The impact of atopic dermatitis on sexual health Misery, L.; Seneschal, J.; Reguiai, Z. ...
Journal of the European Academy of Dermatology and Venereology,
February 2019, 2019-Feb, 2019-02-00, 20190201, 2019-02, Letnik:
33, Številka:
2
Journal Article
Recenzirano
Background
Sexual health is frequently affected by chronic diseases but has been poorly investigated in patients with atopic dermatitis (AD).
Objective
To evaluate the risk factors for impaired ...sexual desire and its relationship with the burden and quality of life of patients with AD.
Methods
A multicentre prospective transversal study in patients with AD. Socio‐demographic and clinical data were obtained from all patients using a specifically developed questionnaire. In addition, patients were asked to answer validated scales, that is ABS‐A, DLQI, SF‐12 and EQ‐5D.
Results
A total of 1024 patients participated in the study. Severity of AD, sites involved and treatment type was found to negatively impact the sexual desire of patients and their partners. In addition, the involvement of the genital and visible areas was associated with a higher burden and more significant alterations in quality of life.
Conclusions
The results of this study are substantial and clearly demonstrate the deep impact of AD on sexual health, its relationship with disease‐related burden and alterations to quality of life. Psychosociological as well as neurosensory phenomena could help to understand these data.
Background
The development of vitiligo during treatment with biological agents is an unusual event and only a few isolated cases have been reported.
Objectives
To describe the clinical ...characteristics and evolution of patients developing new‐onset vitiligo following initiation of a biological agent for chronic inflammatory disease; and also to report the clinical course of pre‐existing vitiligo under biological therapy.
Methods
This nationwide multicentre, retrospective study, carried out between July 2013 and January 2015, describes the characteristics of a large series of 18 patients (psoriasis N = 8, inflammatory rheumatic diseases N = 8, ulcerative colitis N = 1, uveitis N = 1) who developed new‐onset vitiligo while receiving a biological agent.
Results
TNFα inhibitors were the most common biological agent involved (13/18) while anti‐IL‐12/23 and anti‐IL‐17 agents or abatacept were less common (4/18 and 1/18 respectively). Mean duration of biological agent exposure before vitiligo onset was 13.9 ± 16.5 months. Outcome was favourable for most patients (15/17) while maintaining the biological agent. Data were also collected for 18 patients (psoriasis N = 5, inflammatory rheumatic diseases N = 10, inflammatory bowel diseases N = 2, SAPHO N = 1) who had pre‐existing vitiligo when treatment with a biological agent started (TNFα inhibitors N = 15, ustekinumab N = 1, rituximab N = 1, tocilizumab N = 1). Vitiligo progressed in seven patients and was stable or improved in eight cases.
Conclusion
Vitiligo may thus emerge and/or progress during treatment with various biological agents, mainly TNFα inhibitors and could be a new paradoxical skin reaction. De novo vitiligo displays a favourable outcome when maintaining the biological agent, whereas the prognosis seems worse in cases of pre‐existing vitiligo.
Background
The impact of psoriasis on quality of life (QoL), sexuality and empathy requires better understanding in patient–partner relationships.
Objectives
To evaluate the influence of psoriasis on ...partner QoL, presence of sexual dysfunction (SDy) in couples and empathy in partners of psoriasis patients.
Methods
A total of 183 adult psoriasis patients and their partners participated in this observational, cross‐sectional and non‐comparative study. Severity of psoriasis was measured using the Psoriasis Area and Severity Index. Patient QoL was assessed using the Dermatology Life Quality Index and the Short Form‐12 (SF12). The impact of psoriasis on partner QoL was measured with the Family Pso and the SF12. Presence of SDy and empathy in partners were assessed using the Family Pso.
Results
Overall, 49.7% of the patients had moderate‐to‐severe psoriasis. Patient psoriasis severity and patient QoL were correlated with partner psychological distress. The largest QoL impairment was observed in female patients with moderate‐to‐severe psoriasis. The stronger QoL alteration observed in female psoriasis patients, compared to their partners, was not observed in male psoriasis patients vs. their partners. There was no relationship between partner QoL and patient age and duration of psoriasis. Most patients, but less than half of the partners, reported SDy with age being a being a significantly more important impacting factor than disease severity. Both psoriasis clinical severity and/or a significant impact on QoL were associated factors for SDy in male partners of psoriasis women, but not in female partners of psoriatic men. Reporting empathy was higher among young male partners of psoriasis patients. In both male and female partners, patient psoriasis clinical severity was not associated with empathy.
Conclusions
Psoriasis impact on patient–partner QoL, sexuality and empathy should be considered more thoroughly by dermatologists when formulating treatment plans and making treatment decisions.
Summary
Background
Omalizumab is approved as an add‐on therapy for the treatment of chronic spontaneous urticaria (CSU) in patients with inadequate response to H1‐antihistamine treatment. The ...urticaria control test (UCT) is a reliable, concise tool developed as an alternative to the 7‐day urticaria activity score (UAS7) – the standard for CSU disease activity assessment.
Objectives
This prospective, open‐label, phase IV study evaluated the efficacy and safety of omalizumab in French adult patients with CSU nonresponsive to H1‐antihistamine treatment.
Materials and methods
Patients n = 136; stratified 1 : 2 (with angio‐oedema : without angioedema) received omalizumab 300 mg subcutaneously every 4 weeks for 12 weeks. Study assessments included UCT, UAS7, angio‐oedema activity score and d‐dimer levels (exploratory objective).
Results
At Week 12, 74·6% of the patients achieved disease control UCT score ≥ 12 (primary endpoint) and 67·7% of patients showed well‐controlled disease (UAS7 ≤ 6). There was a strong negative correlation between UCT score and UAS7 at Week 12 (Spearman's correlation coefficient −0·839). Mean plasma d‐dimer concentration was elevated at baseline (1002·1 ng mL−1) and decreased notably at Week 8 (455 ng mL−1). Among the nine patients with a very high baseline d‐dimer concentration (> 3000 ng mL−1), eight were responders (UAS7 ≤ 6) at Week 12.
Conclusions
Omalizumab was efficacious in patients with CSU nonresponsive to H1‐antihistamines. The UCT was a reliable tool for disease assessment and the scores correlated well with UAS7. This study does not support the usefulness of d‐dimer to monitor long‐term disease prognosis in adult urticaria; however, it may indicate patients who respond to omalizumab.
What's already known about this topic?
Omalizumab is recommended as the third‐line treatment for chronic spontaneous urticaria (CSU), as an add‐on to H1‐antihistamines.
The urticaria control test (UCT) is a recently validated tool for disease control assessment in patients with CSU.
Elevated plasma levels of d‐dimer observed in some patients with CSU suggests a potential role of d‐dimer as a biomarker in CSU treatment response and prognosis.
What does this study add?
Omalizumab controlled symptoms and improved quality of life in French patients with moderate‐to‐severe CSU.
UCT was a reliable tool for the assessment of urticaria control.
d‐dimers are elevated in some patients with CSU and change in response to treatment with omalizumab.
This study does not support the usefulness of d‐dimer to monitor long‐term disease prognosis in adult urticaria; however, it may indicate patients who respond to omalizumab.
Linked Comment: Giménez‐Arnau. Br J Dermatol 2019; 180:12–13.
Plain language summary available online
Respond to this article
Background
Dupilumab is the first biotherapy available for the treatment of moderate‐to‐severe childhood atopic dermatitis (AD).
Objective
The aim of this study was to evaluate the effectiveness and ...safety of dupilumab in daily practice.
Methods
Patients aged 6–11, who had received a first dose of dupilumab, were included in this multicentre retrospective cohort study. The primary endpoint was change in SCORAD after 3 months of treatment. Secondary endpoints were change in IGA score at 3 months, proportion of patients with SCORAD50 and SCORAD75, description of adverse events and proportion of children in our cohort who would be excluded from pivotal phase 3 clinical trial.
Results
Eighty patients were included. After 3 months of treatment, there was a significant decrease in SCORAD (mean: 21.8 ± 13.8 vs 53.9 ± 18.5; P < 0.0001) and IGA (1.3 ± 0.8 vs 3.5 ± 0.7; P < 0.0001). Conjunctivitis was observed in 11.3% (n = 9/80); three patients experienced dupilumab facial redness (DFR); 17.5% (n = 14/80) reported injection site reactions; 6.3% (n = 5/80) discontinued treatment. 61.2% (n = 49/80) children were ineligible in the phase 3 trial.
Limitations
There is no control group. Because it was a real life study based on information from patient medical records in a French multicentre cohort, we cannot rule out the presence of reporting bias generated by the use of patient reported characteristics and missing information.
Conclusion
These real‐life data confirm the efficacy and safety of dupilumab in children with moderate to severe AD extended to dyshidrosis and atopic prurigo, but it also revealed a lower frequency of DFR and conjunctivitis. However, administration in injectable form may be a barrier in this age group.
Background
In 2018 in France, overall mean health‐related out‐of‐pocket (OOP) expenditures were 214.00€/year/patient.
Aim
To evaluate OOP expenditures for psoriasis patients in France.
Methodology
...Observational, cross‐sectional, non‐comparative, multicentre study in 3000 patients with clinically confirmed psoriasis who responded to a specific digital questionnaire collecting demographic and socio‐economic characteristics, assessing the 3 domains (severity, psychosocial impact and past history and interventions) of the patient’s Simplified Psoriasis Index (sa‐SPI) and expenditures to manage psoriasis, including OOP. Multivariate linear regression was conducted to search for factors associated with higher OOP.
Results
In total, 2681 patients completed the questionnaire and, of those, 2562 provided clinically validated data. Overall, 60% were women; the mean age was 49.4 ± 14.8 years. 30% of the patients declared that they suffered from psoriatic arthritis. The final mean sa‐SPI core was 10.86 ± 9.70.
Of these 2562 patients, 243 (9.5%) had severe, 442 (17.3%) moderate and 1877 (73.3%) mild psoriasis. In addition, 932 (36.4%) patients reported facial involvement, 724 (28.25%) genital impairment and 1124 (43.8%) lesions on the limbs.
Mean OOP expenditures to manage psoriasis per patient were 531.00€, 439.74€ ± 939.85€ for patients with mild, 791.06€ ± 1367.67€ with moderate and 1077.64€ ± 1680.14€ for patients with severe psoriasis. For patients with psoriasis in the genital area, the median amount of expenditures (251.17€; CI95% 138.35;363.99) was significantly higher than that for the face (183.85€; CI95% 78.76;288.94) or limbs (199.96€; CI95% 93.77;306.15); (P < 0.001).
More than 90% of the patients had OOP expenditures for over‐the‐counter products (97.5%) and alternative care (92.0%), especially for emollients and/or hydrating products.
Conclusion
In France, in 2019, OOP expenditures to manage psoriasis were on average more than twice as high as the overall mean health‐related OOP expenditures estimated by the French Health Agency in 2018. These results should lead health authorities to review certain standards of healthcare reimbursement.
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