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.