Megan H. Noe

Psoriasis and the risk of diabetes: A prospective population-based cohort study

Background Data evaluating the impact of objectively measured psoriasis severity on type 2 diabetes mellitus (T2DM) risk are lacking. Objective To determine the risk for T2DM in patients with psoriasis compared with that in adults without psoriasis, stratified by categories of directly assessed body surface area (BSA) affected by psoriasis. Methods A prospective, population‐based, cohort study from the United Kingdom in which 8124 adults with psoriasis and 76,599 adults without psoriasis were followed prospectively for approximately 4 years. Results There were 280 incident cases of diabetes in the psoriasis group (3.44%) and 1867 incident cases of diabetes in those without psoriasis (2.44%). After adjustment for age, sex and body mass index, the hazard ratios for development of incident diabetes were 1.21 (95% confidence interval [CI], 1.01‐1.44), 1.01 (95% CI, 0.81‐1.26), and 1.64 (95% CI, 1.23‐2.18) in the groups with 2% or less of their BSA affected, 3% to 10% of their BSA affected, and 10% or more of their BSA affected compared with in the groups without psoriasis, respectively (P = .004 for trend). Worldwide, we estimate an additional 125,650 new diagnoses of T2DM per year in patients with psoriasis as compared with in those without psoriasis. Limitations Relatively short‐term follow‐up and exclusion of prevalence cases, which may have masked associations in patients with less extensive psoriasis. Conclusion Clinicians may measure BSA affected by psoriasis to target diabetes prevention efforts for patients with psoriasis.

Increased prevalence of HCV and hepatic decompensation in adults with psoriasis: a population-based study in the United Kingdom

The hepatitis C virus (HCV) is a major cause of global morbidity and mortality, with conflicting evidence regarding a possible association with psoriasis.

The Association of Age With Clinical Presentation and Comorbidities of Pyoderma Gangrenosum

Importance Pyoderma gangrenosum is an inflammatory neutrophilic dermatosis. Current knowledge of this rare disease is limited owing to a lack of validated diagnostic criteria and large population studies. Objective To evaluate the association of age with the clinical presentation and comorbidities of pyoderma gangrenosum. Design, Setting, and Participants This was a multicenter retrospective cohort study performed at tertiary academic referral centers in urban settings. Adults (≥18 years) who were evaluated and diagnosed as having pyoderma gangrenosum at the Brigham and Women’s and Massachusetts General Hospitals from 2000 to 2015 and the University of Pennsylvania Health System from 2006 to 2016 were included. Main Outcomes and Measures Patient demographics, clinical features, medical comorbidities, and treatment. Results Of the 356 validated cases of pyoderma gangrenosum included in the study, 267 (75%) were women and 284 (84.8%) were white. The mean (SD) age at presentation was 51.6 (17.7) years. Pathergy was recorded in 100 patients (28.1%). A total of 238 patients (66.9%) had associated medical comorbidities: inflammatory bowel disease in 146 patients (41.0%); inflammatory arthritis in 73 patients (20.5%); solid organ malignant neoplasms in 23 patients (6.5%); hematologic malignant neoplasms in 21 patients (5.9%); and hematologic disorders, specifically monoclonal gammopathy of undetermined significance, myelodysplastic syndrome, and polycythemia vera in 17 patients (4.8%). When stratified by age, pathergy was more common in patients 65 years or older (36.3% vs 24.3%; P = .02). Inflammatory bowel disease was the only medical comorbidity that was more common in patients younger than 65 years (47.7% vs 26.6%; P < .001), while a number of medical comorbidities were more common in those 65 years or older, including rheumatoid arthritis (13.3% vs 6.2%; P = .03), ankylosing spondylitis (1.8% vs 0%; P = .04), solid organ malignant neoplasms (13.3% vs 3.3%; P < .001), hematologic malignant neoplasms (9.7% vs 4.1%; P = .04), and the aforementioned hematologic disorders (10.6% vs 2.1%; P < .001). Conclusions and Relevance Although clinical presentation in this large cohort was similar between different age groups, disease associations varied by age. The findings of this study may allow for a more focused, age-specific evaluation of patients with pyoderma gangrenosum.

Research Techniques Made Simple: Pharmacoepidemiology Research Methods in Dermatology

Clinical trials have several important limitations for evaluating the safety of new medications, leading to many adverse events not being identified until the postmarketing period. Descriptive studies, including case reports, case series, cross-sectional, and ecologic studies, help identify potential safety signals and generate hypotheses. Further research using analytic study methods, including case-control studies and cohort studies, are necessary to determine if an association truly exists and to better understand the potential for causation. Pharmacoepidemiology research examines the use and effects of drugs when used in large populations of patients, using a variety of study designs and biostatistical techniques to reduce the confounding and systematic error associated with observational research. Understanding the strengths and limitations of pharmacoepidemiology research techniques is necessary to interpret the validity of drug safety studies, guiding both individual patient decisions and broader public health decisions.

Outcomes of Comorbidities with Biologic and Systemic Agents

Psoriasis is a chronic inflammatory disease and those with severe disease have higher rates of cardiometabolic comorbidities including major adverse cardiovascular events and death. Evidence from large observational studies suggests that treatment with both methotrexate and TNF inhibitors may reduce the risk of major cardiovascular events in those with severe disease. Further research is needed to understand how newer biologics (IL 12/23 inhibitors, IL-17 inhibitors) alter cardiovascular disease outcomes and cardiometabolic risk factors. Additionally, prospective randomized control trials are necessary to better understand the effect of systemic therapies on the incidence of major cardiovascular events.

Sweet syndrome in patients with and without malignancy: A retrospective analysis of 83 patients from a tertiary academic referral center

Background Sweet syndrome is a neutrophilic dermatosis that may be categorized into classic, malignancy‐associated, and drug‐induced subtypes. Few studies have systematically analyzed this rare disorder. Objective To describe the clinicopathologic characteristics and treatment of Sweet syndrome and identify characteristics associated with concurrent malignancy. Methods We retrospectively reviewed patients with Sweet syndrome at the University of Pennsylvania from 2005 to 2015. Results We identified 83 patients (mean age, 57 years; 51% male) with Sweet syndrome: 30% with the classic form, 44% with the malignancy‐associated form, 24% with the drug‐induced form in the setting of malignancy, and 2% with the drug‐induced form. Acute myeloid leukemia was the most common malignancy (in 24 of 83 patients [29%]). Filgrastim was the most common medication (used in 8 of 83 patients [10%]). Leukopenia (P < .001), anemia (P = .002), thrombocytopenia (P < .001), absence of arthralgia (P < .001), and histiocytoid or subcutaneous histopathology (P = .024) were associated with malignancy (χ2 test). Limitations This was a retrospective study that represents patients from a single tertiary academic referral center, which may limit its generalizability to other settings. Conclusion When caring for patients with Sweet syndrome, dermatologists should be aware of the potential association of leukopenia, anemia, thrombocytopenia, absence of arthralgia, and histiocytoid or subcutaneous histopathology with malignancy.

Autoimmune skin disease among dermatology outpatients in Botswana: a retrospective review

There is a paucity of data describing autoimmune skin diseases in sub‐Saharan Africa and in HIV positive cohorts. We describe the incidence of autoimmune skin diseases in public dermatology clinics in Botswana.

Quantification of granuloma volume and response to treatment in cutaneous sarcoidosis using 3-dimensional high-frequency ultrasound scan

3D HFU: 3-dimensional high-frequency ultrasound scan CSAMI: Cutaneous Sarcoidosis Activity and Morphology Instrument PET/CT: positron emission tomography/ computed tomography C utaneous involvement occurs in 25% to 30% of patients with sarcoidosis. Effective treatment of the disease has historically been challenging given a lack of an objective, reproducible marker of disease activity. Here we present a case using 3-dimensional high-frequency ultrasound (3D HFU) to quantify cutaneous granuloma volume as a measure of disease activity.