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
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Contact: Robert Conn or Jim Steele
RConn@WFUBMC.edu
336-716-4587
Wake Forest University Baptist Medical Center
1-Jul-1998