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News - December 2020

News - December 2020

New Biomarker for Vascular Inflammation in Psoriasis Identified
vascular biomarkerCCL20 was strongly associated with vascular endothelial inflammation among patients with psoriasis, according to the findings of a recent study.

“Psoriasis is associated with increased cardiovascular risk that is not captured by traditional proinflammatory biomarkers,” the researchers said. They investigated the relationship between Psoriasis Area and Severity Index (PASI), circulating proinflammatory biomarkers, and vascular health. Among patients with psoriasis and age- and sex-matched controls, the researchers analyzed 273 proteins using the OLINK platform and measured vascular endothelial inflammation and health using direct transcriptomic analysis of brachial vein endothelial cells.

The researchers identified CCL20, IL-6, and IL-17A as the top three circulating proinflammatory cytokines. CCL20 correlated with vascular endothelial inflammation more so than IL-6 and IL-17A, they added. After adjusting for potential confounders, the researchers found the association between CCL20 and vascular endothelial inflammation was still significant.

In nested models, they also found CCL20 added value to a model for predicting vascular endothelial inflammation that already incorporated PASI, Framingham Risk, high-sensitivity C-reactive protein, IL-17A, and IL-6.

“We demonstrate that CCL20 expression has a strong association with vascular endothelial inflammation, reflects systemic inflammation, and may serve as a potential biomarker of impaired vascular health in psoriasis,” the researchers concluded.

Elnabawi YA, Garshick MS, Tawil M, et al. CCL20 in psoriasis: a potential biomarker of disease severity, inflammation, and impaired vascular health. J Am Acad Dermatol. Published online November 27, 2020. doi:10.1016/j.jaad.2020.10.094

Teledermatology Triage Associated With Cost Reduction
A recent study found using teledermatology to triage and manage dermatology patients within a capitated health care system may be associated with significant savings.

Researchers compared the cost of managing newly referred patients with a teledermatology triage system with those receiving conventional care at the Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG) in California. A total of 2098 patients were included, with 1154 men, 879 patients who identified as non-White, and 1099 patients with Medi-Cal insurance.

To estimate costs, the researchers created decision-tree models to generate possible care paths with teledermatology triage and within a conventional care model. They then applied the costs associated with primary care, dermatology, and teledermatology visits to estimate the cost of managing patients within each care path for 6 months. In addition, they calculated the mean cost per patient within each model; for the teledermatology path, added costs included software implementation and maintenance costs. The primary outcome was the mean cost to the health care organization to manage newly referred patients with or without teledermatology triage.

The mean cost per patient to the health care organization in the decision-tree model with teledermatology triage was $559.84 (SD, $319.29), the researchers said. In the model for conventional care, they found the mean cost per patient was $699.96 ($390.24).

In the model, teledermatology was associated with a statistically significant mean cost savings per patient of $140.12 ($11.01). “Given an annual dermatology referral volume of 3150 patients, the analysis estimates an annual savings of $441,378,” the researchers noted.

“Implementation of a teledermatology triage system within the dermatology department at the ZSFG was associated with cost savings, suggesting that managed health care settings may experience significant cost savings from using teledermatology to triage and manage patients,” they concluded.

Zakaria A, Miclau TA, Maurer T, Leslie KS, Amerson E. Cost minimization analysis of a teledermatology triage system in a managed care setting. JAMA Dermatol. Published online November 18, 2020. doi:10.1001/jamadermatol.2020.4066

Positive Patch Testing More Likely Among Patients With Hand Eczema
patch testingHand eczema (HE) was associated with a higher proportion of positive patch tests, according to the findings of a recent study in Journal of the American Academy of Dermatology.

Researchers analyzed data from the 2000 to 2016 North American Contact Dermatitis group (N=37,113) to characterize the clinical characteristics, etiologies, and allergen prevalence among adults with HE referred for patch testing.

A total of 10,034 patients were diagnosed with HE, with differences of overlap between allergic contact, irritant, and atopic dermatitis, the researchers said. In particular, the group found that among patients with HE, allergic contact HE varied but both atopic HE increased and irritant HE decreased over time.

In addition, a higher proportion of positive patch tests was associated with HE (67.5% vs 63.8%; chi-square, P<.0001). They also found significantly higher odds of positive patch test reactions and clinical relevance in 13 and 16 of the 25 most common allergens, respectively, associated with HE. These allergens included preservatives, metals, topical therapies, and rubber accelerators.

Silverberg and colleagues found methylisothiazolinone, nickel, formaldehyde, quaternium-15, and fragrance mix I to be the most common clinically relevant allergens.

“HE in adults was associated with higher proportions of positive patch tests, with a heterogeneous profile of allergens,” the researchers concluded. “Patch testing remains an important tool in the evaluation of patients with HE.”

Silverberg JI, Warshaw EM, Atwater AR, et al. Hand dermatitis in adults referred for patch testing: analysis of North American Contact Dermatitis Group Data, 2000–2016. J Am Acad Dermatol. Published online November 28, 2020. doi:10.1016/j.jaad.2020.11.054

Conjunctivitis Is the Most Common Ocular Comorbidity in AD
A study published in Journal of the American Academy of Dermatology found that conjunctivitis was the most common ocular comorbidity among patients with atopic dermatitis (AD).

In the study, the researchers searched EMBASE, PubMed, SCOPUS, and Web of Science to identify studies that assessed the association between AD and conjunctivitis as well as other ocular surface diseases (OSDs). They performed a meta-analysis of 134 studies and estimated pooled random-effects prevalence and odds ratio (OR).

Compared with reference individuals, AD was associated with conjunctivitis (OR, 2.78; 95% CI, 2.33-3.32), the researchers said. The prevalence of conjunctivitis was 31.7% (95% CI, 27.7-35.9) among patients with AD compared with 13.3% (95% CI, 11.0-15.7) among reference individuals.

In addition, the research group found that keratoconus (OR, 3.71; 95% CI, 1.99-6.94) and ocular herpes simplex (OR, 3.65; 95% CI, 2.04-6.51) were associated with AD.

“Signs and symptoms of conjunctivitis and other OSDs in AD may be underreported, making proactive inquiry and examination by physicians treating AD patients important,” the researchers concluded.

Ravn NH, Ahmadzay ZF, Christensen TA, et al. Bidirectional association between atopic dermatitis, conjunctivitis and other ocular surface diseases: a systemic review and meta-analysis. J Am Acad Dermatol. Published online November 26, 2020. doi:10.1016/j.jaad.2020.11.037

Keloid-Related Pain Reduced With 1064-nm Nd:YAG Laser
keloid on chestA majority of patients with a symptomatic keloid treated with a 1064-nm Nd:YAG laser exclusively saw a total resolution in pain after treatment. The study results were published in Lasers in Surgery and Medicine.

The authors noted how keloids have recently been successfully treated with Nd:YAG laser in conjunction with 5-fluorouracil and intralesional corticosteroids, so they sought to study the effects of Nd:YAG laser alone. In their study, eight patients with Fitzpatrick skin types I through VI presented for treatment of keloids with associated symptoms of pain. Of these patients, seven had previously been treated with intralesional steroid injections without resolution of symptoms, and keloids were mostly commonly located on the trunk.

Patients were treated with two passes under a long-pulsed 1064-nm Nd:YAG laser with a 10-mm spot size. Fluence was set between 18 to 19 J/cm2 with a pulse duration of 60 ms. Treatment was repeated every 3 to 8 weeks. Patients reported pain scores before and after treatments.

Following treatment, patients reported an improvement in pain with an average 5-point reduction on a 10-point scale (range, 2-10). Patients first noticed an improvement in pain after 3.25 treatments (range, 1-5). In total, five reported complete resolution of their pain. In addition, no patients experienced further scarring or pigmentary changes following treatment, but transient erythema and mild edema were noted.

Analysis of the results with Wilcoxon signed-rank test demonstrated a statistically significant improvement in keloid pain (z=2.46; P=.01); however, the study was limited by its sample size. The authors concluded that patients with keloids treated with 1064-nm Nd:YAG laser experience a significant reduction in pain. n

Patel PM, Bakus AD, Garden BC, Lai O, Jones VA, Garden JM. Treatment of pain in keloids using only a long-pulsed 1064 nm Nd:YAG Laser. Lasers Surg Med. Published online November 25, 2020. doi:10.1002/lsm.23363

Study Highlights Suicide, Mental Health Risk Among Finasteride Users
Research found an increased risk of suicidality, depression, and anxiety among young men prescribed finasteride for alopecia.

“There is ongoing controversy about the adverse events of finasteride, a drug used in the management of alopecia and benign prostatic hyperplasia (BPH),” the researchers said. “In 2012, reports started emerging on men who had used finasteride and either attempted or completed suicide.”

In the pharmacovigilance case-noncase study, the researchers analyzed the relationship between finasteride use and psychological adverse events (depression and anxiety) and suicidality (ideation, attempt, completed suicide) using data from VigiBase, the World Health Organization global database of individual case safety reports. They calculated the reporting odds ratio (ROR) as well as conducted extensive sensitivity analyses, stratified by indication (alopecia and BPH) and age, that compared finasteride with other therapies for alopecia and BPH, therapies with similar mechanisms of action, and reports of suicidality before and after 2012.

Among finasteride users, there were total of 356 reports of suicidality and 2926 reports of psychological adverse events. The researchers identified a significant disproportionality signal for suicidality (ROR, 1.63; 95% CI, 1.47-1.81) and psychological adverse events (ROR, 2.06; 95% CI, 1.81-2.34) with finasteride use. 

Sensitivity analyses showed younger patients (> 45 years) and those with alopecia had significant disproportionality signals for increased suicidality, with ROR of 3.47 (95% CI, 2.90-4.15) and ROR of 2.06 (95% CI, 1.81-2.34), respectively. These signals were not detected in older patients with BPH, the researchers noted. In sensitivity analyses, the researchers found reports of these adverse events significantly increased after 2012 (ROR, 2.13; 95% CI, 1.91-2.39).

“This study’s findings suggest that the risk of suicidality, depression, and anxiety should be considered when prescribing finasteride to younger patients with alopecia who may be more vulnerable to the drug’s adverse effects,” they concluded. “The sensitivity analyses suggest that these disproportional signals of adverse events may be due to stimulated reporting and/or younger patients being more vulnerable to finasteride’s adverse effects.” n

Nguyen D, Marchese M, Cone EB, et al. Investigation of suicidality and psychological adverse events in patients treated with finasteride. JAMA Dermatol. Published online November 11, 2020. doi:10.1001/jamadermatol.2020.3385

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