Background
A considerable disease period often precedes initiation of a biologic in patients with psoriasis. Little is known about this important period in patients’ lives. Evaluation of this ...‘journey’ can reveal important insights and opportunities for physicians and healthcare decision makers.
Objectives
(i) To describe patient and treatment characteristics until the start of biologic treatment in patients with severe psoriasis, (ii) to assess shifts in early (2005–2009) versus established (2010–2015) biologics prescription periods, (iii) to assess changes in hospital/day care admissions before vs. after starting biologics.
Methods
Explorative, retrospective study on the treatment characteristics of the disease period until first biologic, presented with descriptive statistics of patients included in the BioCAPTURE registry. Journeys of 2005–2009 and 2010–2015 were compared with statistical tests to identify important shifts.
Results
Median TUS (time until conventional systemic) was 11.0 years and median TUB (time until biologic) was 18.9 years for all patients treated from 2005 to 2015. Most patients received three different conventional antipsoriatic systemic therapies. We noticed a small trend towards a shorter journey (TUB) with only two conventional systemic agents instead of three before initiating a biologic in later years (2010–2015, vs. 2005–2009). We also noticed a significant decrease in (day care) admissions comparing the two years before, versus the first two years after the start of a biologic treatment (17.7 vs. 8.6 admissions/100 follow‐up years, P < 0.001). Cyclosporine, intensive topical treatment (dithranol), retinoids and PUVA therapy lost popularity in recent years.
Conclusion
The ‘journey’ of patients with psoriasis towards a biologic is still long and characterized by many different treatments. Shifts towards fewer conventional drugs before biologic initiation and a clear decrease in hospital and day care admissions before vs. after a biologic are seen. Improvement of this journey, especially in young or recently diagnosed patients, can decrease negative influences on patients’ lives and reduce societal impact.
Background
Appropriate management and prevention of both under‐ and overtreatment in older skin cancer patients can be challenging. It could be helpful to incorporate frailty screening in ...dermato‐oncology care, since frailty is associated with adverse health outcomes.
Objectives
This study aimed to identify and prioritize the requirements a frailty screening tool (FST) should fulfil in dermato‐oncology practice and to select the best existing FST(s) for this purpose.
Methods
A modified two‐round Delphi procedure was performed among 50 Italian and Dutch specialists and patients to review and prioritize a list of potential FST requirements, using a 5‐point Likert scale. Consensus was defined as a mean score of ≥4.0. A systematic literature search was performed to identify existing multidomain FSTs, which were then assessed on the requirements resulting from the modified Delphi procedure.
Results
Consensus was achieved on evaluation of comorbidities (4.3 ± 0.7), polypharmacy (4.0 ± 0.9) and cognition (4.1 ± 0.8). The FST should have appropriate measurement properties (4.0 ± 1.0), be quickly executed (4.2 ± 0.7), clinically relevant (4.3 ± 0.7), and both easily understandable (4.1 ± 1.2) and interpretable (4.3 ± 0.7). Of the 26 identified FSTs, four evaluated the content‐related domains: the Geriatric‐8 (G8), the modified Geriatric‐8 (mG8), the Groningen Frailty Indicator (GFI) and the Senior Adult Oncology Program 2 (SAOP2) screening tool. Of these, the G8 was the most extensively studied FST, with the best psychometric properties and execution within 5 min.
Conclusions
The G8 appears the most suitable FST for assessing frailty in older adults with skin cancer, although clinical studies assessing its use in a dermato‐oncology population are needed to further assess whether or not frailty in this particular patient group is associated with relevant outcomes (e.g. complications and mortality), as seen in previous studies in other medical fields.
Nail Psoriasis, the unknown burden of disease Klaassen, K.M.G.; van de Kerkhof, P.C.M.; Pasch, M.C.
Journal of the European Academy of Dermatology and Venereology,
December 2014, Letnik:
28, Številka:
12
Journal Article
Recenzirano
Background
Psoriasis can be found at several different localizations which may be of various impact on patients' quality of life (QoL). One of the easy visible, and difficult to conceal localizations ...are the nails.
Objective
To achieve more insight into the QoL of psoriatic patients with nail psoriasis, and to characterize the patients with nail involvement which are more prone to the impact of the nail alterations caused by psoriasis.
Method
A self‐administered questionnaire was distributed to all members (n = 5400) of the Dutch Psoriasis Association. The Dermatology Life Quality Index (DLQI) and the Nail Psoriasis Quality of life 10 (NPQ10) score were included as QoL measures. Severity of cutaneous lesions was determined using the self‐administered psoriasis area and severity index (SAPASI).
Results
Patients with nail psoriasis scored significantly higher mean scores on the DLQI (4.9 vs. 3.7, P = <0.001) and showed more severe psoriasis (SAPASI, 6.6 vs. 5.3, P = <0.001). Patients with coexistence of nail bed and nail matrix features showed higher DLQI scores compared with patients with involvement of one of the two localizations exclusively (5.3 vs. 4.2 vs. 4.3, P = 0.003). Patients with only nail bed alterations scored significant higher NPQ10 scores when compared with patients with only nail matrix features. Patients with psoriatic arthritis (PsA) and nail psoriasis experiences more impairments compared with nail psoriasis patients without PsA (DLQI 5.5 vs. 4.3, NPQ10 13.3 vs. 7.0). Females scored higher mean scores on all QoL scores.
Conclusion
Greater attention should be paid to the possible impact nail abnormalities have on patients with nail psoriasis, which can be identified by nail psoriasis specific questionnaires such as the NPQ10. As improving the severity of disease may have a positive influence on QoL, the outcome of QoL measurements should be taken into account when deciding on treatment strategies.
BACKGROUNDChronic pruritus is frequently seen in daily dermatological practice and is associated with marked impact on quality of life. Research on the use of gabapentin and oral antidepressants in ...daily dermatological practice is scarce.OBJECTIVETo evaluate the efficacy and safety of gabapentin and oral antidepressants in patients with chronic pruritus in daily clinical practice.METHODSA prospective observational single-center cohort study was conducted including adult patients with chronic pruritus and an indication for systemic treatment between June 2016 and May 2019.RESULTSSystemic treatment with gabapentin and/or antidepressants was initiated in 31 patients with severe chronic pruritus (median average pruritus NRS score 7.0), in which most cases no underlying origin was identified (83.9%). In patients treated with gabapentin 900-1800 mg/day (N = 25), median average pruritus NRS decreased to 5.5 (IQR 3.0) after 4 weeks and remained stable up to 24 weeks of treatment. Efficacy of antidepressants was variable, with the highest response after initiation of amitriptyline, nortriptyline, and mirtazapine. Side effects were frequently observed in both gabapentin and antidepressant treatments; however, were mostly mild and temporary.LIMITATIONSThis was a single-site observational study, with limited sample size.CONCLUSIONTreatment with gabapentin and antidepressants should be considered in patients with chronic pruritus unresponsive to conventional treatment.
Summary
Background In the pathogenesis of psoriasis, proinflammatory T cells are strongly involved in the inflammatory process, where regulatory T‐cell (Treg) function is impaired.
Objectives As ...effective Treg function is associated with a numerical balance between Treg and effector T cells, we wondered whether Treg/T‐helper cell ratios may be associated with certain stages of the inflammatory process. We opted for the margin zone model as a dynamic approach.
Methods From nine patients with chronic plaque psoriasis, 3‐mm punch biopsies were obtained from the centre and margin of the lesion, perilesional skin and distant uninvolved skin. Skin biopsies of 10 healthy volunteers were included as a control. Samples were analysed using immunohistochemistry and immunofluorescence.
Results In the transition from symptomless to lesional skin, a significant increase of CD3+, CD4+ and Foxp3+ cells was found. In seven of nine patients the ratio of Treg (Foxp3+) vs. CD4+ T cells was higher in the distant uninvolved skin than in the perilesional and lesional skin. Interestingly, the Foxp3/CD4 ratio in the distant uninvolved skin was even higher than in the skin of healthy controls. Notably, we found that most of the interleukin (IL)‐17 expression was not related to CD4+ cells, but to mast cells.
Conclusions The relatively high Foxp3/CD4 ratio in symptomless skin of patients with psoriasis suggests an active immune controlling mechanism distant from the psoriatic plaque. In the margin and centre of the plaque the ratio appears skewed towards effector cells associated with inflammation. IL‐17, an important driver of the psoriatic process, is mostly related to mast cells, and only sporadically to T cells.
What’s already known about this topic?
•
T‐helper cells play an important role in the pathogenesis of psoriasis.
What does this study add?
•
The present study lends support for a critical role of the regulatory T cell (Treg) vs. T‐helper cell balance in the transition from symptomless to lesional psoriatic skin. Foxp3/CD4 ratios were higher in symptomless skin than in lesional psoriatic skin, and even higher than in healthy skin. This may suggest activated and functional immune controlling mechanisms in the skin of patients with psoriasis.
Summary
Background
Psychosocial stress can be a risk factor for the maintenance and exacerbation of chronic inflammatory diseases, such as psoriasis and rheumatoid arthritis (RA).
Objectives
To gain ...insight into the specificity of the psychophysiological stress response during chronic inflammation, we assessed autonomic and neuroendocrine responses to stress in different chronic inflammatory diseases.
Methods
Thirty patients with psoriasis (nine women, mean age 58·5 years ± 12·4), 34 patients with RA (16 women, mean age 60·8 years ± 9·2) and 25 healthy controls (16 women, mean age 55·6 years ± 8·7) underwent a standardized psychosocial stress task (Trier Social Stress Test). Salivary levels of α‐amylase and cortisol and self‐reported tension levels were measured before and after the stress test.
Results
The cortisol response to stress was heightened in patients with psoriasis compared with patients with RA and healthy controls, whereas there were no differences in the autonomic and self‐reported measures.
Conclusions
The altered neuroendocrine stress response in patients with psoriasis suggests that stressful events might have different physiological consequences for specific patient groups with chronic inflammatory conditions, possibly adversely affecting disease status.
What's already known about this topic?
Psychological stress can be a risk factor for maintenance and exacerbation of chronic inflammatory conditions, such as psoriasis and rheumatoid arthritis (RA).
It is not yet fully known whether patients with various chronic inflammatory conditions show distinct physiological stress response patterns.
What does this study add?
This is the first study to compare the psychophysiological stress response of patients with psoriasis, patients with RA and healthy controls.
Patients with psoriasis show a heightened cortisol response to an experimentally induced real‐life stressor compared with patients with RA and controls.
Summary
Background
Psoriasis in children has a significant negative impact on the quality of life (QoL) and effective treatment can improve this. The two‐compound ointment calcipotriol 50 μg g−1 and ...betamethasone dipropionate 0·5 mg g−1 is an effective treatment option for moderate‐to‐severe psoriasis in adults.
Objectives
To study prospectively the effectiveness and safety of calcipotriol/betamethasone dipropionate ointment in paediatric patients with mild‐to‐moderate plaque psoriasis in daily clinical practice and to investigate the influence on QoL.
Methods
Data were obtained from a prospective, longitudinal paediatric psoriasis registry, called Child‐CAPTURE. Severity was assessed using the Psoriasis Area and Severity Index (PASI) and body surface area (BSA). The Children's Dermatology Life Quality Index (CDLQI) was used to assess QoL and visual analogue scores (VAS) for pain and itch were collected. For safety data the number of (serious) adverse events was recorded.
Results
Seventy‐three patients (mean age 10·8 years, range 3–18) were treated for a median time of 35·0 weeks (range 1·0–176·0). At week 12, mean PASI decreased 15·4% (from 5·2 to 4·4), BSA barely changed, and median CDLQI decreased significantly from 5·5 to 4·0. VAS scores for pain and itch declined. At week 24, mean PASI decreased to 4·3 (17·3%). No related serious adverse events were observed.
Conclusions
In this daily clinical practice study in paediatric psoriasis, calcipotriol/betamethasone dipropionate ointment initially improved mild‐to‐moderate psoriasis and then maintained its effect. In addition, it improved QoL, with few adverse events.
What's already known about this topic?
A two‐compound ointment containing calcipotriol 50 μg g−1 and betamethasone dipropionate 0·5 mg g−1 is an effective treatment for moderate‐to‐severe psoriasis in adults.
Studies on its effectiveness in paediatric psoriasis are not available.
What does this study add?
In this prospective observational study, we provide daily clinical practice evidence on the effectiveness and safety of calcipotriol/betamethasone dipropionate ointment in children with mild‐to‐moderate plaque psoriasis.
Summary
Background
Localized scleroderma (LoS) is characterized by a phase of disease activity followed by remission. However, disease recurrences occur. Knowledge concerning these recurrences can ...help prompt treatment, thereby preventing disease damage.
Objectives
To investigate the frequency and characteristics of disease recurrences in paediatric‐ and adult‐onset LoS, and to identify patient variables that are associated with a higher risk of disease recurrence.
Methods
Retrospective chart reviews were performed of patients with LoS. Data concerning the frequency and characteristics of the disease recurrences were collected. A multivariate analysis was performed to identify patient variables that were associated with a higher risk of disease recurrence.
Results
In total, 344 patients were included in the analysis, of whom 119 (35%) had paediatric‐onset LoS and 225 (65%) had adult‐onset LoS. Disease recurrence was present in 27% (n = 32) of the paediatric‐onset group and 17% (n = 39) of the adult‐onset group (P = 0·037). Multivariate analysis identified a statistically significant association between disease recurrence and the linear LoS of the limbs subtype, independent of age at disease onset.
Conclusions
Recurrences in LoS occurred in almost one‐quarter of the patients and were most frequent in the linear LoS of the limbs subtype, independent of age at disease onset. These disease recurrences can occur even after many years of quiescent disease. Awareness of the high recurrence rates may help treating physicians to recognize reactivation of the disease, leading to a decreased delay in treatment reinitiation.
What's already known about this topic?
Localized scleroderma is characterized by a phase of disease activity followed by remission. However, disease recurrences occur.
What does this study add?
Recurrences occur in almost one‐quarter of patients and are more frequent in the linear localized scleroderma of the limbs subtype, independent of age at disease onset.
Awareness of high recurrence rates may help treating physicians to recognize reactivation of the disease, leading to a decreased delay in treatment reinitiation.
According to the guidelines for the treatment of psoriasis, phototherapy is given in courses of UVB exposure starting at 50–70% of the minimal erythema dose, MED, with subsequently incremental ...dosages, but keeping erythemal skin reactions to a minimum by restraining the dosages when necessary. In this review, this classical principle of short‐term near erythematogenic UVB therapy without further UVB maintenance therapy is challenged as it is evidently not optimal for psoriasis as a chronic condition. There is old experimental evidence supplemented with growing knowledge on the mode of action of phototherapy and more recent data on low‐level UVB regimens as maintenance therapy that should urge us to revisit our guidelines on phototherapy to address psoriasis for what it is: a chronic condition.
PDF
