Background Given its public health impact, there is need for broad and representative data on the humanistic burden of atopic dermatitis (AD). Objective To establish the humanistic burden of AD in US ...adults. Methods Data were from the 2013 US National Health and Wellness Survey; AD self-reports were propensity-matched with non-AD controls and with psoriasis controls. Bivariate analyses were conducted on burden outcomes between the AD and control groups. Results Demographics and baseline characteristics were comparable between matched groups. Subjects with AD (n = 349) versus non-AD controls (n = 698) had significantly higher rates of anxiety, depression, and sleep disorders (29.8%, 31.2%, and 33.2% vs 16.1%, 17.3%, and 19.2%, respectively all P < .001); a lower Short Form-36 v2 mental component summary score (44.5 vs 48.0, respectively P < .001); a lower physical component summary score (47.6 vs 49.5, respectively P = .004), and lower health utilities (0.67 vs 0.72, respectively P < .001) in addition to a higher work absenteeism rate (9.9% vs 3.6%, respectively P < .001) and activity impairment rate (33.6% vs 25.2%, respectively P < .001). Subjects with AD and psoriasis controls (n = 260 each) showed similar impairment in health-related quality of life and productivity. Limitations Data were self-reported. Conclusion AD is associated with a substantial humanistic burden that is similar in magnitude to that of psoriasis, which is also recognized for its debilitating symptoms, indicating the need for more effective treatments for AD.
Background Psoriasis is a predictor of morbidity. It is important to determine the extent to which psoriasis remains undiagnosed. Objective To determine the prevalence of psoriasis. Methods We ...conducted a cross-sectional study using the National Health and Nutrition Examination Survey 2003-2004. Results The prevalence of diagnosed psoriasis was 3.15% (95% confidence interval CI, 2.18-4.53), corresponding to 5 million adults. Approximately 17% of these patients have moderate to severe psoriasis based on body surface area report and 25% rate psoriasis a large problem in everyday life. The prevalence of undiagnosed active psoriasis by conservative estimate was 0.4% (95% CI, 0.19-0.82), corresponding to approximately 600,000 US adults, and 2.28% (95% CI, 1.47-3.50) by a broader definition, corresponding to 3.6 million US adults. Undiagnosed patients had a trend toward being more likely to be male, nonwhite, less educated, and unmarried compared with patients who had received a diagnosis. Limitations The method for determining the presence of psoriasis had limited ability to detect mild disease and only fair interrater agreement. Conclusion More than 5 million adults have been diagnosed with psoriasis. A large number have undiagnosed psoriasis and there are important disparities which may be associated with not receiving medical attention.
Psoriasis is a chronic inflammatory disease that affects more than 60 million persons worldwide and is characterized by red, scaly plaques that itch, crack, and bleed. Any area of the skin can be ...affected, with the scalp, genitals, palms, and soles being especially burdensome. The disease course is varied; approximately 20% of patients have moderate-to-severe cutaneous involvement, and among those patients, inflammatory arthritis develops in approximately 30%. Advances in genetics, immunology, and epidemiology have redefined psoriasis — previously thought to be “just a skin disease” — as a systemic condition associated with obesity, diabetes, major cardiovascular events, and a life . . .
Psoriasis is a common chronic inflammatory disease of the skin that is increasingly being recognized as a systemic inflammatory disorder. Psoriatic arthritis is a well-known comorbidity of psoriasis. ...A rapidly expanding body of literature in various populations and settings supports additional associations between psoriasis and cardiometabolic diseases, gastrointestinal diseases, kidney disease, malignancy, infection, and mood disorders. The pathogenesis of comorbid disease in patients with psoriasis remains unknown; however, shared inflammatory pathways, cellular mediators, genetic susceptibility, and common risk factors are hypothesized to be contributing elements. As additional psoriasis comorbidities continue to emerge, education of health care providers is essential to ensuring comprehensive medical care for patients with psoriasis.
Population-based estimates on the prevalence of atopic dermatitis in adults vary widely. The objectives of this study were to determine the prevalence of atopic dermatitis in the population of the ...United States, the distribution of disease severity, and its impact on health-related quality of life. Among 1,278 participating adults, the prevalence (95% confidence interval) of atopic dermatitis was 7.3% (5.9–8.8). Overall, 60.1% (56.1–64.1) of participants were classified as having mild, 28.9% (25.3–32.7) as having moderate, and 11% as having severe (8.6–13.7) disease. Patients with atopic dermatitis and those with more severe disease had higher scores in the dermatology life quality index (mean standard deviation for AD patients = 4.71 6.44 vs. control individuals = 0.97 2.12) (P < 0.001) and the hospital anxiety (mean standard deviation for AD patients = 7.03 4.80 vs. control individuals = 4.73 4.8) and depression (mean, standard deviation for AD patients = 5.83 4.54 vs. control individuals = 3.62 3.61) scales, indicating a worse impact on quality of life and an increased likelihood of anxiety or depression. Based on our prevalence estimates, 16.5 million adults would have a diagnosis of atopic dermatitis, with 6.6 million meeting criteria for moderate to severe disease. Our study confirms the high prevalence and disease burden of atopic dermatitis in this population.
The disease burden of atopic dermatitis (AD) in European populations is not well known.
To establish the disease burden in European adult patients with AD.
Data were from the 2016 National Health and ...Wellness Survey conducted in France, Germany, Italy, Spain, and the United Kingdom. Bivariate analyses were conducted on outcomes between controls without AD matched to patients with self-reported AD (both n = 1860).
Patients with AD and a subset of patients with inadequately controlled AD (IC-AD) versus controls without AD, respectively, reported significantly higher (P < .001) 36-Item Short Form Health Survey Physical and Mental Component Summaries (PCS, MCS), and anxiety (31.9% and 51.7% vs 14.4%), depression (25.8% and 36.2% vs 12.9%), and sleep disorder (22.7% and 39.7% vs 12.6%) prevalences. Patients with IC-AD versus controls without AD reported significantly greater (P < .001) overall work (57.1% vs 23.7%) and activity impairment (51.7% vs 26.5%). In addition, 21.6% of patients with AD and 37.9% of patients with IC-AD reported ≥1 emergency department visit in the previous 6 months versus 16.5% of controls without AD, and 93.1% of patients with AD versus 84.2% of those without AD had ≥1 clinician visit (both P < .001). Of these, patients with IC-AD showed greater burden on most outcomes than patients with controlled AD.
Low response rate, possible selection bias due to survey technology availability, and patient-reported data susceptible to recall bias.
Patients with AD reported significant burden on health, health-related quality of life, productivity, activities, and health care.
Early-stage cutaneous T-cell lymphoma (CTCL) is a skin-limited lymphoma with no cure aside from stem cell transplantation. Twelve patients with stage IA-IIA CTCL were treated in a phase 1 trial of ...0.03% and 0.06% topical resiquimod gel, a Toll-like receptor 7/8 agonist. Treated lesions significantly improved in 75% of patients and 30% had clearing of all treated lesions. Resiquimod also induced regression of untreated lesions. Ninety-two percent of patients had more than a 50% improvement in body surface area involvement by the modified Severity-Weighted Assessment Tool analysis and 2 patients experienced complete clearing of disease. Four of 5 patients with folliculotropic disease also improved significantly. Adverse effects were minor and largely skin limited. T-cell receptor sequencing and flow cytometry studies of T cells from treated lesions demonstrated decreased clonal malignant T cells in 90% of patients and complete eradication of malignant T cells in 30%. High responses were associated with recruitment and expansion of benign T-cell clones in treated skin, increased skin T-cell effector functions, and a trend toward increased natural killer cell functions. In patients with complete or near eradication of malignant T cells, residual clinical inflammation was associated with cytokine production by benign T cells. Fifty percent of patients had increased activation of circulating dendritic cells, consistent with a systemic response to therapy. In summary, topical resiquimod is safe and effective in early-stage CTCL and the first topical therapy to our knowledge that can induce clearance of untreated lesions and complete remissions in some patients. This trial was registered at www.clinicaltrials.gov as #NCT813320.
•Topical resiquimod is a safe, effective therapy for early-stage CTCL that can clear both treated and untreated skin lesions.•Responding patients had T-cell recruitment into skin, enhanced T-cell effector functions, and eradication of the malignant T-cell clones.
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