Mathias Tiedemann Svendsen

Medical adherence to topical corticosteroid preparations prescribed for psoriasis: A systematic review.

Abstract Objective: Topical corticosteroids and corticosteroid combinations are the principal treatments in psoriasis. The aim of this study was to investigate published literature dealing with medical adherence to topical corticosteroid or corticosteroid combinations in patients with psoriasis. Materials and methods: Systematic electronic searches in English language literature were done until September 2015 without publication date restriction. Results: We identified 11 studies consisting of five surveys, two prospective studies, one qualitative study, one mixed-method study, one register study, and one interventional study. Observation periods varied and rates of nonadherence ranged from 8% to 88.3%. The rates were reported by patients on eight nonvalidated scales and one validated scale, measured by medication weight in two studies, and in two studies rates of nonadherence were measured using prescription registers. Thirty-four multifactorial determinants of nonadherence were found. One designed intervention consisted of a disease management program, which improved adherence in the study period. Overall, the studies included were heterogeneous in design and had a high risk of bias. Conclusion: To improve health outcome in topical treatment of psoriasis, further studies should be conducted addressing determinants of nonadherence and test interventions to improve adherence. Validated measurements of medical nonadherence, prescription registers, or medication-weight are needed.

Worldwide utilization of topical remedies in treatment of psoriasis: a systematic review.

Abstract Objective: To review published literature describing the global use of topical antipsoriatics. Materials and methods: Search for English-language articles in Embase, Pubmed, PsycINFO and Cochrane Library. Results: Fifty-four selected publications were found, describing psoriasis patients’ use of topical antipsoriatics, using six different methods to collect data. The eight most frequently used topical treatments from the regions North/South America, North/Central/South Europe, Asia, Middle East and Australia were: corticosteroids used by 16–79%, complementary and alternative medicines used by 10–62%, phototherapies used by 0.4–75%, calcipotriol used by 4.2–73%, corticosteroid/calcipotriol combinations used by 3.3–71%, tar used by 0.8–66%, anthralin used by 15% and emollients used as monotherapy by 1–23%. Rates of patient-reported adherence to topical remedies ranged from 51% to 90% and rates of patient-reported satisfaction with topical as it pertains to symptom control ranged from 12% to 52%. Conclusion: The identified use patterns are varying and reflect a lack of data from large parts of the world and noncomparable studies using heterogeneous study designs. However, this study emphasizes the importance of medical professionals involvement of the patient with respect to choosing prescribed topical treatment and the possibility of patients’ use of alternative treatments. More drug utilization studies, both survey and register based, from different parts of the world are needed to provide more conclusive evidence about patients’ use of topical antipsoriatics.

Hydrochlorothiazide use is strongly associated with risk of lip cancer

The diuretic hydrochlorothiazide is amongst the most frequently prescribed drugs in the United States and Western Europe, but there is suggestive evidence that hydrochlorothiazide use increases the risk of lip cancer.

A novel mutation in the EDAR gene causes severe autosomal recessive hypohidrotic ectodermal dysplasia

We report on a 2‐year‐old girl presenting with a severe form of hypohidrotic ectodermal dysplasia (HED). The patient presented with hypotrichosis, anodontia, hypohidrosis, frontal bossing, prominent lips and ears, dry, pale skin, and dermatitis. The patient had chronic rhinitis with malodorous nasal discharge. The girl was the second born child of first‐cousin immigrants from Northern Iraq. A novel homozygous mutation (c.84delC) in the EDAR gene was identified. This mutation most likely causes a frameshift in the protein product (p.S29fs*74). This results in abolition of all ectodysplasin‐mediated NF‐kB signalling. This complete loss‐of‐function mutation likely accounts for the severe clinical abnormalities in ectodermal structures in the described patient.

A Retrospective Study of Clinical and Mutational Findings in 45 Danish Families with Ectodermal Dysplasia

Ectodermal dysplasias form a complex, nosologic group of diseases with defects in at least 2 ectodermal structures. A retrospective study of patients with ectodermal dysplasia seen at our department over a period of 19 years (1994-2013) was performed. The study population consisted of 67 patients covering 17 different diagnoses. Forty-five families were identified of which 26 were sporadic cases with no affected family members. In 27 tested families a disease-causing mutation was identified in 23 families. Eleven mutations were novel mutations. To our knowledge, we present the first large ectodermal dysplasia cohort focusing on clinical manifestations in combination with mutational analysis. We recommend a nationwide study to estimate the prevalence of the ectodermal dysplasia and to ensure relevant molecular genetic testing which may form the basis of a national ectodermal dysplasia database.

eHealth Technologies as an Intervention to Improve Adherence to Topical Antipsoriatics: A Systematic Review

Abstract Background: Topical antipsoriatics are recommended first-line treatment of psoriasis, but rates of adherence are low. Patient support by use of electronic health (eHealth) services is suggested to improve medical adherence. Objective: To review randomised controlled trials (RCTs) testing eHealth interventions designed to improve adherence to topical antipsoriatics and to review applications for smartphones (apps) incorporating the word psoriasis. Material and methods: Literature review: Medline, Embase, Cochrane, PsycINFO and Web of Science were searched using search terms for eHealth, psoriasis and topical antipsoriatics. General analysis of apps: The operating systems (OS) for smartphones, iOS, Google Play, Microsoft Store, Symbian OS and Blackberry OS were searched for apps containing the word psoriasis. Results: Literature review: Only one RCT was included, reporting on psoriasis patients’ Internet reporting their status of psoriasis over a 12-month period. The rate of adherence was measured by Medication Event Monitoring System (MEMS®). An improvement in medical adherence and reduction of severity of psoriasis were reported. General analysis of apps: A total 184 apps contained the word psoriasis. Conclusion: There is a critical need for high-quality RCTs testing if the ubiquitous eHealth technologies, for example, some of the numerous apps, can improve psoriasis patients’ rates of adherence to topical antipsoriatics.

Psoriasis patients’ experiences concerning medical adherence to treatment with topical corticosteroids

Nonadherence to topical treatment of psoriasis is a common cause of treatment failure. This focus group study was conducted to obtain the patients’ own experiences and explanations regarding medical adherence. The participants consisted of eight primary adherent patients with moderate psoriasis treated with corticosteroid or corticosteroid–calcipotriol combinations, purposefully sampled by age and sex at a dermatology outpatient clinic. Secondary medical adherence was supported by accessibility of the prescribing physician, the prescriber taking time to listen, having a more manageable disease, using a nonstaining product, and establishing routines around treatment at home. Secondary medical adherence was affected negatively by changes in daily routines, if the treatment influenced the patient’s sexual life, having too little time in the consultation room, lack of confidence in the prescriber, diverging information from health care personnel, experiencing side effects, having fear of side effects, impractical formulations of topical products, and impatience regarding time before an effect of the treatment was observed. From this study, the recommendations for the prescribing doctor to improve medical adherence are, the doctor needs to take time to listen to the patient, prescribe a topical product that is easy to apply and less greasy, inform the patients about benefits from treatments, and explain the rationale behind the treatment plan.

Contact sensitization to Geranium robertianum L. in an amateur gardener

A 68-year-old male retired non-atopic school librarian was referred for suspected plant contact dermatitis. The patient had taken up gardening as a hobby when he retired from work: mowing the lawn, cutting hedges and weeding in his garden. For 6–10 years, he had suffered from transient dermatitis on his eyelids, which he attributed to a habit of wiping his eyelids with his hands during gardening. The patient suspected weeds, and especially Herb Robert, which had spread in his garden, to be the main culprits. He tried to avoid contact with this plant by using safety glasses and gloves while gardening. Prior to referral, patch testing was performed with the baseline series and Herb Robert leaf, flower, and stem (tested ‘as is’), and the only reaction was slight erythema at D3 caused by the plant leaf. Prick tests elicited positive reactions to dog, cat, and house dust mite. Patch testing was repeated with the baseline series (TRUE Test® Panel 1–3 supplemented with pet.-based allergens) and eye drops, various Compositae (Asteraceae) plant extracts and allergens, primin and lichen acid mix, falcarinol, and the patient’s own plant Herb Robert. The plant was chopped and tested ‘as is’ with

Occupational allergic contact dermatitis caused by heroin (diacetylmorphine) and morphine.

A 40-year-old nurse with known nickel allergy and hand eczema had, for 3 years, been working in a municipal treatment centre for drug addicts. She had developed work-related airborne acute erythematous and oedematous facial dermatitis when handing heroin (diacetylmorphine or diamorphine, CAS no. 561-27-3) and morphine [CAS no. 52-26-6 as hydrochloride (HCl)] to the clients. Patch tests were performed in two separate sessions. Patch test materials were applied to the back for 2 days with Finn Chambers® on Scanpor® tape (SmartPractice®, Phoenix, AZ, USA), and readings were performed on day (D) 3 or 4 and D7. First, the patient was tested with the baseline series (TRUE Test® Panels 1–3), except for nickel, supplemented with pet.-based allergens (SmartPractice®) and morphine HCl 1% aq. On D3 and D7, the patient had a +++ reaction to morphine HCl. A second patch test session was carried out to better characterize the patient’s sensitization to opioid analgesics. We used four different narcotics supplied by the

Two Young Children with Rashes on Their Trunk and Extremities.

CASE PRESENTATIONS Case 1 A 23-month-old child presented to the pediatric ward with a rash on the trunk and extremities (Figure 1). There was a remarkable acral angioedema (Figure 2) with the consequence that the child was not able to stand or walk. Skin symptoms such as annular wheals with central palsy were observed. The patient had gastrointestinal symptoms and diarrhea, and a short period of fever (38.5°C rectally) the week before hospital presentation. Blood samples showed no leukocytosis, but did show mildly elevated C-reactive protein (CRP) levels at 32 mg/L (normal range <8 mg/L). Case 2 A 12-month-old child was referred by the local general practitioner to the pediatric ward with a rash. Five days before presentation to the pediatric ward, the child was given antibiotic treatment (amoxicillin) for otitis media. The treatment was discontinued because of appearance of elevated itchy, annular wheals and fever (38.8°C rectally).