ABSTRACT
Itch is a common symptom of dermatologic diseases associated with significant impairment of health-related quality of life (QoL). This study reveals disparities in itch symptom experience and itch impact on QoL. A retrospective study of patient-reported outcome measure (PRO) data (ItchyQoL, Itch NRS, Pain Interference, Anxiety) for 387 outpatient dermatology visits to characterize the impact of itch on patients' QoL and itch symptom experience based on skin color in patients with dermatologic disease. Most patients were Caucasian females (67%) with mean age of 48 years. Correlative analyses showed mild itch associated with emotional impacts on QoL (p < 0.01), while severe itch associated with functional and emotional impacts on QoL (p < 0.01). African American (AA) patients reported more "severe-range" answers for 15 (68%) ItchyQoL items and had higher ItchyQoL mean scores (p = 0.001). ItchyQoL demonstrated an emotional impact on QoL by mild itch, but a functional and emotional impact on QoL by severe itch. Further, AAs suffered from greater itch-related impairment in QoL than Caucasian patients, especially due to scarring and sleeplessness.
Subject(s)
Black or African American , Patient Reported Outcome Measures , Pruritus , Quality of Life , Severity of Illness Index , White People , Humans , Pruritus/psychology , Pruritus/diagnosis , Pruritus/etiology , Female , Quality of Life/psychology , Middle Aged , Male , Retrospective Studies , Adult , White People/psychology , White People/statistics & numerical data , Black or African American/psychology , Black or African American/statistics & numerical data , Skin Diseases/psychology , Skin Diseases/diagnosis , AgedABSTRACT
Although B cells account for a significant proportion of the lymphocytic infiltrate in discoid lupus erythematosus (DLE), their contribution to pathogenesis is unknown. In this study, we compare the immune landscape of 17 subjects with DLE with that of 21 subjects with subacute cutaneous lupus erythematosus using transcriptomic and histologic analyses of lesional skin. A few of the subjects (3 of 17 subjects with DLE, and 5 of 21 subjects with subacute cutaneous lupus erythematosus) had concomitant systemic lupus erythematosus. Using a modified Autoimmune Profiling Panel (NanoString Technologies, Seatle, WA), we show that B-cellâspecific genes, including canonical panâB cell markers CD19 (P = 0.0060), MS4A1 (CD20) (P = 0.0047), and CD79a (P = 0.0201), are among the most upregulated genes in DLE. Numerous other genes encoding B-cellâassociated proteins, including Igs, BAFF receptors, and FCRL family members, are similarly enriched. Relative cell type scoring reveals that among various inflammatory cell types, only B cells are more prevalent in DLE. Digital whole-image slide analysis of immunohistochemistry for B cells (CD20) and T cells (CD3) supports our gene expression findings of a disproportionately greater B-cell infiltrate in DLE lesions. Overall, this study identifies a B-cellâpredominant signature unique to DLE and highlights the importance of studying the role of cutaneous B cells in DLE pathogenesis.
Subject(s)
Lupus Erythematosus, Cutaneous , Lupus Erythematosus, Discoid , Lupus Erythematosus, Systemic , Humans , Lupus Erythematosus, Cutaneous/diagnosis , Lupus Erythematosus, Cutaneous/genetics , Lupus Erythematosus, Discoid/diagnosis , Lupus Erythematosus, Discoid/genetics , Skin/pathology , T-Lymphocytes/metabolismABSTRACT
Patient-reported outcome (PRO) measures play an important role in clinical care. Currently, a broad-spectrum, validated PRO measure suitable for all dermatology patients, as part of clinical care, does not exist. Patient-reported Outcome Measures Information System (PROMIS) measures track specific domain outcomes across all diseases. To assess the relevance and utility of a computer-adaptive health assessment consisting of three PROMIS domains in routine dermatologic care. This retrospective study evaluated a PROMIS health assessment, consisting of three computer-adaptive test domains (pain interference, anxiety, and depression), administered as part of routine clinical care in three dermatology clinics at an academic medical center. The primary objective was to identify clinically significant associations between high PROMIS domain scores (i.e., t score > 55) and dermatologic disease, as well as change in PROMIS domain scores in response to treatment. The majority of patients who initiated the assessment completed all domains (88.7%). In patients with atopic dermatitis, acne, hidradenitis suppurativa, and psoriasis, high PROMIS scores correlated with clinically relevant outcomes, such as severe disease, unsuccessful treatment, uncontrolled disease, and the presence of a mental health condition. PROMIS Pain Interference, anxiety and depression identified patients with severe disease, unsuccessful treatment regimens, poorly-controlled disease, and/or mental health comorbidities for multiple skin conditions. Further utilization of PROMIS domains in routine clinical care will promote patient-centered care and improve quality of care.
Subject(s)
Information Systems , Patient Reported Outcome Measures , Skin Diseases/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Anxiety/diagnosis , Anxiety/etiology , Anxiety/psychology , Child , Depression/diagnosis , Depression/etiology , Depression/psychology , Female , Health Status , Humans , Male , Mental Health , Middle Aged , Pain/diagnosis , Pain/etiology , Pain/psychology , Quality of Life , Retrospective Studies , Severity of Illness Index , Skin Diseases/complications , Skin Diseases/diagnosis , Skin Diseases/psychology , Young AdultABSTRACT
Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are life-threatening, cutaneous reactions often associated with culprit drugs. A growing body of knowledge has deepened our understanding of the pathophysiology and clarified mechanisms such as drug-specific cytotoxicity mediated by T-cells, genetic linkage with HLA and non-HLA genes, TCR restriction, and cytotoxicity mechanisms. Physicians should broadly consider the etiology of SJS/TEN in order to better understand treatment strategies as well as identify which patients may be at risk for developing this condition. Mechanisms for how radiotherapy and rare malignancies may contribute to the development of TEN and SJS have been proposed.
Subject(s)
Liposarcoma/radiotherapy , Radiotherapy/adverse effects , Stevens-Johnson Syndrome/etiology , Humans , Male , Middle Aged , Radiation Injuries , Skin/pathology , Stevens-Johnson Syndrome/pathologyABSTRACT
Squamous cell carcinomas (SCCs) often arise secondary to UV-induced DNA damage resulting in genetic mutations, but can also occur in the setting of prolonged inflammation. Folliculitis decalvans (FD) is a rare cicatricial alopecia with a complex, multifactorial pathogenesis that results in chronic inflammation and scarring. We present a patient with severe, chronic FD who developed metastatic squamous cell carcinoma of the scalp.