Itch NRS Suitable for Pediatric Psoriasis Population
Use of the Itch Numeric Rating Scale (NRS) in adults with psoriasis is common, but standard use in a similar pediatric population has not been established. A qualitative study supports the content validity of the Itch NRS for pediatric patients with psoriasis. The results were published in Pediatric Dermatology.
They performed semi-structured qualitative interviews among a sample of pediatric patients diagnosed with plaque psoriasis. In total, 22 children completed concept elicitation interviews and 25 completed cognitive interviews.
When asked about their most frequent symptoms, 14 (61%) participants reported itching and 15 (65%) reported flaking. In addition, a majority of patients said the itching was bothersome, and approximately half reported that itch impacted their
regular activities.
When it came to the Itch NRS, a majority of the interviewees reported that completing the survey would be easy. They further indicated that the meaning of the response options was similar to the intended value. In general, the Itch NRS was well received and described as easy and relevant to the pediatric psoriasis experience.
The authors concluded that the qualitative study supported the content validity of the Itch NRS in pediatric patients with psoriasis as young as age 8 years. Future research, they said, should explore the impact of itch on the lives of pediatric patients with psoriasis.
Reference
Mannix S, Edson-heredia E, Paller AS, Yosipovitch G, Burge R, Kleinman L. The experience of itch in children with psoriasis: a qualitative exploration of the Itch Numeric Rating Scale. Pediatr Dermatol. Published online December 18, 2020. doi:10.1111/pde.14403
Two Agents Found to be the Most Efficient in Treating Nail Psoriasis
Tofacitinib and ixekizumab are the most effective systemic agents in treating nail psoriasis, according to a recent publication in the Journal of the American Academy of Dermatology.
Researchers performed a systematic review and network meta-analysis to evaluate the efficacy of several small molecule inhibitors and biologics in treating nail psoriasis. The improvement in nail score in 10 to 16 and 24 to 26 weeks and 100% improvement of Nail Psoriasis Severity Index (NAPSI) was analyzed.
In total, 39 studies with 13 treatment arms involving 15,673 patients with nail psoriasis were included in the systematic review and network meta-analysis. Among the studied agents, tofacitinib and ixekizumab showed the most improved nail score at 10 to 16 weeks and 24 to 26 weeks, respectively. Ixekizumab presented 100% improvement of NAPSI and showed the best efficacy among all treatments.
“Tofacitinib and ixekizumab presented the best efficacy for treating nail psoriasis in 10-16 weeks and 24-26 weeks, respectively,” concluded the study authors.
Reference
Huang IH, Wu PC, Yang TH, et al. Small molecule inhibitors and biologics in treating nail psoriasis: a systematic review and network meta-analysis. J Am Acad Dermatol. Published online January 19, 2021. doi:10.1016/j.jaad.2021.01.024
Higher Risk of COVID-19 Is Associated With Inflammatory Skin Conditions
Inflammatory skin conditions increase the risk of COVID-19 but with less severe course, according to a recent publication in the Journal of Allergy and Clinical Immunology.
“By investigating this relationship through a multi-omics approach, we sought to ascertain whether patients with skin conditions are more susceptible to COVID-19,” wrote the study authors.
Researchers conducted an epidemiological study to compare gene expressions across different inflammatory skin conditions and SARS-CoV-2 infected cell lines. A meta-analysis determined the risk of COVID-19 with psoriasis and atopic dermatitis.
COVID-19 risk is increased with inflammatory skin conditions (odds ratio [OR], 1.55; P=1.4 x 10-9), but the mechanical ventilation risk is decreased (OR, 0.22; P=8.5 x 10-5). Researchers observed overlap in gene expression between the infected normal bronchial epithelial cells and inflammatory skin diseases.
“Together our findings suggest association between inflammatory skin conditions and higher risk of COVID-19, but with less severe course, and highlight shared components involved in anti-COVID19 immune response,” concluded the study authors.
Reference
Patrick MT, Zhang H, Wasikowski R, et al. Associations between COVID-19 and skin conditions identified through epidemiology and genomic studies. J Allergy Clin Immunol. Published online January 21, 2021. doi:10.1016/j.jaci.2021.01.006
Cannulas Associated With Lower Risk of Vascular Occlusion
A recent cohort study found filler injections with a cannula was associated with a lower risk of intravascular occlusion events vs needle injections, though the majority of events were minor and resolved without further injury or scarring for both needles and cannulas.
Researchers wanted to compare the prevalence of filler-associated vascular occlusion events of the face of microcannulas vs needles. They performed a retrospective cohort study using a random sample of 370 board-certified dermatologists, with a mean (SD) years in practice of 22.3 (11.1) years. Between August 2018 and August 2019, respondents completed a form describing volume statistics pertaining to patients undergoing filler procedures in their practices.
Among the 370 participants, 1.7 million syringes of filler were injected. At least one occlusion was reported by 106 (28.6%) respondents. The study group found one occlusion per 6410 injections with a needle vs one per 40,882 injections with a cannula. Upon analysis, cannulas had 77.1% lower odds of occlusion compared with needles.
Further analysis found that respondents who had more than 5 years’ experience injecting fillers had 70.7% lower odds of occlusion than those who were less experienced with the procedure. An additional injection per week decreased the odds of occlusion by 1%. A majority (85%) of occlusions had no long-term sequelae. Occlusions were most likely to occur in the nasolabial folds and lips, though the glabella had the highest mean occlusion severity.
The study showed that that filler injections with needles and cannulas were associated with a very low risk of intravascular occlusions, with most being minor events without long-term sequelae, though cannulas were less often associated with occlusions than needles. “Whether a needle of cannulas is most appropriate for injection may depend on patient factors, anatomic site, and the type of defect being treated,” concluded the authors.
Reference
Alam M, Kakar R, Dover JS, et al. Rates of vascular occlusion associated with using needles vs cannulas for filler injection. JAMA Dermatol. Published online December 30, 2020. doi:10.1001/jamadermatol.2020.5102
Study Finds Home-Based NB-UVB Plus Corticosteroid More Effective for Localized Vitiligo
Combination treatment with a home-based handheld narrowband UV-B (NB-UVB) and a topical corticosteroid (TCS) may be a more effective option for treatment of localized vitiligo than TCS alone. The results of the study comparing the two therapies were published in British Journal of Dermatology.
Because evidence of effectiveness is limited for vitiligo treatments, the authors compared NB-UVB alone and TCS plus NB-UVB with TCS alone over a 9-month treatment period with 12-month follow-up. The randomized, placebo-controlled trial recruited patients (aged ≥5 years) with active vitiligo affecting greater than 10% of skin. In total, 517 participants were included.
Participants were randomized to receive either TCS (mometasone furoate 0.1% and dummy NB-UVB), NB-UVB (with placebo TCS), or combination therapy (TCS + NB-UVB). Patients applied TCS once daily on alternating weeks and NB-UVB was administered on alternate days in escalating doses (adjustments made for erythema). Therapy success was analyzed by a target patch assessed by the participant-reported Vitiligo Noticeability Scale.
At the study conclusion, primary outcome data were available for 370 participants. Among the three therapy arms, proportions with target patch treatment success were 17% for TCS, 22% for NB-UVB, and 27% for combination. Notably, combination treatment was superior to TCS alone (P=.032). Participants using interventions with greater than 75% expected adherence were more likely to achieve treatment success, but these effects were lost upon treatment cessation, the authors noted.
While combination treatment was relatively safe and well-tolerated as well as superior to TCS alone, it was only successful in one-quarter of participants. In addition, the authors stated more study is needed into strategies for maintaining treatment response.
Reference
Thomas KS, Batchelor JM, Akram P, et al. Randomized controlled trial of topical corticosteroid and home-based narrowband ultraviolet B for active and limited vitiligo: results of the HI-Light Vitiligo Trial. Br J Dermatol. Published online December 28, 2020. doi:10.111/bjd.19592
Acne Common Among Transgender Patients Receiving MHT
Acne increases in prevalence among transgender patients following initiation of masculinizing hormone therapy (MHT), according to a study recently published in JAMA Dermatology.
Researchers aimed to assess the risk of acne among a large population of transgender patients who received MHT, as well as define the clinical risk factors for acne diagnosis among this patient group. They conducted a retrospective cohort study using the electronic health records of patients from a community health center that serves sexual and gender minorities. To be included in the study, patients must have received MHT between January 1, 2014, and December 31, 2017, and be followed for at least 1 year.
Acne was defined by the ICD-10 clinical modification codes for the condition, and based on the data, overall prevalence and incidence proportions over 2 years following MHT initiation were calculated. Univariate analysis was used to evaluate the association of all factors with acne diagnosis, and multivariate analysis tested for independent predictors.
Among the 988 patients (median age, 25.8 years) included in the study, 307 (31.1%) were diagnosed with acne. The researchers noted that the 1-year post-MHT acne incidence proportion was 19.0%, but the 2-year incidence proportion was 25.1%. Interestingly, they found that patients who were younger at MHT initiation were more likely to develop acne.
“Acne is a common condition among transgender patients on MHT, with a prevalence increasing from 6.3% to 31.1%,” concluded the researchers. They added that patients aged 18 to 21 years may be at an increased risk of acne after MHT initiation.
Reference
Thoreson N, Park JA, Grasso C, et al. Incidence and factors associated with acne among transgender patients receiving masculinizing hormone therapy. JAMA Dermatol. Published online January 20, 2021. doi:10.1001/jamadermatol.2020.5347
