News - August 2021

Alopecia Areata Has High Comorbidity Burden, Few Effective Treatment Options

Approximately half of patients with alopecia areata (AA) are prescribed treatment within a year of diagnosis and existing off-label treatments are not frequently used, according to a recent publication in Advances in Therapy.

“Using administrative claims data, this analysis seeks to assess the prevalence of comorbidities, evaluate treatment patterns, and describe costs of care in patients diagnosed with AA in the USA,” wrote the study authors.

Researchers performed a retrospective, observational claims analysis utilizing data from a commercial claims and encounters database and a Medicare Supplemental database to study patients who had at least one outpatient visit, inpatient admission, or health care provider visit with an AA diagnosis between January 1, 2011, and December 21, 2018. Patients must have had no other hair loss-related disorders and have been continuously enrolled with medical and pharmacy benefits 12 months before AA diagnosis. Statistical analyses were used to summarize comorbid conditions, treatments related to AA or other autoimmune/inflammatory conditions, and all-cause and AA-specific health care costs and resource utilization identified from claims data.

Patients with AA had a high prevalence of comorbidities, with 22.4% having hyperlipidemia, 21.8% hypertension, 13.1% thyroid disorders, 10.8% contact dermatitis or eczema, 9.5% depression, and 8.4% anxiety. Autoimmune diseases associated with AA included atopic dermatitis, psoriasis, chronic urticaria, and rheumatoid arthritis. During the 12-month follow-up, 55.8% of patients were prescribed treatment for their AA or other comorbidities. Within 7 days of AA diagnosis, 44.9% of treated patients were prescribed therapy. Most patients received topical steroids and less received oral steroids. All-causes expenses reached $11,241 while AA costs were $419.12.

“Patients with AA have a high comorbidity burden and lack of treatment,” concluded the study authors. “Current AA treatments, including systemic therapies other than oral steroids, were not frequently utilized in this study population...Health care costs incurred by patients with AA went beyond AA-related expenses.”

Reference
Senna M, Ko J, Tosti A, et al. Alopecia areata treatment patterns, healthcare resource utilization, and comorbidities in the US population using insurance claims. Adv Ther. 2021;10.1007/s12325-021-01845-0. doi:10.1007/s12325-021-01845-0

Hidradenitis Suppurativa Likely Caused by Gene-Gene Interactions

Genetics play a large role in hidradenitis suppurativa (HS) susceptibility, according to a recent study.

“Our objective was to estimate the relative importance of genetic and environmental factors underlying HS susceptibility,” wrote the study authors. They joined information on zygosity with that of HS status through a national registry. HS cases were identified and heritability was assessed. From the registry of approximately 100,000 twins, 170 twins (from 163 pairs) were diagnosed with HS.

Results were highly indicative of gene-gene interactions. Twin pairs were monozygotic with a case-wise concordance rate of 28% and corresponding familial risk of 73 times that of the background population. Biometrical modelling suggested a heritability of 0.80 with a multilocus index of 230, noting a possibility of up to six interacting loci.

“This twin study is substantially larger, and employs a more valid phenotype than prior studies,” concluded the study authors. “Genet- ics account for the majority of the HS susceptibility, and HS is most likely caused by gene-gene interactions rather than monogenetic mutations or solely additive genetic factors,” they continued.

Reference
Kjaersgaard Andersen R, Clemmensen SB, Larsen LA, et al. Evidence of gene-gene interaction in Hidradenitis suppurativa - a nationwide register study of Danish twins. Br J Dermatol. Published July 21, 2021. doi:10.1111/bjd.20654

Patients With Uncontrolled AD Dissatisfied With Treatment Strategies

Patients with uncontrolled atopic dermatitis (AD) are highly dissatisfied with their therapy and have a negative outlook on their quality of life (QOL), according to a recent study published in Dermatology and Therapy.

“The objective of this study was to investigate the effects of topical AD therapies on disease control, physician and patient treatment satisfaction, and QOL in a real-world setting,” wrote the study authors.

Researchers performed a retrospective, point-in-time study of physician-completed medical records and patient surveys. Patient-reported outcomes included the Dermatology Life Quality Index (DLQI), Children’s DLQI (CDLQI), Patient-Oriented Eczema Measure (POEM), and the Work Productivity and Activity Impairment (WPAI) questionnaire.

Results showed that 24.5% of patients had physician-reported uncontrolled AD. Rates of physician dissatisfaction with current treatment were 32% and were 24.8% for patients. The percentages were higher for patients with uncontrolled AD compared with controlled AD. Poorer disease control correlated with higher rates of treatment dissatisfaction and were reported among patients receiving topical with systemic therapy. Increased impairment in the DLQI, CDLGI, POEM, and WPAI were also reported with uncontrolled disease.

“In summary, doctors and their patients currently using topical medications to treat AD reported that treatments were not working well enough and that uncontrolled disease was negatively affecting patients’ quality of life and work, indicating that additional treatment options are needed,” concluded the study authors.

Reference
Anderson P, Austin J, Lofland JH, Piercy J, Joish VN. Inadequate disease control, treatment dissatisfaction, and quality-of-life impairments among US patients receiving topical therapy for atopic dermatitis. Dermatol Ther (Heidelb). 2021;10.1007/ s13555-021-00580-2. doi:10.1007/s13555-021-00580-2

Integrative Medicine Common for Patients With Cutaneous T-Cell Lymphoma

Integrative medicine is commonly used by patients with cutaneous T-cell lymphoma (CTCL), according to the results of a study published in Complementary Therapies in Medicine.

Researchers sought identify patterns of integrative medicine use and health-related quality of life (HRQoL) in patients with CTCL through a cross-sectional, online survey, created in conjunction with the Cutaneous Lymphoma Foundation and distributed to its social media followers and listserv.

Upon analysis, 292 responses were included, with 87% of respondents having mycosis fungoides and 12% having Sézary syndrome. Of the participants, 59% reported using integrative medicine for their CTCL, with 48% using it to treat and 47% to manage symptoms. Commonly used modalities of integrative medicine used included vitamins/minerals (32%), prayer/meditation (26%), diet (24%), and exercise/yoga (22%). Patients who used integrative medicine reported higher itch scores vs nonusers, and HRQoL was worse among patients who reported using integrative medicine.

In conclusion, use of integrative medicine is common among patients with CTCL. “[Integrative medicine] interventions require further study given use by CTCL patients to treat disease and ameliorate symptoms,” added the study authors.

Reference
Mahurin HM, Tarabadkar E, Hippe DS, et al. Integrative medicine use in patients with cutaneous T-Cell lymphoma: a cross-sectional survey study. Complement Ther Med. 2021;61:102762. doi:10.1016/j.ctim.2021.102762

Greater Microbiome Diversity and Biofilm Found in Noninflammatory Comedones of Acne

Noninflammatory comedones of acne vulgaris contain biofilm formations and greater microbiota diversity compared with papules and uninvolved skin, according to a recent study published in International Journal of Dermatology.

Researchers examined biofilm and skin microbiota in patients with acne to understand the role of these factors in the development of acne lesions. Thin sections of punch biopsy specimens of uninflamed comedones, inflammatory lesions, and uninvolved adjacent skin of patients were examined. Biofilms were detected using epifluorescence and confocal laser scanning microscopy. Microbiota were analyzed using pyrosequencing with taxonomic classification of 16s rRNA gene amplicons.

Of the 39 skin specimens examined, 23% contained biofilm. Comedones most frequently contained biofilm (55.6%) vs biofilm being present in only 22.2% of papules and uninvolved skin. The highest alpha diversity and greatest abundance of Staphylococcus was also found in comedones.

“The microenvironment of the comedone differs from that of inflammatory lesions and unaffected skin,” concluded the study authors. “The increased frequency of biofilm in comedones may account for the lack of host inflammatory response to these lesions,” they continued.

Reference
Loss M, Thompson KG, Agostinho-Hunt A, et al. Noninflammatory comedones have greater diversity in microbiome and are more prone to biofilm formation than inflammatory lesions of acne vulgaris. Int J Dermatol. 2021;60(5):589-596. doi:10.1111/ijd.15308

Patients With IMIDs Have Positive Perception of Nutrition on Symptom Management

The majority of patients with immune-mediated inflammatory diseases (IMIDs) acknowledge the importance of nutrition and its importance on symptom management, but they need more dietary advice from health care professionals (HCPs).

“We aimed to directly collect information from patients with IMID about their dietary behaviors and their perceptions of the influence of nutrition on their disease,” explained the study authors.

Researchers invited adult patients with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, Crohn disease, ulcerative colitis, or psoriasis to participate in a study that assessed patients’ dietary knowledge and choices. The participants, 50 for each disease, completed a questionnaire developed to identify the diet regimens they were following or recommended and their perceptions of the diet and impact on their disease.

Results showed that 44% of patients changed their eating habits since receiving their diagnosis. Most patients who changed their diet were diagnosed with inflammatory bowel disease and made the change on their own initiative. Patients who did not change their diet did not receive advice from their HCPs. Overall, 74% of participants reported positive consequences of nutrition on their symptoms and 60% reported negative consequences. The perceived impact of nutrition on disease symptoms varied across diseases, with patients with psoriasis experiencing positive consequences and patients with Crohn disease reporting negative ones.

“Even if differences exist across diseases, the importance of nutrition and its potential positive role in symptom management is acknowledged by the majority of the patients,” concluded the study authors. “However, there is a need and a demand from patients to receive more dietary advice,” they continued.

Reference
Pham T, Sokol H, Halioua B, et al. Immune-mediated inflammatory diseases and nutrition: results from an online survey on patients' practices and perceptions. BMC Nutr. 2021;7(1):38. doi:10.1186/s40795-021-00446-y

Rate of Hypothyroidism is High in Patients With Rosacea

Rates of hypothyroidism are higher in patients with rosacea compared with a control group, according to a recent study published in Anais Brasileiros de Dermatologia.

“The authors hypothesized that shared pathogenic mechanisms can provide a link between rosacea and thyroid disorders and thus, the authors aimed to investigate whether there is a relationship between thyroid disorders (hypo- and hyperthyroidism) and rosacea,” explained the study authors.

Researchers performed a large case-control study on 2091 patients with rosacea (1546 women, 545 men; mean age 48.73 ± 14.53 years) and 9572 age- and gender-matched controls (7009 women, 2563 men; 48.73 ± 15.1. years) who were admitted to a dermatology outpatient clinic. All patients were evaluated for hypothyroidism and hyperthyroidism using disease-specific International Classification of Diseases codes.

The prevalence rates of hypothyroidism were high in patients with rosacea, with an odds ratio of 1.3 (95% CI, 1.13-1.49; P<.001). No significant difference was found for the rate of hyperthyroidism in patients with rosacea and controls. Hypothyroidism increased in the rosacea arm towards 80 to 89 years of age.

“In this study, the frequency of hypothyroidism was significantly increased in rosacea patients and no association between hyperthyroidism and rosacea was shown,” concluded the study authors.

Reference
Akin Belli A, Alatas ET, Kara Polat A, Akbaba G. Assessment of thyroid disorders in patients with rosacea: a large case-control study. An Bras Dermatol. Published online July 15, 2021. doi:10.1016/j.abd.2021.02.004

Prevalence of RA and Psoriasis is High in Patients With Actinic Keratoses

Patients with actinic keratoses (AKs) had high associations with rheumatoid arthritis (RA) and psoriasis but not Behçet disease, Crohn disease, ulcerative colitis, or multiple sclerosis.

“The current study aimed to find the associations between AK and systemic inflammatory diseases, including [RA], psoriasis, Behçet disease, Crohn disease, ulcerative colitis, and multiple sclerosis,” explained the study authors.

Researchers performed a population-based retrospective cohort study that used a large nationwide database to investigate the associations between AKs and systemic inflammatory diseases. Patients over 20 years of age and newly diagnosed with AK between January 2012 and December 2017, who had not been diagnosed with AK at least 5 years before enrollment, were included in the study. Associations between AK and other inflammatory diseases were analyzed with statistical tests.

Study results showed that patients with AK had higher odds for rheumatoid arthritis and psoriasis compared with the control group. Associations between patients with AK and Behçet disease, Crohn disease, ulcerative colitis, and multiple sclerosis in the AK group were not statistically significant.

“To our knowledge, this is the first epidemiological study to investigate the associations between systemic inflammatory diseases and AK based on a large nationwide database,” concluded the study authors.

Reference
Kim HJ, Kim YH, Yun SY, Yu DS, Lee YB. Association of actinic keratosis with rheumatoid arthritis and psoriasis: a nationwide population-based study in Korea. Acta Derm Venereol. 2021;101(7):adv00510. doi:10.2340/00015555-3877