Search

Purpose: Patients report wanting more informationabout psoriasis and clear expectations from the onsetof therapy. Dermatologists do not think patientsreceive or internalize adequate information. There isa need for further explanation of treatment regimensto increase knowledge, compliance, and patientsatisfaction. Recent advancements in web technologyhave the potential to improve these psoriasisoutcomes.Methods: A web based application was created toeducate psoriasis patients using video, graphics,and textual information. An investigator blinded,randomized, controlled study evaluated the website’sefficacy in 50 psoriasis patients at Wake Forest BaptistHealth Dermatology. Patients were randomized intotwo groups: Group 1 received a link to the educationalweb app and a survey following their visit; Group 2received a link to the survey with no educational webapp. The survey assessed patient knowledge, selfreportedadherence to medication, and adequacy ofaddressing concerns. Twenty two patients completedthe study.Results: Patients in the web app group scored anaverage of 11/14 on the psoriasis knowledge quiz,whereas patients in the control group scored anaverage of 9/14 for an improvement of roughly 18%(p=0.008, n=22).Conclusion: Web app based education viaDermPatientEd.Com is an efficient way toimprove knowledge, but we did not demonstrateimprovements in self-reported medication adherenceor the ability to address concerns of psoriasis patients.

Introduction: We developed dermatology patienteducation videos and a post-operative text messageservice that could be accessed universally via webbasedapplications. A secondary outcome of thestudy was to assess patient opinions of text-messages,email, and video in the health care setting which isreported here.Methods: An investigator-blinded, randomized,controlled intervention was evaluated in 90 nonmelanomaMMS patients at Wake Forest BaptistDermatology. Patients were randomized 1:1:1:1 forexposure to: 1) videos with text messages, 2) videosonly,3) text messages-only, or 4) standard of care.Assessment measures were obtained by the use ofREDCap survey questions during the follow up visit.Results: 1) 67% would like to receive an email withinformation about the procedure beforehand2) 98% of patients reported they would like otherdoctors to use educational videos as a form of patienteducation3) 88% of our patients think it is appropriate forphysicians to communicate to patients via textmessage in certain situations.Conclusion: Nearly all patients desired physicians touse text-messages and video in their practice and themajority of patients preferred to receive an email withinformation about their procedure beforehand.

Objective: To assess the cost-effectiveness from thepayer perspective of using dermatologists versuspediatricians to treat acne in adolescents ages 10-18. Methods: A Markov model was constructed toexplore outcomes over a 2-year period from the USprivate payer perspective. Patients ages 10-18 withacne entered the model under the “dermatologist”and “pediatrician” conditions. In each 3-month cycle,each modeled patient received topical retinoids,benzoyl peroxide (BP), antibiotics, or no treatment,and could progress to an acne-free state or remainin an acne state. Results: The average patient spent42.3% of the time in acne-free states under thedermatologist condition and 28.0% of the time inacne-free states under the pediatrician condition.The cohort of 1000 patients experienced 1900 totalquality-adjusted life years (QALYs) at a cost of $2.33million in the dermatologist condition and 1883 totalQALYs at a cost of $1.62 million in the pediatriciancondition, yielding an ICER of $40,000/QALY. Mostsensitivity analyses confirmed the base case results.Conclusion: Dermatologist treatment appears costeffectiverelated to producing additional QALYs at acost of less than $100,000 per QALY gained. Healthplans should consider creating incentives to directenrollees to dermatologists for acne treatment.

Purpose: Evidence on treatment preferences of patients with moderate-to-severe atopic dermatitis (AD) in the United States (US) is limited and an assessment of treatment preferences in this group is warranted. Materials and methods: An online discrete choice experiment survey was conducted (June 2023) among US adults with self-reported moderate-to-severe AD or experience with systemic therapy who had inadequate response to topical treatments. Preference weights estimated from conditional logistic regression models were used to calculate willingness to trade off and attributes’ relative importance (RI). Results: Participants (N=300; mean age: 45years; 70% females; 52% systemic therapy experienced) preferred treatments with higher efficacy, lower risk of adverse events (AEs), and less frequent blood tests (p<.05). Treatment attributes, from high to low RI, were itch control (38%), risk of cancer (23%), risk of respiratory infections (18%), risk of heart problems (11%), sustained improvement in skin appearance (5%), blood test frequency (3%), and frequency and mode of administration (2%); together, AE attributes accounted for more than half of the RI. Conclusions: Participants preferred AD treatments that maximize itch control while minimizing AE risks, whereas mode of administration had little impact on preferences. Understanding patients’ preferences may help improve shared decision-making, potentially leading to enhanced patient satisfaction with treatment, increased engagement, and better clinical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Topical treatments for mild-to-moderate (MM) atopic dermatitis (AD) include emollients, corticosteroids, calcineurin inhibitors, a Janus kinase inhibitor, and a phosphodiesterase 4 inhibitor, which differ in multiple ways. This study aimed to quantify the conditional relative importance (CRI) of attributes of topical treatments for MM AD among adult and adolescent patients and caregivers of children with MM AD. Materials and methods: A discrete-choice experiment (DCE) survey was administered to US adults and adolescents with MM AD and caregivers of children with MM AD. Each choice task comprised 2 hypothetical topical treatments characterized by efficacy, adverse events, vehicle, and application frequency. Data were analyzed using a random-parameters logit model to calculate the CRI of each attribute. Results and conclusions: 300 adults, 331 adolescents, and 330 caregivers completed the DCE. Avoiding changes in skin color (CRI 29.0) and time until itch improves (26.6) were most important to adults, followed by time until clear/almost clear skin (17.8). Application frequency (3.0) did not have a statistically significant impact on adults’ choices. Adolescents were less concerned about changes in skin color than adults or caregivers; caregivers were less concerned about time until clear/almost clear skin than patients. Physicians should consider age-relevant aspects of preferences in treatment discussions with patients and caregivers. [ABSTRACT FROM AUTHOR]

Objective: To describe the published efficacy and adverse event rates associated with existing biologics for the treatment of pityriasis rubra pilaris (PRP). Data Sources: A literature review using the PubMed database (January 1990-July 2023) was conducted. Multiple search combinations were conducted using "pityriasis rubra pilaris" and various biologics as keywords to identify relevant articles. Study Selection and Data Extraction: Inclusion criteria included all study types that were published within the past 30 years in English and mentioned at least one biologic and PRP. A preliminary search yielded a total of 499 results. After screening using inclusion and exclusion criteria, 77 relevant articles (69 case reports, 5 case series, 2 clinical trials, and 1 retrospective analysis) were analyzed. Data Synthesis: TNF-α inhibitors have been evaluated and are effective in treating PRP. However, recent treatment with anti-interleukin (IL)-17 and anti-IL-23 therapies such as ustekinumab, secukinumab, and ixekizumab are emerging as new treatment options with a mean improvement in PRP Area and Severity Index scores, change in severity of erythema, scaling, and thickness of PRP lesions. From initial clinical trials, secukinumab and ixekizumab are promising treatment options for achieving remission. Relevance to Patient Care and Clinical Practice: This review compares the efficacy for numerous biologics and a discussion to guide clinicians on benefits and risks in choosing a biologic for PRP patients. Conclusions: Biologics may be a favourable treatment option leading to greater patient adherence due to reduced dosing frequencies, improvement in quality of life, and reduction in frequency and severity of flares. [ABSTRACT FROM AUTHOR]

When left untreated, psoriasis and rosacea can have long-term health and psychosocial implications. The purpose of this study was to estimate the percentage of Americans with psoriasis or rosacea who are not being treated. Patient data from a large claims-based database were analyzed to identify the number of patients who are treated for psoriasis or rosacea. The numbers of patients treated were compared to the estimated prevalences of these diseases in the general population, identified from previously published sources. Of the 18,632,362 patients in the database, 140,439 (0.75%) were seen for psoriasis and 165,130 (0.89%) were seen for rosacea. Based on published sources, 3.2% of Americans have psoriasis and about 5.0% have rosacea. We therefore estimated that 77% of people with psoriasis and 82% of people with rosacea are untreated. Greater awareness, resources, and community outreach projects are potential tools that could eliminate this disparity and increase the quality of life for patients with these diseases.

Although 90% of dermatologists discourage the use of tanning beds, about half of psoriasis patients report using tanning beds and most of these note improvement. The purpose of this investigation was to determine if dermatology residents are advocating the tanning bed use to their patients.

The experimental advantages of zebrafish make this model system highly amenable to the field of dermatology. Zebrafish skin development is similar to humans and its genome is ~70% orthologous to the human genome. Its external developmental process allows for genetic manipulation and analysis of embryogenesis within a short time frame with all important internal organs and skin compartments formed within 6 days. Zebrafish models of cutaneous human diseases offer insight into pathogenesis and a unique platform for testing of potential therapies. This review details the specific advantages of zebrafish and highlights its use in dermatological research.

Hypothyroidism is a common disease, and there may be a link between hypothyroidism and inflammatory skin disease. The purpose of this study is to assess whether hypothyroidism is more prevalent in psoriasis or rosacea patients. We utilized a large claims-based database to analyze rates of hypothyroidism in patients with psoriasis and rosacea compared to other patients with skin diseases. Participants were patients between 20-64 years of age with ICD-9 diagnosis codes for psoriasis, rosacea, and hypothyroidism. We found that rates of hypothyroidism in rosacea and psoriasis patients were similar to rates of hypothyroidism in those without rosacea or psoriasis.

Patient outcomes and clinical improvement are closely related to topical medication adherence, and is especially important in chronic dermatological diseases such as psoriasis. About one-fifth of patients undergoing topical treatment were dissatisfied with its convenience for various reasons. Providers can help increase adherence through selecting the correct medication vehicle, involving family members or friends in the patient’s mediation application, and explaining likely side effects to the patient prior to use of the medication. Increased inherence will lead to better psoriasis disease control.