News - September 2021

Patients With Psoriasis Have Anxiety, Depression, and Poor Individual Coping Resources

Patients with psoriasis scored high on hypochondriasis scales, signaling associations with anxiety, depression, suicidal ideation, and poor individual coping resources, according to a recent publication in Dermatology.

Researchers aimed to assess hypochondriasis and personality traits in psoriasis patients by conducting an observational study of patients using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) test. Demographic and clinical data were collected.

The mean age of the patients was 53.7 (±13.5) years with a mean disease duration of 23.3 (±15.7) years. A total of 27.9% and at least 25% of patients were observed to have pathologically elevated scores in the hypochondriasis and MMPI-2 scales, respectively. The Ego Strength and Dominance scales had the lowest scores. Female gender was associated with higher scores in the hypochondriasis scale. Any alcohol consumption was reported in 72.8% of patients and heavy alcohol consumption was reported in 8.1%.

“About one-third of patients with psoriasis have high scores in the MMPI-2 hypochondriasis evaluation scale,” concluded the study authors. “Poor individual coping resources also appeared to be distinctive psychological features in a significant proportion of psoriatic patients,” they added.

Reference
Gisondi P, Geat D, Ferrazzi A, Bellinato F, Girolomoni G. Hypochondriasis and personality traits of patients with chronic plaque psoriasis. Dermatology. Published online July 29, 2021. doi:10.1159/000517018

Pediatric Patients With HS Utilize High-Cost Emergency Department Care

Pediatric patients with hidradenitis suppurativa (HS) are more likely utilize emergency services during their journey to receiving a diagnosis than adult patients with the disease, found a study published in JAMA Dermatology.

Researchers aimed to assess the clinical characteristics and health care utilization patterns of pediatric vs adult patients with HS in a retrospective cohort study. Adult (n=7633) and pediatric (n=1094) patients with HS claims from a database during a study period of January 1, 2021, to December 31, 2016, were included in the study. The main outcomes included concurrent diagnoses, outpatient care by discipline, emergency/urgent care, and inpatient claims.

Pediatric patients with HS were likely to see pediatricians, dermatologists, emergency department (ED) staff, and family physicians during their journey to receiving a diagnosis of folliculitis and comedones. They also had high rates of acne vulgaris, acne conglobate, obesity, and anxiety disorders and a higher percentage of HS-specific claims for emergency and urgent care services. Adult patients were more likely to have inpatient stays. The mean cost per ED claim was similar between pediatric and adult patient groups. The largest cost for either group was the cost of inpatient visits.

“This cohort study suggests that pediatric patients utilize high-cost ED care when HS can often be treated as an outpatient,” concluded the study authors. “These data suggest that there are opportunities to improve recognition of HS in pediatric patients by nondermatologists and dermatologists,” they continued.

Reference
Hallock KK, Mizerak MR, Dempsey A, Maczuga S, Kirby JS. Differences between children and adults with hidradenitis suppurativa. JAMA Dermatol. Published online August 11, 2021. doi:10.1001/jamadermatol.2021.2865

NEA Amplifies Patient Voice During the Institute for Clinical and Economic Review Meeting

The National Eczema Association (NEA) amplified the patient voice in the evaluation of new treatments for atopic dermatitis (AD) in a public meeting held by the Institute for Clinical and Economic Review (ICER). This is a final step in their 2021 evaluation of the clinical effectiveness and value of Janus kinase inhibitors and monoclonal antibodies for the treatment of AD.

NEA is the only patient advocacy organization in the United States dedicated to the 31 million people affected by AD and other forms of eczema. Thus, it was invited to provide lived experience data and insights to describe the quality-of-life impacts of AD.

NEA’s participation in the event highlighted AD as a chronic, heterogeneous disease with significant burden. Patients with AD suffer from itch, pain and sleep loss; social, academic, economic and lifestyle impacts from the disease. The burden of disease is often accompanied by limited long-term treatment options. NEA emphasized that each new treatment option can alleviate the social and emotional effects of AD on patients.

"NEA's goal for this process, as with everything we do, is to ensure patients are involved and their important voice is heard," said Julie Block, president and chief executive officer of NEA. "With a disease as variable as eczema, there is not a singular patient perspective. Through our patient-reported data and first-person patient accounts, we've aimed to show the diverse and burdensome lived experience of AD and the need for more targeted treatments available to patients."

Reference
National Eczema Association. NEA brings patient voice to evaluation of new treatments for atopic dermatitis. Press release. Published August 10, 2021. Accessed August 17, 2021. https://www.prnewswire.com/news-releases/nea-brings-patient-voice-to-evaluation-of-new-treatments-for-atopic-dermatitis-ad-301351798.html

Interaction With Images of Celebrities, Self Significantly Related to Acceptance of Cosmetic Surgery

A recent Italian study of habits on the social media platform, Instagram, found that women who interacted with image-based content related to celebrities and self were significantly more accepting of cosmetic surgery. The results were published in the journal Aesthetic Plastic Surgery.

The authors wrote that the study was to determine whether Instagram images-based activities related to self, friends, and celebrities could influence a woman’s acceptance of cosmetic surgery and enhancements. Participants included 305 women with a mean age of 23 years. All women completed a questionnaire with several scales, including the Instagram Image Activity Scale, the Instagram Appearance Comparison Scale, the Body Shape Questionnaire-14, and the Acceptance of Cosmetic Surgery Scale. The researchers then performed a path analysis, in which participant activity was posited as predictors of Instagram appearance comparison, body dissatisfaction, and acceptance of cosmetic surgery based on their respective evaluation scale.

Upon analysis, it was found that activities related to celebrities and the participant (self) were significantly related to cosmetic surgery acceptance both directly and indirectly. Activities related to friends, however, were not directly or indirectly related to acceptance.

“Overall, these findings provide information about the role that activities carried out on Instagram, appearance comparison and body dissatisfaction, play on the acceptance of surgery for aesthetic reasons among women,” concluded the authors. They added that health care providers in the cosmetic and aesthetic space should consider the psychological aspects and influence of sociocultural factors as part of their practice and the interest in cosmetic surgery. 

Reference
Di Gesto C, Nerini A, Policardo GR, Matera C. Predictors of acceptance of cosmetic surgery: Instagram images-based activities, appearance comparison and body dissatisfaction among women. Aesthetic Plast Surg. Published online September 3, 2021. doi:10.1007/s00266-021-02546-3

Surgical Delays Associated With Moderate SCCs, But Not Low-Grade SCCs or BCCs

A retrospective review recently published by Journal of the American Academy of Dermatology found that delays in Mohs surgery under 1 year were associated with growth of higher-grade squamous cell carcinomas (SCCs).

Given that the evidence is limited whether surgical delays can be a factor in tumor growth for SCCs and basal cell carcinomas (BCCs), researchers aimed to identify associations between tumor subpopulations, tumor growth, and surgical delay.

They retrospectively analyzed 299 SCCs and 802 BCCs treated with Mohs surgery. Surgical delay was defined as time from biopsy to surgery, and tumor growth was defined as change in diameter from biopsy to postoperative defect.

Overall, surgical delays ranged from zero to 331 days. For SCCs, histologic subtype and prior treatment were independent predictors of tumor growth. Further, tumor growth and surgical delay were found to be associated with poorly differentiated and moderately differentiated SCCs, with approximately 0.28-cm and 0.24-cm growth rates per month of delay, respectively. Notably, tumor growth was not associated with prior treatment of SCCs. No BCC subgroups with surgical delay were associated with tumor growth.

“Surgical delays under a year were associated with tumor growth for higher-grade SCCs, with effect sizes bearing potential for clinical significance,” wrote the study authors. Dermatologists are encouraged to continue to seek appropriate and timely treatment for their patients with nonmelanoma skin cancers.

Reference
Lee J, Forrester VJ, Novicoff WM, Guffey DJ, Russell MA. Surgical delays less than 1 year in Mohs micrographic surgery associated with tumor growth in moderate- and poorly-differentiated squamous cell carcinomas but not lower-grade squamous cell carcinomas or basal cell carcinomas, a retrospective analysis. J Am Acad Dermatol. Published online September 6, 2021. doi:10.1016/j.jaad.2021.08.059

Upadacitinib Safe, Effective Therapy for Patients With AD in Comparator Trial

Upadacitinib demonstrated better efficacy in patients with moderate to severe atopic dermatitis (AD) compared with dupilumab and is a safe treatment option, according to a study by Blauvelt et al in JAMA Dermatology.

Researchers performed a 24-week, head-to-head, phase 3b, multicenter, randomized, double-blinded, double-dummy, active-controlled clinical trial (Heads Up) that compared the safety and efficacy of upadacitinib with dupilumab among 692 adults with moderate to severe AD who were candidates for systemic therapy. Patients were randomized to receive oral upadacitinib
(30 mg once daily) or subcutaneous dupilumab (300 mg every other week). The primary end point was 75% improvement in
Eczema Area and Severity Index (EASI 75) at week 16, and secondary endpoints were percentage change in pruritus and proportion of patients achieving improvements in EASI (100, 90, and 75).

The trial included 348 patients in the upadacitinib arm and 344 patients in the dupliumab arm. Patients who achieved EASI 75 at week 16 was significantly greater for patients receiving upadacitinib than those receiving dupilumab (247 [71.0%] vs 210 [61.1%]). All ranked secondary end points (ie, pruritus and EASI) showed superiority for upadacitinib, including 27.9% of patients achieving EASI 100 at week 16 receiving upadacitinib vs only 7.6% receiving dupliumab.

In addition, upadacitinib was observed to be safe. Serious treatment-emergent adverse events (AEs) and AEs leading to drug discontinuation were 2.9% and 2.0% for upadacitinib and 1.2% and 1.2% for dupilumab, respectively.

“During 16 weeks of treatment, upadacitinib demonstrated superior efficacy vs dupilumab in patients with moderate-to-severe AD, with no new safety signals,” concluded the study authors.

Reference
Blauvelt A, Teixeira HD, Simpson EL, et al. Efficacy and safety of upadacitinib vs dupilumab in adults with moderate-to-severe atopic dermatitis: a randomized clinical trial. JAMA Dermatol. Published online August 4, 2021. doi:10.1001/jamadermatol.2021.3023

Study Suggests Screening for PCOS in Adult Women With Moderate to Severe Acne

Patients with adult female acne (AFA) of a younger age, with premenstrual flares, and irregular menstruation should be screened for polycystic ovary syndrome (PCOS), according to a study  seeking to define clinical characteristics of AFA.

Of the 208 patients included in the study, 47.1% had persistent acne, 26.9% had late-onset acne, and 26% had recurrent acne. Acne was predominately located on the cheeks and the perioral area, and common aggravating factors of premenstruation and stress. Higher body mass index (BMI) positively correlated with acne severity, and perimenopausal acne was found in 6.7% of patients. Mean Dermatology Life Quality Index score was 8.0 ± 5.4 (range, 0-23).

PCOS was diagnosed in 48.1% of participants. The disease was associated with younger age (≥25 to <33 years), premenstrual flares, and irregular menstruation, but not hirsutism or androgenetic alopecia, in both univariate and multivariate analysis.

“Persistent acne with moderate severity was common in patients [with AFA] and higher BMI was associated with acne severity,” stated the study authors. They recommended screening patients with AFA for PCOS, especially when presenting with the factors of  younger age, with premenstrual flares of acne, and irregular menstruation.

Reference
Chanyachailert P, Chularojanamontri L, Chantrapanichkul P, et al. Adult female acne: Clinical characteristics and factors significantly associated with polycystic ovary syndrome. Australas J Dermatol. Published online August 23, 2021. doi:10.1111/ajd.13700