Laura K. DeLong

The Impact of Pruritus on Quality of Life The Skin Equivalent of Pain

OBJECTIVE To compare the impact of chronic pruritus and chronic pain on quality of life (QoL) using directly elicited health utility scores. DESIGN Cross-sectional study. SETTING Convenience sample of patients attending the Emory Dermatology Clinic, Emory Spine Center, and Emory Center for Pain Management, Atlanta, Georgia. PARTICIPANTS Adult men and women (aged ≥ 18 years) experiencing chronic pain or pruritus for 6 weeks or more. MAIN OUTCOME MEASURES The mean utility score of patients with chronic pruritus was compared with that of patients with chronic pain. A regression analysis was performed to determine the impact of the primary predictor variable-symptom type-on the primary outcome variable-mean utility score (a metric representing the impact on QoL). RESULTS The study included 73 patients with chronic pruritus and 138 patients with chronic pain. The mean (SD) utility among patients with pruritus was 0.87 (0.27) compared with 0.77 (0.31) for patients with pain (P < .01). After symptom severity, duration, and demographic factors were controlled for, only symptom severity (0.03 [P < .05]) and single marital status (-0.12 [P = .02]), but not symptom type (P = .43), remained significant predictors of the mean symptom utility score. CONCLUSIONS Chronic pruritus has a substantial impact on QoL, one that may be comparable to that of pain. The severity of symptoms and the use of support networks are the main factors that determine the degree to which patients are affected by their symptoms. Addressing support networks in addition to developing new therapies may improve the QoL of itchy patients.

Annual direct and indirect health care costs of chronic idiopathic urticaria: a cost analysis of 50 nonimmunosuppressed patients.

OBJECTIVE To estimate annual direct and indirect health care costs in patients with chronic idiopathic urticaria (CIU) managed with conventional therapies. DESIGN A cost analysis consisting of a survey-guided and retrospective medical record review of direct and indirect health care costs from a societal perspective in patients with CIU. SETTING The Johns Hopkins University allergy and dermatology ambulatory clinics. PARTICIPANTS Fifty adults with active CIU were recruited in sequential order. Individuals who were taking corticosteroids or other immunosuppressants in the month before enrollment were excluded from the study. MAIN OUTCOME MEASURES We estimated direct health care costs, which included laboratory, medication, outpatient visit, and emergency department and hospital visit costs. We also estimated indirect costs, which included earnings lost owing to travel to outpatient visits and absences from work owing to CIU-related illness. RESULTS Patients with CIU consumed a mean (SD) of

A pilot study in discrepancies in quality of life among three cutaneous types of rosacea.

2047 (

Utilization and rationale for the implementation of total body (digital) photography as an adjunct screening measure for melanoma.

1483) annually. Because CIU is primarily an outpatient disease, medication costs alone accounted for 62.5% (

Severity of Cutaneous Findings Predict the Presence of Systemic Symptoms in Pediatric Maculopapular Cutaneous Mastocytosis

1280) of the total annual cost. Indirect costs accounted for 15.7% (

Clinical meaning in skin-specific quality of life instruments: a comparison of the Dermatology Life Quality Index and Skindex banding systems.

322) of the total costs. CONCLUSIONS High medication costs, followed by total indirect costs, result in the largest economic burden among patients with CIU. High medication costs may place low-income patients at risk for suboptimal treatment and increased burden due to poorly controlled disease. Our estimated total health care costs for CIU are comparable to those of other skin diseases such as vitiligo and bullous disease.

Overview of Health Status Quality-of-Life Measures

REFERENCES 1. Carlin CS, Feldman SR, Krueger JG, Menter A, Krueger GG. A 50% reduction in the Psoriasis Area and Severity Index (PASI 50) is a clinically significant endpoint in the assessment of psoriasis. J Am Acad Dermatol 2004;50:859-66. 2. Knodell RG, Ishak KG, Black WC, Chen TS, Craig R, Kaplowitz N, et al. Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology 1981;1:431-5. 3. Peterson JR, Hsu FC, Simkin PA, Wener MH. Effect of tumour necrosis factor a antagonists on serum transaminases and viraemia in patients with rheumatoid arthritis and chronic hepatitis C infection. Ann Rheum Dis 2003;62:1078-82. 4. Magliocco MA, Gottlieb AB. Etanercept therapy for patients with psoriatic arthritis and cocncurrent hepatitis C virus infection: report of 3 cases. J Am Acad Dermatol 2004;51:580-4. 5. Marotte H, Fontanges E, Bailly F, Zoulim F, Trepo C, Miossec P. Etanercept treatment for three months is safe in patients with rheumatological manifestations associated with hepatitis C virus. Rheumatology (Oxford) 2007;46:97-9.

Effects of Total-Body Digital Photography on Cancer Worry in Patients With Atypical Mole Syndrome

The primary objective of our study was to update the prevalence of total body photography (TBP) utilization and the rationale for its implementation as an adjunctive screening measure by academic dermatologists across the USA, and investigate the emergence of total body digital photography (TBDP). Our secondary objective was to further examine how TBP/TBDP is being incorporated into the dermatology screening examination in academic pigmented lesion clinics. A questionnaire was mailed to 113 dermatology departments across the USA. About 43% (49/113) of surveyed departments responded. TBP was used by 67% (33/49) of the respondents. Of these respondents, 33% (11/33) used TBDP alone, 33% (11/33) used TBDP in combination with nondigitally based TBP, and 33% (11/33) used nondigital TBP with print photos. The three most frequently cited reasons for the use of full-body baseline photographs were that they reduced patient anxiety, led to fewer biopsies, and helped to find melanoma early in the curable stage. Respondents who did not use full body baseline photographs cited logistical constraints as the number one reason, followed by perceived lack of utility. In conclusion, our study shows that there is a significant number of academic dermatologists using TBP/TBDP. However, this study also shows that there are conflicting beliefs among academic dermatologists concerning the efficacy of TBP/TBDP. At this point with a documented growing trend in utilization of TBP, more studies are needed to evaluate the efficacy of this screening adjunct to diagnose melanoma early and positively impact survival because of early diagnosis.

Future Directions in Dermatology Quality of Life Measures

Although the prognosis of maculopapular cutaneous mastocytosis (MPCM), also referred to as urticaria pigmentosa, is often benign, clinicians lack evidence to reliably predict those at risk of associated systemic manifestations. We sought to elucidate clinical markers of disease severity to provide better treatment and prognostic information for individuals with MPCM. A retrospective chart review querying characteristics of children diagnosed with MPCM in the Emory Dermatology Clinic was performed. Follow‐up was obtained through a clinical encounter or telephone interview. Linear regression was used to determine predictors of the number of MPCM‐related systemic symptoms. Of 67 subjects, 57% were male, and the mean age of onset was 4.5 months. The maximum number of MPCM lesions was 1 to 10 in 16%, 11 to 30 in 33%, 31 to 50 in 25%, 51 to 100 in 6%, and more than 100 in 20% of subjects. For their MPCM lesions, 46% of subjects reported itching, 34% flushing, and 25% blistering. Reported systemic symptoms included diarrhea (22%), abdominal pain (15%), wheezing or dyspnea (13%), vomiting (10%), bone pain (10%), headaches (8%), cough (10%), rhinorrhea (8%), irritability (6%), and anaphylaxis (1.5%). In a multivariate linear regression analysis, the maximum number of MPCM lesions (p = 0.02) and the number of skin symptoms (p < 0.01) were statistically significant predictors of the number of systemic symptoms, controlling for age of onset, body sites involved, and sex. The correlation between cutaneous findings and symptomatology could aid clinicians in identifying individuals with MPCM who might warrant systemic evaluation and therapy.

Preference-Based Measures in Dermatology: An Overview of Utilities and Willingness to Pay

Clinical meaning can be assigned to scores of health status measures by using a variety of approaches. The anchor-based approach involves determining the difference on a quality of life (QOL) scale that corresponds to a self-reported small but important change on a global scale given concomitantly, which serves as an independent anchor. This article focuses on the anchor-based banding approach and reviews methods to assign clinical meaning to QOL measures, specifically the Dermatology Life Quality Index (DLQI) and Skindex. This article also includes pilot data that compares the DLQI and Skindex using these previously validated banding systems.