Dermatology

doi: 10.1159/000494877pmid: N/A

doi: 10.1159/000495479pmid: N/A

Salame, Nicole; Perez-Chada, Lourdes M.; Singh, Sanminder; Callis Duffin, Kristina; Garg, Amit; Gottlieb, Alice B.; Latella, John; Merola, Joseph F.; Armstrong, April W.

doi: 10.1159/000490413pmid: 30121657

Treatment satisfaction is paramount to the field of dermatology. Treatment dissatisfaction directly impacts patient outcomes and health care delivery. A critical need exists for standardized, validated treatment satisfaction measures in dermatology. Comprehensive evaluation of the performance of treatment satisfaction instruments used in psoriasis is lacking. We sought to critically appraise the literature on measurement properties of treatment satisfaction instruments used in psoriasis. We performed a systematic review to identify treatment satisfaction instruments used in psoriasis and corresponding studies on their measurement properties. We followed the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology to inform a best evidence synthesis. Eleven instruments were identified. Six achieved positive content validity ratings, 2 achieved positive reliability and structural validity ratings, and 1 achieved a positive internal consistency rating. The REFlective evaLuation of psoriasis Efficacy of Treatment and Severity (REFLETS) and the Spanish Satisfaction With Treatment of Psoriasis Questionnaire (SSWTPQ) had the highest overall performance. Measurement property data for treatment satisfaction instruments were found to be insufficient in identifying a single best treatment satisfaction instrument for psoriasis. Additional studies are required to better characterize the measurement properties of treatment satisfaction measures and allow for standardized assessments across psoriasis clinical trials and clinical practice.

Calzavara-Pinton, Piergiacomo; Zanca , Arianna; Arisi, Mariachiara; Rossi, Maria Teresa ; Zane, Cristina; Venturini, Marina; Ortel, Bernhard

doi: 10.1159/000491782pmid: 30205372

Background: The prevalence of narrow-band ultraviolet B (NB-UVB) use in Europe for moderate and severe psoriasis is unknown, because national registries for psoriasis do not monitor this treatment. Objectives: To quantify the use of phototherapy, biologics or conventional treatments in psoriasis, in a setting where European Medicines Agency (EMA) eligibility criteria for biologics were strictly applied, and phototherapy was included among first-line treatments. Methods: We followed a cohort of 1,090 patients who were referred to the only centre entitled to prescribe biologics and phototherapy during a 5-year period. Results: The cumulative number of treatment cycles was: 1,047 with NB-UVB phototherapy, 650 with systemic treatments and 239 with biologics; 754 patients received at least 1 course of NB-UVB phototherapy, 422 at least 1 course with a systemic treatment and 137 with a biologic; 595 patients were treated only with phototherapy. Conclusions: Regular use of NB-UVB as first-line treatment for moderate and severe psoriasis and adherence to the EMA eligibility criteria for biologics led to a relatively restricted use of biologics.

Sigurdardottir, Gunnthorunn; Ekman, Anna-Karin; Verma, Deepti; Enerbäck, Charlotta

doi: 10.1159/000491819pmid: 30176661

Background: In psoriasis, a common immune-mediated disease affecting 2–3% of the population worldwide, there is an increased prevalence of extracutaneous diseases including obesity, the metabolic syndrome, and cardiovascular disease. This is believed to be linked to systemic inflammation. In previous studies, we have explored various markers in plasma and serum to characterize the ongoing systemic inflammation in psoriasis patients compared to controls. We have identified several markers that were altered in psoriasis patients, but which all were unresponsive to narrowband UVB (NB-UVB) treatment. Objective: The objective of the study was to evaluate the effect of NB-UVB treatment on markers of cardiovascular risk and systemic inflammation in psoriasis. Methods: The levels of 17 potential biomarkers with an association with cardiovascular risk were quantitated in plasma from 37 age- and gender-matched psoriasis patients and controls at baseline and in 21 psoriasis patients after 12 weeks of NB-UVB treatment to identify a systemic treatment response. Results: We identified the mediators endocan-1, CXCL16, and sVEGFR1, which were systemically decreased in psoriasis at baseline, as well as FABP3, FABP4, and sIL-1R1, which showed normal baseline levels. After 10–12 weeks of NB-UVB treatment, endocan-1 and CXCL16 were restored to normal levels, while sVEGFR1, FABP3, FABP4, and sIL-1R1 showed a significant reduction. Conclusion: The current study expands the number of potential biomarkers in psoriasis by including a greater number and variety of mediators, approaching the systemic inflammation from additional vantage points, including soluble immune receptors and adipocyte contribution, to provide a more complete picture of the systemic inflammatory state in psoriasis.

Wang, Ben; Liu, Ling-Ling; Zhao, Zuo-Tao; Tu, Ping

doi: 10.1159/000489701pmid: 30227428

Aim: To investigate whether the skin barrier function is impaired with regard to the pH value, water content, transepidermal water loss (TEWL), and the integrity of the stratum corneum, and whether the expression of caspase-14 is altered in moderate to severe chronic hand eczema (CHE). Methods: Thirty patients with moderate to severe CHE treated at our institute and 30 healthy volunteers were included in this study. The pH value, water content, TEWL, and the integrity of the stratum corneum were measured in all subjects. Results: Significantly increased pH value, decreased water content, elevated TEWL, and impaired integrity of the stratum corneum were observed in the lesional skin of CHE patients compared with the nonlesional skin of CHE patients and the normal skin of healthy volunteers. The expression of caspase-14 decreased in the lesional and nonlesional skin of CHE patients compared with the normal skin of healthy volunteers, especially prominent in the nonlesional skin. The mean optical density (OD) value of immunohistochemical staining for caspase-14 was significantly lower in the nonlesional skin than in the lesional skin and normal skin (p < 0.01 for both). Although the mean OD value was lower in the lesional skin than in the normal skin, the difference was not statistically significant (p > 0.05). Conclusion: Skin barrier dysfunction indeed occurs in CHE patients, which may be related to mechanisms associated with a downregulated expression of caspase-14.

Abdualrasool, Mosa; Al-Shanfari, Saad; Booalayan, Hussain; Boujarwa, Abdulwahab; Al-Mukaimi, Abdullah; Alkandery, Omar; Akhtar, Saeed

doi: 10.1159/000492054pmid: 30286465

Background: This study aimed to (i) assess the prevalence of exposure to environmental tobacco smoke (ETS) at homes, (ii) assess the prevalence of atopic dermatitis and (iii) evaluate the association between ETS exposure and atopic dermatitis status among adolescents. Methods: During October 2015, a cross-sectional study design was implemented using a self-administered, modified version of the ISAAC (International Study of Asthma and Allergies in Childhood) questionnaire among students enrolled in nine high schools of one of the six governorates of Kuwait. Prevalence of ETS exposure at home (1 or more smokers at home vs. none) and atopic dermatitis were computed. A multivariable log-binomial regression model was used to evaluate the adjusted association between ETS exposure and atopic dermatitis. Results: Of 800 invited students, 746 (93.3%) participated, of whom 74.8% were Kuwaiti and 50.1% were female with a mean (SD) age of 16.8 (0.68) years. Prevalence of ETS exposure at home was 54%. Prevalence of atopic dermatitis was 14.9%. A final multivariable log-binomial regression model showed that compared with the adolescents free from atopic dermatitis, adolescents with atopic dermatitis were significantly more likely to have had ETS exposure at home (adjusted prevalence ratio = 1.49; 95% CI: 1.03–2.14; p = 0.034) or tended to be female (adjusted prevalence ratio = 1.42; 95% CI: 0.99–2.03; p = 0.054). Conclusions: A high prevalence of ETS exposure at home among adolescents was recorded. ETS exposure and female gender were significantly associated with atopic dermatitis status. Intervention fostering voluntary adoption of a smoke-free home rule may help protect the adolescents against ETS exposure and alleviate the menace of associated morbidity.

Libon, Florence; Nikkels, Arjen F.

doi: 10.1159/000492749pmid: 30199884

Monfort, Jean-Benoît; Cury, Karine; Moguelet, Philippe; Chasset, François; Bachmeyer, Claude; Francès, Camille; Barbaud, Annick; Senet, Patricia

doi: 10.1159/000492669pmid: 30199871

Background: The histological characteristic of hypertensive leg ulcers (HLU) is the presence of “arteriolosclerosis.” The pertinence of performing a skin biopsy to diagnose HLU is questionable, as cutaneous arteriolosclerosis may be related to patient comorbidities. The objective here was to evaluate the frequency of arteriolosclerosis in skin leg biopsies performed in patients without ulcer and in control patients with HLU. Methods: We performed a retrospective study between January 2013 and July 2014. Patients were included if they had undergone a deep skin biopsy on the lower limbs, in the absence of any leg ulcer. Controls were patients with typical HLU. Results: Fifty-eight patients and 6 controls were included. Hypertension was present in 25 patients (43%). Arteriolosclerosis, defined as fibrous endarteritis, was present in 35 out of 58 patients (60%) and in all of the controls. No hyalinosis or hyperplastic proliferative arteriolosclerosis was observed in the patients or controls. Only age was an independent factor associated with the presence of cutaneous arteriolosclerosis (p &x#3c; 0.0001). Conclusion: Cutaneous arteriolosclerosis is significantly and independently associated with age. Thus, skin biopsy seems not to be necessary for the diagnosis of HLU but only for a differential diagnosis.

Tounouga, Dahlia Noëlle; Kouotou, Emmanuel Armand; Nansseu, Jobert Richie; Zoung-Kanyi Bissek, Anne-Cécile

doi: 10.1159/000492175pmid: 30205412

Background: The burden of Kaposi sarcoma (KS) is increasing fast among HIV-infected populations, but the disease remains desperately underexplored in Cameroon, where the burden of HIV is high. Methods: This is a retrospective cross-sectional study carried out over a period of 16 years (January 2001 to December 2016) at the HIV day care unit of the Central Hospital of Yaoundé, Cameroon. The diagnosis was based on clinical aspects and histological confirmation, and we used a preconstructed questionnaire for data collection through patients’ electronic and physical files. Results: Among 14,220 files reviewed, 316 cases of KS were identified, yielding a cumulative incidence of 2.2%. In the end, 266 patients (55% male) were included in this study. The patients’ age ranged from 17 to 72 years, with a mean of 37.8 ± 9.5 years. KS was the presenting manifestation of HIV in 89.8% of the cases. Cutaneous lesions occurred more often (81.6%), mainly located on the lower limbs (47.7%); mucous lesions were found in 15.8% of the patients, while 8 patients (3.0%) had associated visceral lesions. The lesions predominantly were lymphedemas (28.6%) and papulonodules (21.1%). At the diagnosis of KS, the median CD4 count was 175 cells/mm³ (interquartile range 80.5–288.5), and 150 patients (56.6%) had CD4 counts < 200 cells/mm³. Conclusions: KS is frequent among our HIV-infected patients; it seems to occur most often at a younger adult age and represents one of the presenting manifestations of HIV/AIDS in our context. It seems to equally affect men and women, occurring more often when CD4 counts are < 200 cells/mm³.