Severe and ChRonic Atopic dermatitis Treatment CoHort (SCRATCH): A Danish Real-world Evidence Atopic Dermatitis Treatment Registry.

Data from real-world use of new systemic treatments in atopic dermatitis (AD) is important for assessing safety and efficacy. The aim of this study is to describe the baseline characteristics of adult patients with moderate-to-severe AD enrolled in the Danish nationwide Severe and ChRonic Atopic dermatitis Treatment CoHort (SCRATCH) database, between October 2017 and August 2021. A total of 282 adult patients were included. Most (62%) were men, the median age at baseline was 43 years (interquartile range (IQR) 29-54 years), and median age at onset of AD was 1 year (IQR 0-6 years). The median Eczema Area and Severity Index at treatment initiation was 19.1 (IQR 11.9-25.7); median Patient Oriented Eczema Measure 21.0 (IQR 16.0-25.0); median Dermatology Life Quality Index 13.0 (IQR 7.0-19.0); and median itch and sleep numerical rating scale scores 8.0 (IQR 6.0-9.0) and 6.0 (IQR 4.0-8.0). Differences were found between the sexes. This registry will provide a source for future efficacy and safety studies.

The effect of age on self-rated skin pain in patients with hidradenitis suppurativa.

BACKGROUND: Hidradenitis suppurativa (HS) is a recalcitrant chronic inflammatory skin disease characterized by recurrent and painful nodules that negatively affect health-related quality of life. Pain is the most disabling symptom of HS, but data on HS pain remain limited. We previously observed a dissociation between pain and number of HS lesions with regards to increasing age. OBJECTIVES: To further explore this observation, we investigated the relationship between experienced HS pain and age, adjusting for other relevant factors that might affect pain assessment. MATERIALS & METHODS: We conducted a retrospective cohort study (n = 342) using data from the Registry for Hidradenitis Suppurativa database. Multiple linear regression analysis was performed for self-evaluated pain (measured on a 0-10 numerical rating scale [NRS]) as an outcome with age and adjusted for the effects of sex, BMI, smoking status, lesion count and percentage of lifetime spent with HS symptoms. RESULTS: The multiple linear regression showed that age was associated with a decreased pain level of 0.31 NRS points/year (95% CI: -0.062; -0.0088; p = 0.044) and number of nodules was associated with an increased pain level of 0.081 NRS points/nodule (95% CI: 0.00077; 0.16; p = 0.048). Percentage of lifetime spent with HS symptoms was not found to significantly affect pain levels. CONCLUSION: This study supports our hypothesis that older HS patients report decreased levels of pain, independent of disease severity, which may be due to factors such as demyelination of nerve fibres, reduced painful physical activity, improved coping, or associated co-morbidities that distract from HS-related pain.

Invasive dermatophytosis mimicking vasculitis.

We report a case of invasive dermatophytosis mimicking vasculitis. A patient consulted the Department of Dermatology, Zealand University Hospital, Roskilde, Denmark for the assessment of violaceous/erythematous lesions thought to be vasculitis. She had prior to this been treated with the immunosuppressive drug teriflunomid. Due to the lesion's erythematous scaling boarder invasive dermatophytosis was suspected. By using direct microscopy a mycological diagnosis was confirmed. We underline the utility of direct microscopy in the diagnosis.

Pharmacological development in hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a chronic, inflammatory, debilitating disease of a relapsing nature which presents with nodules, abscesses, and suppurating lesions of intertriginous areas of the skin. Within recent years, there has been significant progress in terms of the treatment of HS, nevertheless, an unmet need of treatment exists and effective therapy remains a serious challenge. The current treatment strategies are focused on known pathomechanisms underlying and responsible for development of HS lesions, including hyperkeratinization and occlusion of pilosebaceous unit, dysbiosis and the extensive, chronic inflammation. Several cytokines (i.e. TNF-a, IL-1, IL-17, and IL-23) seem to be involved in HS pathogenesis, and their blockade appears as a rational therapeutic approach. So far TNF inhibition with adalimumab remains the only EMA-approved/FDA-approved agent in HS treatment and should be consequently considered first. Other drugs, however, play an increasing role in off-label therapy. In recent years, new phase II and III trials for HS management have appeared aimed at inhibition of specific targetable inflammatory pathways identified in HS. Thus, several new biologics are being investigated, including MABp1 (bermekimab), CJM112, bimekizumab, guselkumab, secukinumab, and IFX-1.

Quality of life considerations and pain management in hidradenitis suppurativa.

All skin diseases involve some element of stigmatization and psychosocial consequence for the individual patient, but few, if any, skin diseases can match the impact of hidradenitis suppurativa (HS) on the patient. The inflamed lesions progressing to noninflamed nodules and abscesses are not only perceived as unclean and stigmatizing by the patients, but also cause pain and scarring making this inflammatory skin disorder unique. It is obvious that the disease has a significant negative impact on the patients' quality of life (QOL). The impact is influenced not only by the pain which is a significant independent contributor to the patients' life quality, but by the clinically significant comorbidity associated with HS. In particular, the psychological comorbidities of depression and anxiety both further compound QOL impairment and pain. It is strongly recommended that these factors be taken into account when planning a treatment strategy for patients with HS, and that specific steps are taken to manage pain and comorbidities associated with the reduced QOL generally experienced by this group of patients. Basic pain management includes anti-inflammatory treatments as well as local- and central-acting analgesics. In more complex cases, access to consultations with a pain specialist may be necessary and may require the judicious use of antidepressants. In addition, it is recommended that patients' QOL be addressed specifically through psychological education and patient support groups.

Methods to assess area and volume of wounds - a systematic review.

Wound measurement is important in monitoring the healing process of chronic wounds and in evaluating the effect of treatment. The objective of this systematic review was to evaluate evidence from the literature on accuracy, agreement, reliability and feasibility of wound measurement techniques described since 1994. Studies were identified by searching the electronic databases PubMed, Embase and Cochrane Library. Of the 12 013 studies identified, 43 were included in the review. A total of 30 papers evaluated techniques for measuring wound area and 13 evaluated techniques for measuring wound volume. The six approaches for measuring wound area were simple ruler method (10 papers), mathematical models (5 papers), manual planimetry (10 papers), digital planimetry (16 papers), stereophotogrammetry (2 papers) and digital imaging method (20 papers). Of these studies, 10 evaluated accuracy, 15 agreement, 17 reliability and 25 mentioned feasibility. The number of wounds examined in the studies was highly variable (n = 3-260). Studies evaluating techniques for measuring wound volume included between 1 and 50 wounds and evaluated accuracy (4 studies), agreement (6 studies), reliability (8 studies) and feasibility (12 studies). Digital planimetry and digital imaging were considered the most accurate and reliable methods for area measurement, particularly in larger and irregularly shaped wounds. None of the three-dimensional technologies have so far had a major impact, because of their low accuracy, high cost and complexity in handling the system set-up.

A systematic literature review to compare quality of life in psoriasis with other chronic diseases using EQ-5D-derived utility values.

BACKGROUND: Psoriasis is a chronic, immune-mediated dermatological disease associated with substantial economic, clinical, and humanistic burden. OBJECTIVE: The aim of this study was to understand the disutility of patients with psoriasis vulgaris, using mean baseline EuroQoL five dimensions (EQ-5D) index scores reported in the published literature, and to compare this to patients with other chronic diseases. METHODS: Two systematic literature searches were conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Searches were conducted in ten databases including Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials (CENTRAL). The first search (December 2013) used search terms psoria* AND (EQ5D OR EQ OR EUROQoL). Only publications of original research, which reported baseline EQ-5D scores for mild/moderate/severe psoriasis, were included. The second search (March 2014) used the terms (systematic review) AND (EQ5D OR EQ 5D OR EuroQoL). Titles were screened by two independent reviewers. Four independent reviewers reviewed titles and full-length papers. EQ-5D scores for psoriasis patients were qualitatively compared with scores from patients with other chronic diseases identified through the literature search. RESULTS: Of 133 publications on psoriasis, 12 met the inclusion criteria. The mean EQ-5D index scores for psoriasis (all severities) ranged from 0.52 (standard deviation: 0.39) to 0.9 (standard deviation: 0.1). Of the 48 results from the second search, six met the inclusion criteria. The reported EQ-5D lower limit for other diseases ranged from 0.20 (Type 2 diabetes mellitus) to 0.66 (liver diseases). The highest EQ-5D estimates for other diseases ranged from 0.79 (liver diseases) to 0.93 (cancer patients). Both lower and upper EQ-5D estimates in psoriasis patients were within the range of those reported for other chronic diseases. CONCLUSION: Comparative studies of morbidity are relevant in health care studies and patient advocacy. This systematic review demonstrates that the ranges of disutility among psoriasis patients are within the ranges of other chronic diseases (cardiovascular diseases, diabetes, end-stage renal diseases, liver diseases, cancer, and visual disorders).

Novel investigational therapies for atopic dermatitis.

Introduction: Atopic dermatitis (AD) is a common skin disease. Although most patients are well served by existing therapies, a subset of patients with severe AD are still not adequately treated. An improved understanding of the pathogenic mechanisms behind the disease has led to the development of a range of potential new drugs for this indication. Areas covered: The authors provide a narrative review of the drugs in Phase II trials listed on Clinicaltrials.gov. The authors supplement this information with recently published literature located through PubMed. The main target of new treatments appears to be the inflammation process, whereas drugs aimed at reducing itching or increasing the barrier function are fewer to nonexistent. A wide range of drugs, including small molecules and antibodies, are being tested. Expert opinion: The focus on inflammation is not only driven by the limitations posed by our current understanding of biology, but also by the broader scope of these drugs, which may be used in other diseases. In alignment with the recent drug development of other dermatological diseases, antibodies directed at key molecules in the pathogenesis of AD appear to be the most promising.

The potential carcinogenic risk of tanning beds: clinical guidelines and patient safety advice.

INTRODUCTION: In 2009, the WHO listed ultraviolet (UV) radiation as a group 1 carcinogen. In spite of this, each year, millions of people tan indoor in Western countries. The aim of this review is to summarize evidence of tanning bed carcinogenesis and to present guidelines for use of tanning beds and patient safety advice. METHODS: A narrative review of the literature was conducted based on both PubMed and Medline searches and on literature review of the retrieved papers. RESULTS: Use of indoor tanning beds represents a significant and avoidable risk factor for the development of both melanoma and nonmelanoma skin cancers. Frequent tanners are more often adolescent females. Tanning beds have additional potential adverse effects such as burns, solar skin damage, infection, and possibly also addictive behavior. DISCUSSION: The effort in preventing UV light-induced carcinogenesis should currently be aimed at developing new strategies for public health information. Tanning beds are one preventable source of UV radiation. In the majority of people solar UV radiation continues to be the major factor and therefore anti-tanning campaigns must always include sunbathers.