Evidence-based dermatologic out-patient treatment.

OBJECTIVE

To determine the evidence base for routine therapeutic decisions in dermatologic out-patients.

DESIGN

A retrospective review of a random sample of primary therapy and literature.

SETTING

University hospital, dermatologic out-patient clinic in Copenhagen

MATERIAL: A random sample of the case notes from 115 out-patients.

METHOD: The evidence base of therapy prescribed when the diagnosis was ascertained was studied in literature searches in MEDLINE and EMBASE. Evidence was structured into primary evidence consisting of randomized controlled trials, and secondary evidence consisting of follow-up studies or the application of trial results between diseases with pathogenic or clinical similarities, e.g. atopic and seborrheic dermatitis.

RESULTS

Randomized controlled trials could be found describing 38% (95% confidence interval: 30-47) of all treatments. Secondary evidence was found for 33% (24-41), while no evidence was found for 23% (16-31) of the given treatments.

CONCLUSIONS

Approximately three-quarters of dermatologic out-patient therapy is based on scientific evidence ranging from randomized controlled trials to logical deduction from analogous clinical situations. The proportion of evidence-based medicine in dermatologic therapy therefore appears to be comparable with that of internal medicine and may thus be above expectations.