Tina Bhutani

Quality-of-Life Instruments: Evaluation of the Impact of Psoriasis on Patients

The negative impact of psoriasis on a patients quality of life (QoL) is well documented in the literature. Patients often suffer poor self-esteem, difficulties in social interactions, and significant psychological distress. It is, therefore, critically important that a clinician evaluate the extent to which the disease impacts a patients QoL. This chapter reviews several validated and reliable generic, dermatology-specific, and disease-specific QoL instruments useful in measuring the impact of psoriasis on patients QoL. These QoL instruments can be especially helpful in identifying those patients who would most benefit from systemic or biologic therapy.

Access to Health Care in Patients With Psoriasis and Psoriatic Arthritis Data From National Psoriasis Foundation Survey Panels

IMPORTANCE This article represents a real-world perspective on access to health care including the number and types of physicians seen by patients with psoriasis. It is important for practicing dermatologists to recognize patients who may be less likely to seek care for this multifaceted systemic disease as well as to be aware of reasons for not seeing physicians. OBJECTIVES To examine the relationship between psoriasis patient characteristics and access to health care and to determine out-of-pocket costs for psoriasis care. DESIGN Cross-sectional survey. SETTING Patients with psoriasis and psoriatic arthritis in the general community in the United States. PARTICIPANTS A random sample of patients with psoriasis and psoriatic arthritis from more than 75,000 National Psoriasis Foundation members. MAIN OUTCOMES AND MEASURES Number and type of physicians seen in the past 2 years and out-of-pocket health care expenses were measured. RESULTS Among 5604 patients with psoriasis and psoriatic arthritis, 92.4% had seen at least 1 physician in 2 years. Compared with males, female patients with psoriasis were 1.47 times more likely to seek care (adjusted odds ratio, 1.47; 95% CI, 1.18-1.83). Patients with private insurance and Medicare were more likely to seek care compared with uninsured patients (adjusted odds ratio, 3.02; 95% CI, 2.23-4.08 and 2.85; 1.91-4.24, respectively). Among patients with psoriasis seeking care, 78.3% were seeing specialists; 22% obtained care from primary care physicians. Primary reasons for not seeking treatments included giving up on disease treatment (27.6%) and prohibitive cost (21%). Compared with patients with mild disease, patients with severe psoriasis were more likely to seek a specialist for care (adjusted odds ratio, 1.64; 95% CI, 1.37-1.98). Patients spent an average of

The role of IL-17 in vitiligo: A review

2528 out-of-pocket per year for psoriasis care. CONCLUSIONS AND RELEVANCE About one-quarter of patients seek psoriasis care from primary care physicians, and insurance status affects care-seeking patterns. Giving up on treatment and prohibitive costs remain primary reasons for not seeking care.

How psoriasis patients perceive, obtain, and use biologic agents: Survey from an academic medical center

IL-17 is involved in the pathogenesis of several autoimmune diseases; however its role in vitiligo has not been well defined. Emerging human and mouse studies have demonstrated that systemic, tissue, and cellular levels of IL-17 are elevated in vitiligo. Many studies have also shown significant positive correlations between these levels and disease activity, extent, and severity. Treatments that improve vitiligo, such as ultraviolet B phototherapy, also modulate IL-17 levels. This review synthesizes our current understanding of how IL-17 may influence the pathogenesis of autoimmune vitiligo at the molecular level. This has implications for defining new vitiligo biomarkers and treatments.

Open-label, pilot study examining sequential therapy with oral tacrolimus and topical tacrolimus for severe atopic dermatitis

Abstract The availability of new biologic agents for the treatment of psoriasis provides hope for improved quality of life outcomes. However, the way patients come to use biologics, the potential barriers they encounter, and their attitudes towards using these medications are still not well studied. Here, we conducted a survey of 106 psoriasis patients at an academic medical center to discern patient attitudes towards biologics. We found that most patients learn of biologics through their physician and perform follow-up research using the Internet. Most patients did not find it difficult to make the decision to start a biologic. Difficulty in obtaining biologics was associated with age less than 55 (p = 0.01), lower income level (p = 0.007), and lack of insurance (p = 0.04). Patients were found to have high satisfaction and compliance rates on biologics. Of patients who missed a dose of their biologic, this was mainly due to logistical reasons such as not having the medication or forgetting to take it, rather than being depressed or overwhelmed. Patients with lower income levels had increased cut backs in personal expenses due to co-payments (p = 0.001). Among respondents, the mean annual out-of-pocket expense for a biologic was

Paradoxical worsening of psoriasis when switching from etanercept to adalimumab: A case series

557.12 per year, with a range of

Recent advances in phototherapy for psoriasis.

0–7000.

Oral vitamin D, still a viable treatment option for psoriasis

BACKGROUND Systemic treatment options for generalized atopic dermatitis (AD) are limited. To our knowledge, there have been no prospective trials examining the use of oral tacrolimus, a calcineurin inhibitor, in AD. OBJECTIVES We assessed the safety and efficacy of sequential therapy with oral tacrolimus and topical tacrolimus in the treatment of generalized AD using the Eczema Area and Severity Index and the Physician Global Assessment scores as the primary end points. METHODS Twelve patients with AD covering at least 50% body surface area were enrolled. Patients in both phases of the study received sequential therapy with oral and topical tacrolimus over a 14-week treatment period. Eczema Area and Severity Index, Physician Global Assessment, and pruritus scores were calculated at each study visit. RESULTS Patients recorded a 67% improvement in the Eczema Area and Severity Index score, a 45% improvement in the Physician Global Assessment score, and a 69% reduction in the pruritus score. LIMITATIONS This investigator-initiated, open-label, single-center, proof-of-concept study lacks a large sample size and placebo control group. CONCLUSION Sequential therapy with oral tacrolimus and topical tacrolimus may be an effective treatment for AD. A large, randomized control study is warranted.

Goeckerman Therapy for the Treatment of Eczema: A Practical Guide and Review of Efficacy

Abstract Background: Etanercept and adalimumab are the most widely used biologic agents for psoriasis today. Large phase III trials have elucidated the much higher efficacy of adalimumab over etanercept; however, no head-to-head comparison data exist for these two medications. Objective: We report four cases of patients well controlled with Enbrel who flared when switched to adalimumab. In all four cases, the patients psoriasis improved when switched back to etanercept. Conclusion: This brief report is intended to alert clinicians of the possibility that, despite the well-known average efficacy advantage of adalimumab over etanercept, some psoriasis patients experience better clinical outcome with etanercept than adalimumab. Therefore, despite the general efficacy difference between these two TNF inhibitors, it may be worth keeping in mind etanercept as an option in patients who have failed with adalimumab.

Depression and suicidality in psoriasis: review of the literature including the cytokine theory of depression.

Phototherapy involves repeated exposure of the skin to ultraviolet light to treat various inflammatory skin conditions such as psoriasis. Recent studies have identified specific immunologic effects of phototherapy that may underlie phototherapy efficacy. Furthermore, recent advancements have been made in developing safe and effective targeted phototherapy modalities for difficult-to-treat areas such as scalp psoriasis. Targeted phototherapy in the form of the excimer laser holds potential for more aggressive, effective treatment and long-lasting remission of psoriasis. Phototherapy is now also used successfully with biologic agents as combination therapy to treat recalcitrant psoriasis. Therefore, though one of the oldest therapeutic modalities for psoriasis, phototherapy remains a mainstay treatment with promise for further advancement.