Sarah L. Taylor

Tanning as an addictive behavior: a literature review

Background: Recent studies have identified reinforcing properties associated with tanning and suggest a possible physiologic mechanism and addiction driving tanning behavior.

Written action plans: potential for improving outcomes in children with atopic dermatitis.

Asthma and atopic dermatitis are common childhood diseases requiring long-term treatment. Adherence to treatment is often poor. Written action plans (WAPs) can improve adherence in pediatric asthma. In this article we review the use of WAPs in pediatric asthma and atopic dermatitis as a basis for assessing WAPs for pediatric patients with atopic dermatitis. Results from a PubMed search for WAPs in pediatric asthma and a Cochrane review on this topic were compiled. Results from a PubMed search for education in pediatric atopic dermatitis were also reviewed. The preponderance of evidence indicates that WAPs improve adherence in pediatric asthma. No such intervention was identified for atopic dermatitis. Few controlled trials directly comparing use to non-use of a WAP were found. WAPs show promise in improving adherence in pediatric asthma, and their effect on adherence in pediatric atopic dermatitis is worthy of further investigation.

Prevalence of pigmentary disorders and their impact on quality of life: a prospective cohort study

Background  Pigmentary disorders are commonly seen in dermatology practice and can have a negative psychosocial impact on patients.

Therapeutic ladder for pemphigus vulgaris: Emphasis on achieving complete remission

BACKGROUND Pemphigus vulgaris (PV) is a blistering autoimmune bullous disease that is usually fatal without proper treatment. There are no clear treatment guidelines for PV at this time. PURPOSE We suggest a standard treatment regimen for patients with PV based on the success of our treatment. METHODS A retrospective chart review of 18 patients with PV was conducted to assess response to a similar approach using mycophenolate mofetil (MMF) and prednisone. Diagnosis was confirmed through routine histology, direct immunofluorescence, and indirect immunofluorescence, and patients were followed up for a total average of 35.2 months. RESULTS We achieved complete disease control in 89% of patients using our treatment algorithm. Fourteen of 18 patients achieved complete disease control on therapy with prednisone and MMF. Three of the 4 patients who did not achieve control on MMF and prednisone went on to receive rituximab therapy, and two of those patients achieved disease control on rituximab. The average length of time from initiating therapy to 75% clearance of lesions was 4.5 months. Three of 18 patients were able to discontinue therapy after an average of 3 years and have remained in complete remission for more than 1 year. LIMITATIONS This was a retrospective chart review with a small patient sample size. CONCLUSIONS The combination therapy of MMF and prednisone is an effective treatment regimen to achieve rapid and complete control of PV. For those patients who fail treatment with MMF and prednisone, rituximab is an efficacious alternative therapy.

Medication adherence among acne patients: a review

Background  Acne is a chronic disease often requiring the use of medications for extended periods of time. In general, adherence decreases over time in patients with chronic diseases, and adherence to topical medications is poor compared to adherence to oral medications, placing individuals using topical medications at increased risk for nonadherence and treatment failure. Poor adherence may also be a common cause of treatment failure in teens with acne.

A randomized controlled pilot study of the effects of an extra office visit on adherence and outcomes in atopic dermatitis.

and parental modeling. Physicians interested in decreasing indoor tanning in young patients should be aware of the mother’s tanning status. Parents are often willing health educators, and previous parent-based interventions have resulted in reductions in sunbathing activity in middle-school children. Interventions directed at mothers before the child initiates tanning have the potential to lead to reduced tanning in the mother and reduced tanning initiation and frequency in the child. Informing mothers of the risks of tanning and the strong influence their tanning behavior will have on their child’s current and future risks may have significant effects, ultimately resulting in less UV exposure. As 31.7% of our sample indoor tanned with a friend during their first experience, future interventions should target peers as well as mothers. We must note that this study is limited by its relatively small sample size, and future studies need to confirm these findings in a wider population.

To test or not to test? An evidence-based assessment of the value of screening and monitoring tests when using systemic biologic agents to treat psoriasis

The development of new treatments for psoriasis provides dermatologists novel ways to help control the disease but raises questions about what laboratory screening tests are required. As of yet, no consensus or guidelines exist for dermatologists to follow and there may be misconceptions about the relative need for screening and monitoring tests in patients treated with biologic agents. Current practice ranges from no testing to blanket screening panels. The purposes of this review are to (1) systematically review the literature on the use of screening and monitoring tests when initiating and continuing biologic treatments (adalimumab, alefacept, efalizumab, etanercept, infliximab) for moderate to severe psoriasis or psoriatic arthritis; and (2) suggest practical guidelines for dermatologists on which to base such testing. We searched the Cochrane Collaborative Database (including the Cochrane Database of Systematic Reviews [Cochrane Reviews] and the Cochrane Central Register of Controlled Trials [Clinical Trials]) and the MEDLINE database using medical subject headings as search terms when available or key words when appropriate. We compiled published data on risk and risk assessment related to systemic psoriasis treatments, used expert opinion where appropriate when published clinical data were not adequately informative, and assigned evidence grades for various screening tests based on standard methods of the US Preventive Services Task Force. Finally, we developed a table of evidence grades for tests used to monitor different systemic medications. There is not strong evidence to recommend most screening tests for monitoring biological treatments. Neither is there strong evidence not to do such testing. Ultimately, from a practical standpoint, it is incumbent on the clinician to consider each patient independently and determine what screening tests are most appropriate for each individual patient.

Rheumatologists’ recommendations on what to do in the dermatology office to evaluate and manage psoriasis patients’ joint symptoms

Background: Psoriasis patients presenting to the dermatologist for skin disease management may have joint symptoms related to psoriatic arthritis. Dermatologists should ask psoriasis patients about these, yet may not be sure about how to best collaborate with rheumatologists in the management of these patients. Objective: To describe how rheumatologists view the role of dermatologists in addressing and identifying signs and symptoms of psoriatic arthritis in psoriasis patients. Methods: A questionnaire was developed concerning the evaluation and management of joint complaints in a dermatology setting. The survey was sent to rheumatologists interested in psoriatic arthritis. Results: Rheumatologists recommended dermatologists ask psoriasis patients about joint pain, stiffness, swelling, and fatigue to evaluate for psoriatic arthritis. Rheumatology referral was recommended if patients had signs of inflammatory joint disease that were unrelieved by non-prescription non-steroidal anti-inflammatory drugs (NSAIDs). Patients with disabling joint symptoms, no improvement on (disease-modifying antirheumatic drug; DMARD) therapy, or with other causes of joint pain should be referred to rheumatology. Rheumatologists recommended that dermatologists only provide DMARD therapy for joint symptoms if concomitant skin disease warrants such treatment. Conclusions: Dermatologists play a pivotal role in preventing joint destruction in psoriasis patients by screening for signs of psoriatic arthritis, initiating treatment, and referring patients to a rheumatologist when appropriate.

Pilot Study of the Effect of Ultraviolet Light on Pain and Mood in Fibromyalgia Syndrome

BACKGROUND There is a lack of effective systemic or adequate symptomatic treatment for pain associated with fibromyalgia syndrome (FMS). Anecdotes suggest ultraviolet (UV) light may be of some benefit. PURPOSE The purpose of the present study was to determine if UV is effective in ameliorating chronic pain in persons with FMS. METHODS Nineteen subjects with FMS were enrolled in a controlled trial of UV and non-UV (control) tanning beds for 2 weeks, followed by randomization to receive UV or non-UV (control) exposure for 6 additional weeks. A follow-up interview was conducted 4 weeks after the last treatment. Pain was assessed with an 11-point numerical pain rating (Likert scale), a visual analogue pain scale (VAS), and the McGill Pain Questionnaire. Mood variables were also assessed. RESULTS During the initial 2 weeks when subjects received both UV and non-UV (control) exposures, the 11-point Likert scale pain score decreased 0.44 points after exposure to UV from pre-exposure levels (S.E. = .095). Additionally, UV exposure resulted in greater positive affect, well-being, relaxation, and reduced pain levels when compared to non-UV (control) exposure (Odds Ratio [OR] = 2.80, p = 0.0059). Following the randomized treatment period, there was slight improvement in pain as measured by the McGill Pain Questionnaire in the UV group compared to the non-UV (control) group (12.2 versus 14.1; p = 0.049); the other pain scales yielded nonsignificant results. Assessment 4 weeks after the last treatment showed no significant differences in scores in the adjusted means for outcomes. CONCLUSIONS Results from this pilot study suggest that tanning beds may have some potential in reducing pain in persons with FMS.

Health behaviour models: A framework for studying adherence in children with atopic dermatitis

Atopic dermatitis (AD) is a common problem of childhood causing considerable distress. Effective topical treatments exist, yet poor adherence often results in poor outcomes. A framework is needed to better understand adherence behaviour. To provide a basis for this framework, we reviewed established models used to describe health behaviour. Structural elements of these models informed the development of an adherence model for AD that can be used to complement empirical AD treatment trials. Health behaviour models provide a means to describe factors that affect adherence and that can mediate the effects of different adherence interventions. Models of adherence behaviour are important for promoting better treatment outcomes for children with AD and their families. These models provide a means to identify new targets to improve adherence and a guide for refining adherence interventions.