Joy Wan

Risk of moderate to advanced kidney disease in patients with psoriasis: population based cohort study.

Objective To determine the risk of chronic kidney disease in patients with psoriasis. Design Population based cohort study and nested cross sectional study. Setting Electronic medical records database based in United Kingdom. Participants Cohort study: patients with psoriasis aged 18-90 each matched to up to five patients without psoriasis based on age, practice, and time of visit. Nested study: patients with psoriasis aged 25-64 with confirmed data on psoriasis severity, each matched to up to 10 patients without psoriasis based on age and practice. Main outcome measures Cohort study: incident moderate to advanced (stage 3 through 5) chronic kidney disease. Nested study: baseline prevalence of chronic kidney disease. Results 136 529 patients with mild psoriasis and 7354 patients with severe psoriasis based on treatment patterns were matched to 689 702 unaffected patients. The adjusted hazard ratios (95% confidence intervals) for incident chronic kidney disease were 1.05 (1.02 to 1.07), 0.99 (0.97 to 1.02), and 1.93 (1.79 to 2.08) in the overall, mild, and severe psoriasis groups, respectively. Age was a significant effect modifier in the severe psoriasis group, with age specific adjusted hazard ratios (95% confidence intervals) of 3.82 (3.15 to 4.64) and 2.00 (1.86 to 2.17) for patients aged 30 and 60, respectively. In the nested analysis of 8731 patients with psoriasis with measurements of affected body surface area matched to 87 310 patients without psoriasis, the adjusted odds ratios (95% confidence intervals) for chronic kidney disease were 0.89 (0.72 to 1.10), 1.36 (1.06 to 1.74), and 1.58 (1.07 to 2.34) in the mild, moderate, and severe psoriasis groups, respectively. Conclusions Moderate to severe psoriasis is associated with an increased risk of chronic kidney disease independent of traditional risk factors.

Association Between Malignancy and Topical Use of Pimecrolimus.

IMPORTANCE A black box warning describes a potential risk of malignancy associated with topical use of pimecrolimus to treat atopic dermatitis due to its similarity to oral calcineurin inhibitors used in solid-organ transplantation and spontaneous reporting of malignancies, including lymphomas and cutaneous malignancies. OBJECTIVE To evaluate the risk of malignancy in a postmarketing study of children exposed to pimecrolimus. DESIGN, SETTING, AND PARTICIPANTS A longitudinal cohort study among a nationwide ongoing long-term cohort of children enrolled in the Pediatric Eczema Elective Registry (PEER) who had a history of atopic dermatitis and pimecrolimus use with data available up through May 2014. MAIN OUTCOMES AND MEASURES Reports of malignancy among those in the PEER compared with expected rates from the Surveillance, Epidemiology, and End Results (SEER) program. RESULTS Overall, 7457 children were enrolled in the PEER, for a total of 26,792 person-years. Children used a mean (SD) of 793 (1356) g of pimecrolimus when enrolled in the study. As of May 2014, five malignancies had been reported. These include 2 leukemias, 1 osteosarcoma, and 2 lymphomas. No skin cancers were reported. The standardized incidence ratio for all malignancies (primary outcome) based on the age-standardized SEER population was 1.2 (95% CI, 0.5-2.8). As secondary analyses, the standardized incidence ratios (based on 2 cases for each) were 2.9 (95% CI, 0.7-11.7) for lymphoma and 2.0 (95% CI, 0.5-8.2) for leukemia. None of these findings were statistically significant. CONCLUSIONS AND RELEVANCE Based on more than 25,000 person-years of follow-up, it seems unlikely that topical pimecrolimus as it was used in the PEER cohort to treat atopic dermatitis is associated with an increased risk of malignancy.

Management of rheumatic and autoimmune blistering disease in pregnancy and postpartum

The treatment of rheumatic and autoimmune skin disease in women who are pregnant or of childbearing potential can present challenges to the dermatologist. We discuss the current approaches to treating lupus erythematosus, antiphospholipid antibody syndrome, dermatomyositis, morphea and systemic sclerosis, mixed connective tissue disease, rheumatoid arthritis, and autoimmune blistering disease in such patients. In the appropriate setting, topical and systemic corticosteroids, hydroxychloroquine, dapsone, azathioprine, and ultraviolet B phototherapy may be safely and cautiously used during pregnancy. Considerations about contraception, planned conception, therapeutic options, and disease control are paramount in optimizing pregnancy outcomes and minimizing risks to both mother and fetus.

Retrospective Analysis of Beta-Blocker Instituted for Treatment of Hemangiomas (RABBIT Study)

Objective. To evaluate the safety and efficacy of our institutional beta-blocker protocol for treatment of complicated infantile hemangiomas (IH). Study Design. A retrospective descriptive study of 76 infants/children with IH treated with oral propranolol at the Children’s Hospital of Philadelphia between June 2008 and August 2010 was performed, assessing both the safety and efficacy of propranolol. Based on preliminary data showing hemangioma recrudescence off-treatment, we reviewed 9 additional patients with recrudescence between August 2010 and December 2011. Results. Mild adverse events included asymptomatic bradycardia, gastrointestinal symptoms, asymptomatic hypotension, cool hands/feet, asymptomatic hypoglycemia, and sleep disturbance. Sixteen patients had recrudescence of IH off-treatment, with propranolol discontinued at a median age of 14 months (interquartile range 10-15 months). Conclusions. Propranolol appears to be associated with minor, not severe symptomatic adverse events. Propranolol appears to be effective in treating complicated IH. Recrudescence can occur off-treatment, even with discontinuing propranolol as late as 15 months of age.

Dermatologist response rates to a mailed questionnaire: a randomized trial of monetary incentives.

To the Editor: Although surveys are frequently used to collect data from dermatologists, response rates are often low, limiting the generalizability of results.1 Monetary incentives have improved physician survey response but have not been tested in dermatologists.2 Moreover, the effect of incentive size remains unclear.2 This study examines the effect of cash incentives on dermatologist response to a mailed questionnaire and its cost-effectiveness. As part of a study about preferences for psoriasis treatment, we surveyed 1000 dermatologists,3 randomizing each to receive an initial questionnaire packet with either

Dermatologist preferences for treatments to compare in future randomized controlled comparative effectiveness trials for moderate to severe psoriasis

5 or

Systematic review of atopic dermatitis disease definition in studies using routinely-collected health data.

10 (with a note offering this token of appreciation) or no cash (Figure 1). Using a modified Dillman Tailored Design method,4 we sent postcard reminders and duplicate surveys to non-respondents after the initial mailing. The study was approved by the University of Pennsylvania Institutional Review Board. FIGURE 1 Flow chart of study design and outcome We compared survey response with respect to physician characteristics and incentives and performed logistic regression to evaluate interactions among possible predictors of response determined a priori. We calculated cost per response and incremental cost-effectiveness, considering only incentive and material costs (

The risk of IgA nephropathy and glomerular disease in patients with psoriasis: A population based cohort study.

1/questionnaire without incentive,

A randomized, double-blind, placebo-controlled proof of concept trial of topical cidofovir, 1% and 3%, for the prevention of beard hair growth in men

1.10/questionnaire with incentive,

Prenatal Risk Factors for PHACE Syndrome: A Study Using the PHACE Syndrome International Clinical Registry and Genetic Repository

0.75/postcard,