Paras P. Vakharia

Severity strata for Eczema Area and Severity Index (EASI), modified EASI, Scoring Atopic Dermatitis (SCORAD), objective SCORAD, Atopic Dermatitis Severity Index and body surface area in adolescents and adults with atopic dermatitis

Scoring systems for assessing the signs of atopic dermatitis (AD) are complex and difficult to interpret. Severity strata are helpful to interpret these assessments properly.

Burden of skin pain in atopic dermatitis

BACKGROUND Atopic dermatitis (AD) is associated with itch, skin inflammation and barrier disruption, and scratching, all of which may be associated with skin pain. OBJECTIVE To characterize the patient burden of skin pain in AD. METHODS We performed a prospective dermatology practice-based study using questionnaires and evaluation by a dermatologist. RESULTS Overall, 305 patients (age range, 13-97 years) were included in the study, with 564 encounters. The cohort included 195 females (63.9%) and 193 whites (63.7%). The mean (SD) age at enrollment was 42.3 (18.1) years, and the mean (SD) age of patient-reported AD onset was 29.6 (31.9) years. At baseline, 144 patients (42.7%) reported skin pain in the past week, with 42 (13.8%) reporting severe or very severe pain. Twenty-four (16.8%) thought the skin pain was part of their itch, 16 (11.2%) from scratching, and 77 (72.0%) from both. Patients with skin pain were more likely to describe their itch using terms that resembled neuropathic pain. Prevalence of skin pain was increased in patients with vs without excoriations (72.6% vs 57.6%; χ2 test P = .02) but not other morphologic characteristics. Skin pain severity was most strongly correlated with the Patient-Oriented Eczema Measure (Spearman ρ = 0.54), followed by ItchyQOL (ρ = 0.52), 5-dimensions of itch scale (ρ = 0.47), Dermatology Life Quality Index (ρ = 0.45), numeric rating scale for itch (ρ = 0.43) and sleep (ρ = 0.36), Patient Health Questionnaire 9 (ρ = 0.36), patient-reported global AD severity (ρ = 0.34), Eczema Area and Severity Index (ρ = 0.23), and objective Scoring AD index (ρ = 0.20) (P < .001 for all). Patients with both severe itch and pain vs those with only one or neither symptom being severe had significant increases in all these measures. CONCLUSION Skin pain is a common and burdensome symptom in AD. Skin pain severity should be assessed with itch severity in AD patients and may be an important end point for monitoring treatment response.

Validation of patient-reported global severity of atopic dermatitis in adults

Atopic dermatitis (AD) is associated with a heterogeneous presentation and clinical course. There is a lack of simple and validated severity assessments that are feasible for clinical practice and epidemiological research.

Chronic exposure to tetracyclines and subsequent diagnosis for non-melanoma skin cancer in a large Midwestern U.S. patient population

Tetracyclines (TCNs) are commonly used in the management of several chronic dermatological disorders, partly due to their affinity for inflamed skin tissue, as they are known to suppress cytokines including tumor necrosis factor-alpha and interleukin-6 that are typically involved in inflammatory skin disorders.1 TCNs are known to be photoreactive following ultraviolet (UV) radiation exposure, a known risk factor for the development of nonmelanoma skin cancer (NMSC), notably basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).2 Previous studies examining the relationship between photoreactive medications, including psoralen compounds and sulfonamide moieties, and NMSC suggest an association. This article is protected by copyright. All rights reserved.

Severity strata for five patient-reported outcomes in adults with atopic dermatitis

Several patient‐reported outcomes have been used to assess the burden of atopic dermatitis (AD). Some are disease specific, such as the Patient‐Oriented Eczema Measure (POEM), while others pertain to itch, for example the numerical rating scale (NRS)‐itch, ItchyQoL and 5‐D itch, or dermatological disease in general, for example the Dermatology Life Quality Index (DLQI). Development of severity strata is essential for proper interpretability of these assessments.

Relationship between EASI and SCORAD severity assessments for atopic dermatitis

Capsule Summary The present study shows a complex relationship between EASI and SCORAD. The results provide support for inclusion of objective-SCORAD and/or SCORAD in addition to EASI in clinical trials.

Apremilast and suicidality – a retrospective analysis of three large databases: the FAERS, EudraVigilance and a large single-centre US patient population

438–443. 3 Seideg ard J, Vorachek WR, Pero RW, Pearson WR. Hereditary differences in the expression of the human glutathione transferase active on trans-stilbene oxide are due to a gene deletion. Proc Natl Acad Sci USA 1988; 85: 7293–7297. 4 Sprenger R, Schlagenhaufer R, Kerb R et al. Characterization of the glutathione S-transferase GSTT1 deletion: discrimination of all genotypes by polymerase chain reaction indicates a trimodular genotype-phenotype correlation. Pharmacogenetics 2000; 10: 557–565. 5 Ibbotson SH, Dawe RS, Dinkova-Kostova AT et al. Glutathione S-transferase genotype is associated with sensitivity to psoralen-ultraviolet A photochemotherapy. Br J Dermatol 2012; 166: 380–388. 6 Kanetsky PA, Holmes R, Walker A et al. Interaction of glutathione S-transferase M1 and T1 genotypes and malignant melanoma. Cancer Epidemiol Biomarkers Prev 2001; 10: 509–513. 7 Solak B, Karkucak M, Turan H et al. Glutathione S-transferase M1 and T1 gene polymorphisms in patients with chronic plaque-type psoriasis: a casecontrol study. Med Princ Pract 2015; 25: 155–158.

New therapies for atopic dermatitis: Additional treatment classes

Background: A wide array of miscellaneous agents is being studied for the treatment of atopic dermatitis (AD), including targeted topical, oral systemic, and biologic agents. Objective: To review the known efficacy and safety to date for such agents being studied for the treatment of AD. Methods: A nonsystematic review of the literature was performed. PubMed and ClinicalTrials.gov were searched for studies assessing agents not described previously for the treatment of AD. Randomized controlled trials were primarily sought, but other study types were also included if they contained pertinent data. Agents are presented by mechanism of action, with analysis of mechanism of action and data regarding efficacy and safety in patients with AD. Results: Data regarding the following agents are presented: omiganan (an antimicrobial peptide), tapinarof (a nonsteroidal anti‐inflammatory agent), PR022 (hypochlorous acid), asimadoline (a &kgr;‐opioid agonist), DS107 (dihomo‐&ggr;‐linolenic acid), ZPL‐389 (a histamine H4 receptor antagonist), secukinumab (an interleukin 17A inhibitor), and fezakinumab (interleukin 22 inhibitor). Limitations: Limited clinical data exist for many of the described agents. Conclusions: As recent research has improved our understanding of AD pathogenesis, various agents with unique mechanisms of action have been studied for the treatment of AD. Many of these hold great therapeutic promise for AD, and continued research and development is warranted.

The Role and Diagnosis of Allergic Contact Dermatitis in Patients with Atopic Dermatitis

Patients with atopic dermatitis (AD) have increased penetration of allergens, immune dysregulation (including shared cytokine pathways), and frequent use of emollients and topical medications, all of which may predispose toward developing allergic contact dermatitis (ACD). Recent systematic reviews have suggested that ACD is a significant clinical problem in both children and adults with AD. While this remains controversial, ACD remains an important comorbidity and potential exacerbant of AD in clinical practice. Common relevant allergens, include lanolin, neomycin, formaldehyde, sesquiterpene lactone mix, compositae mix, and fragrances that are commonly found in AD patients’ personal care products. We herein review the clinical scenarios where patch testing is indicated in AD. In addition, we review the contraindications, preferred patch-testing series, pitfalls, and challenges determining the relevance of positive patch-test reactions in AD patients.

Prevalence of chronic hepatitis B and C in psoriasis patients: A cross-sectional study in a large US population

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