, and sulfacetamide). Patients’ demographic characteristics and components of the health care costs for metronidazole patients like the charges paid for metronidazole, total prescription, and nonprescription charges and total charges for the month were examined. Results: One thousand seven hundre and seventy-one (;69%) of the total 2587 rosacea patients had one or more prescriptions for topical metronidazole. Whites comprised 73% of the patients in the study. After controlling for other variables, adherence to metronidazole and health care costs increased with an increase in age (both P \.001). Compared to whites, African American patients were significantly less adherent to metronidazole (P \.001). Compared to whites, African Americans and other races were associated with an 8.6% and 10.3% decrease in total health care costs, respectively (both P \.001). An increase in number of metronidazole refills was not associated with an increase in health care costs.
MARCH 2009
J AM ACAD DERMATOL
AB93