Daniel J. Pearce

The comorbid state of psoriasis patients in a university dermatology practice

Background: Psoriasis treatment is frequently complicated by the various types and severities of disease as well as the large number of therapies available. Another critical consideration in treatment planning is the presence of comorbid diseases. Purpose: The purpose of this study was to evaluate the relative prevalence of major comorbid disease states in patients with psoriasis and to identify significant predictors of these concurrent diseases in such patients. Methods: A retrospective chart review of 753 patients from an academic dermatology practice was performed. The patients were identified by ICD‐9 code for psoriasis in billing records of patients seen between 1997 and 2000. Data on comorbidities were compiled from review of electronic chart notes from all physician visits in the university practice. Results: Comorbid diagnoses were listed in 551 out of 753 (73%) charts. As would be expected, hypertension, dyslipidaemia, diabetes and heart disease were the most common comorbidities; renal failure and hepatitis were least likely. Hepatitis was associated with use of systemic therapies (odds ratio = 2.19) and non‐white race. When compared with national prevalence estimates, psoriasis patients had increased heart disease, hypertension, diabetes and emphysema; however, these findings must be interpreted with some caution. Conclusions: Comorbid diseases are common in psoriasis patients and should be taken into account during treatment planning and surveillance; they may pose unique challenges in caring for patients with psoriasis, particularly those requiring systemic therapy.

The negative impact of psoriasis on the workplace

Background: The health‐related quality of life and economic impact of psoriasis has been documented. However, the negative impact of psoriasis on the workplace is poorly understood. Aim/Methods: Through anonymous surveys from 30 subjects of each of three psoriasis severity groups we aim to quantify the workplace impact experienced by psoriasis patients and factors that may contribute to this impact. Data were collected using several previously validated measures including the Work Productivity Assessment Index (WPAI), SF‐8, Hospital Anxiety and Depression (HADS) and past medical/psoriasis history. Results: Psoriasis patients experienced negative impact at work as measured by the WPAI; this impact is directly associated with disease severity. The other instruments confirmed the negative impact of psoriasis though the degree of impact did not always correlate with disease severity or work impact. Owing to the relatively small numbers, the significance of these findings is not certain. Conclusions: This preliminary study finds that psoriasis is associated with a reduction in work productivity and social functioning; this may explain the relatively high cost of this disease on both a macro‐ and microeconomic level. As there was a lack of significant trends in this study, formal inferences are limited and further investigation is warranted.

Novel combination regimens: Biologics and acitretin for the treatment of psoriasis – a case series

Combination therapy has long been a mainstay of psoriasis treatment, particularly for those that suffer from moderate-to-severe disease. The biologics represent a new and exciting approach to psoriasis treatment though their use in combination regimens has not been adequately examined. This brief series reports on the combination of biologics with acitretin in the treatment of psoriasis.

Incidence, Risk Factors, and Preventative Management of Skin Cancers in Organ Transplant Recipients: A Review of Single‐ and Multicenter Retrospective Studies from 2006 to 2010

Background Organ transplant recipients (OTRs) taking immunosuppressants are at high risk of skin cancer, which is the most common malignant condition in OTRs, so dermatologic surveillance is important for OTRs. Objectives To characterize the most common skin cancers arising from chronic immunosuppression in OTRs. Methods A PubMed search for retrospective single‐ and multicenter studies reporting skin cancer incidence from 2006 to 2010 was undertaken. Data regarding each studys immunosuppressive regimen, affected skin cancer cohort, and associated risk factors were extracted. Results Thirty‐six articles that met our inclusion criteria reported incidences of nonmelanoma skin cancer (NMSC), Kaposis sarcoma, melanoma, and Merkel cell carcinoma. NMSC was the most commonly reported cancer of all skin cancers after transplantation. Common risk factors were sex, age, sunlight exposure, and immunosuppressive agent‐related (duration, type). Conclusion Sun education programs and frequent screenings in organ transplant clinics have provided the best preventative strategies after transplantation, although the characteristics of the immunosuppressive regimen also play an important role. Thus, the adjuvant strategy of modifying immunosuppression may be effective when confronting severe transplant‐associated skin cancer. Although the decision‐making process for curbing levels of immunosuppression is difficult, further long‐term, randomized controlled studies should assess the effect of using less immunosuppressant medication while preserving graft function.

The cost-effectiveness and cost of treatment failures associated with systemic psoriasis therapies

Background: Psoriasis is difficult at times to treat and treatment failures are not uncommon regardless of approach. With the advent of expensive biologic therapies for psoriasis there is increasing discussion on the cost efficacy of a given systemic or biologic agent. An alternative and overlooked aspect of cost efficacy is the cost that accrues from treatment failures. Methods: We review the literature and develop a model to analyze the cost‐effectiveness and the cost of treatment failures per success for various systemic psoriasis agents using a 12‐week treatment period. Results: For continuous‐dose agents, the cost‐effectiveness results are: methotrexate

Psoriasis treatment in the United States at the end of the 20th century.

623, acitretin

Electrosurgery: Part I. Basics and principles

2729, cyclosporine

New treatments for psoriasis: Which biologic is best?

2969, nUVB

Adherence to acitretin and home narrowband ultraviolet B phototherapy in patients with psoriasis

3692, PUVA

A randomized controlled pilot study of strategies to increase adherence in teenagers with acne vulgaris

4668, etanercept