Dermatologists' views and opinions about photo(chemo)therapy and conventional systemic psoriasis therapies: results from a Belgian survey

Background: Experts' opinions about old and new psoriasis therapies are well documented.

Objectives: To document the views and opinions of a large, diverse group of dermatologists about psoriasis treatment.

Participants/methods: A survey was conducted among Belgian dermatologists. In addition to demographic and professional characteristics, the questionnaire assessed the self-rated level of experience, frequency of use, preference and considerations regarding UVB, PUVA, methotrexate (MTX), cyclosporin (CsA) and acitretin. Multivariate logistic regression analyses were performed to investigate predictors of these dermatologist-based outcomes.

Results: Of the 628 contacted dermatologists, 310 responded (response rate of 49.3%). The dermatologists were significantly more experienced with photo(chemo)therapy than with systemic agents (p < or = 0.02); about half reported none or little experience with MTX and CsA. Also, photo(chemo)therapies were significantly more frequently used than systemic drugs (p < or = 0.01). In the last year, almost 40% had not used and less than 10% had used MTX or CsA more than 10 times. Despite the limitations of PUVA, it was preferred to UVB, followed by acitretin (+/- phototherapy), and MTX and CsA were considered final options by most dermatologists. After adjusting for confounding variables, age, years in practice, seeing and treating more patients, residency programme and/or access to UV therapy were significantly associated with limited experience, regular use and/or preference of studied therapies.

Conclusion: Either a substantial proportion of the dermatologists does not need or wish to use conventional systemic psoriasis therapies or they may need better and more uniform training during and after their residency. This may improve patient care and patient selection for other treatments.