Howa Yeung

Psoriasis Severity and the Prevalence of Major Medical Comorbidity: A Population-Based Study

IMPORTANCE Despite the growing literature on comorbidity risks in psoriasis, there remains a critical knowledge gap on the degree to which objectively measured psoriasis severity may affect the prevalence of major medical comorbidity. OBJECTIVE To examine the prevalence of major medical comorbidity in patients with mild, moderate, or severe psoriasis, classified objectively based on body surface area involvement, compared with that in patients without psoriasis. DESIGN, SETTING, AND PARTICIPANTS Population-based cross-sectional study of patient data from United Kingdom-based electronic medical records; analysis included 9035 patients aged 25 to 64 years with psoriasis and 90,350 age- and practice-matched patients without psoriasis. MAIN OUTCOMES AND MEASURES Prevalence of major medical comorbidity included in the Charlson comorbidity index. RESULTS Among patients with psoriasis, 51.8%, 35.8%, and 12.4%, respectively, had mild, moderate, or severe disease based on body surface area criteria. The mean Charlson comorbidity index was increasingly higher in patients with mild (0.375 vs 0.347), moderate (0.398 vs 0.342), or severe psoriasis (0.450 vs 0.348) (each P < .05). Psoriasis overall was associated with higher prevalence of chronic pulmonary disease (adjusted odds ratio, 1.08; 95% CI, 1.02-1.15), diabetes mellitus (1.22; 1.11-1.35), diabetes with systemic complications (1.34; 1.11-1.62), mild liver disease (1.41; 1.12-1.76), myocardial infarction (1.34; 1.07-1.69), peptic ulcer disease (1.27; 1.03-1.58), peripheral vascular disease (1.38; 1.07-1.77), renal disease (1.28; 1.11-1.48), and rheumatologic disease (2.04; 1.71-2.42). Trend analysis revealed significant associations between psoriasis severity and each of the above comorbid diseases (each P < .05). CONCLUSIONS AND RELEVANCE The burdens of overall medical comorbidity and of specific comorbid diseases increase with increasing disease severity among patients with psoriasis. Physicians should be aware of these associations in providing comprehensive care to patients with psoriasis, especially those presenting with more severe disease.

Metabolic Syndrome in Patients with Psoriatic Disease

Psoriasis is a common Th-1 and Th-17-mediated chronic inflammatory disease that has been associated with metabolic syndrome, a constellation of cardiovascular risk factors including obesity, hypertension, dyslipidemia, and insulin resistance. Overlapping inflammatory pathways and genetic susceptibility may be potential biologic links underlying this association. Multiple epidemiologic studies have consistently demonstrated higher prevalence of metabolic syndrome in patients with psoriasis. Dose-response relationships between more severe psoriasis and higher prevalence of metabolic syndrome components were recently established. This association has important clinical implications for the comprehensive management of psoriasis: Patients with psoriasis should be routinely screened for metabolic syndrome and treated accordingly to manage cardiometabolic risk, while clinicians should monitor potential effects on treatment efficacy and safety in patients with comorbid psoriasis and metabolic syndrome. Further research will be necessary to establish the directionality of this association and to explore the effect of treatment on these comorbid diseases.

Sexual Orientation and Indoor Tanning Device Use: A Population-Based Study.

Author Contributions: Dr Wright and Mr Mazori had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Dr Wright and Mr Mazori are co–first authors and Dr Vleugels and Dr Femia are co–last authors. Study concept and design: Wright, Mazori, Patel, Femia, Vleugels. Acquisition, analysis, or interpretation of data: Wright, Mazori, Merola, Femia, Vleugels. Drafting of the manuscript: Wright, Mazori, Femia. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Wright, Mazori. Administrative, technical, or material support: Wright, Patel, Femia. Study supervision: Wright, Merola, Femia, Vleugels.

Reliability and Validity of Cutaneous Sarcoidosis Outcome Instruments Among Dermatologists, Pulmonologists, and Rheumatologists

Importance Dermatologists, pulmonologists, and rheumatologists study and treat patients with sarcoidosis with cutaneous manifestations. The validity of cutaneous sarcoidosis outcome instruments for use across medical specialties remains unknown. Objective To assess the reliability and validity of cutaneous sarcoidosis outcome instruments for use by dermatologists and nondermatologists treating sarcoidosis. Design, Setting, and Participants We performed a cross-sectional study evaluating the use of the Cutaneous Sarcoidosis Activity and Morphology Instrument (CSAMI) and Sarcoidosis Activity and Severity Index (SASI) to assess cutaneous sarcoidosis disease severity and the Physicians Global Assessment (PGA) as a reference instrument. Four dermatologists, 3 pulmonologists, and 4 rheumatologists evaluated facial cutaneous sarcoidosis in 13 patients treated at a cutaneous sarcoidosis clinic in a 1-day study on October 24, 2014; data analysis was performed from November through December 2014. Main Outcomes and Measures Interrater and intrarater reliability and convergent validity, with correlation with quality-of-life measures as the secondary outcome. Results All instruments demonstrated excellent intrarater reliability. Interrater reliability (reported as intraclass correlation coefficient [95% CI]) was good for the CSAMI Activity scale (0.69 [0.51-0.87]) and PGA (0.66 [0.47-0.85]), weak for the CSAMI Damage scale (0.26 [0.11-0.52]), and excellent for the modified Facial SASI (0.78 [0.63-0.91]). The CSAMI Activity scale and modified Facial SASI showed moderate correlations (95% CI) with the PGA (0.67 [0.57-0.75] and 0.57 [0.45-0.66], respectively). The CSAMI Activity scale but not the modified Facial SASI showed significant correlations (95% CI) with quality-of-life instruments, such as the Dermatology Life Quality Index (Spearman rank correlation, 0.70 [0.25-0.90]) and the Skin Stigma raw score of the Sarcoidosis Assessment Tool (Pearson product moment correlation, 0.56 [0.01-0.85]). Conclusions and Relevance The CSAMI and SASI were reliable and valid in assessing cutaneous sarcoidosis among our diverse group of specialists. The CSAMI Activity score also correlated with quality-of-life measures and suggested construct validity. These results lend credibility to expand the use of the CSAMI and SASI by dermatologists and nondermatologists in assessing cutaneous sarcoidosis disease activity.

Use and Cost of Actinic Keratosis Destruction in the Medicare Part B Fee-for-Service Population, 2007 to 2015

Importance Actinic keratosis is prevalent and has the potential to progress to keratinocyte carcinoma. Changes in the use and costs of actinic keratosis treatment are not well understood in the aging population. Objective To evaluate trends in the use and costs of actinic keratosis destruction in Medicare patients. Design, Setting, and Participants A billing claims analysis was performed of the Medicare Part B Physician/Supplier Procedure Summary Master Files and National Summary Data of premalignant skin lesion destructions performed from 2007 to 2015 among Medicare Part B fee-for-service beneficiaries. Main Outcomes and Measures Mean number of actinic keratosis lesions destroyed and associated treatment payments in 2015 US dollars estimated per 1000 Medicare Part B fee-for-service beneficiaries. Data analysis was performed from November 2017 to July 2018. Results More than 35.6 million actinic keratosis lesions were treated in 2015, increasing from 29.7 million in 2007. Treated actinic keratosis lesions per 1000 beneficiaries increased from 917 in 2007 to 1051 in 2015, while mean inflation-adjusted payments per 1000 patients decreased from

Teledermatology and teledermatopathology as educational tools for international dermatology: a virtual grand rounds pilot curriculum

11 749 to

Patient-reported reasons for the discontinuation of commonly used treatments for moderate to severe psoriasis

10 942 owing to reimbursement cuts. The proportion of actinic keratosis lesions treated by independently billing nurse practitioners and physician assistants increased from 4.0% in 2007 to 13.5% in 2015. Conclusions and Relevance This study’s findings suggest that actinic keratosis imposes continuously increasing levels of treatment burden in the Medicare fee-for-service population. Reimbursement decreases have been used to control rising costs of actinic keratosis treatment. Critical research may be warranted to optimize access to actinic keratosis treatment and value for prevention of keratinocyte carcinoma.

Comparative effectiveness of commonly used systemic treatments or phototherapy for moderate to severe plaque psoriasis in the clinical practice setting.

Teledermatology may improve dermatologic care access in underserved areas and expand the clinical experience of dermatologists‐in‐training. The potential for teledermatology to supplement global health curricula in dermatology residency education has not been explored.