Publications

BACKGROUND: Hidradenitis suppurativa (HS) and psoriasis are inflammatory skin diseases associated with obesity. Each disease is likely to impact the quality of life of patients, but the relative impact of each disease is unknown.

OBJECTIVES: This study aimed to determine whether skin disease or obesity is more distressing to obese patients who have either psoriasis or HS.

METHODS: A cohort of obese patients with psoriasis and HS was surveyed using a time-trade-off utility. T-tests and regression analysis were used to compare differences in impact on quality of life between skin disease and obesity for patients with HS and psoriasis. Further analyses were adjusted for degree of obesity and severity of disease.

RESULTS: A total of 79 subjects completed the survey. Obese patients with HS were heavier than patients with psoriasis (mean body mass index 38.1 kg/m2 vs. 34.9 kg/m2). Obese patients with either HS or psoriasis were both willing to trade a significantly higher proportion of their life to live without skin disease than to live at a normal weight (p = .01). This effect persisted after controlling for disease severity and weight. Patients with HS were willing to trade significantly more years of life to live at a normal weight than obese patients with psoriasis (14 vs. 7; p < .04).

LIMITATIONS: This was a small study conducted at an academic institution.

CONCLUSION: In this study population, obesity was more severe in patients with HS than in those with psoriasis. Even after controlling for relative severity, HS was more problematic for subjects in this study than weight when these conditions existed concomitantly.

PURPOSE: To determine the characteristics of clinically active academic physicians most affected by administrative burden; the correlation between administrative burden, burnout, and career satisfaction among academic physicians; and the relative value and burden of specific administrative tasks.

METHOD: The authors analyzed data from the 2014 Massachusetts General Physicians Organization Survey. Respondents reported the percentage of time they spent on patient-related administrative duties and rated the value and burden associated with specific administrative tasks. A five-point Likert scale and multivariate regression identified predictors of administrative burden and assessed the impact of administrative burden on perceived quality of care, career satisfaction, and burnout.

RESULTS: Of the eligible workforce, 1,774 physicians (96%) responded to the survey. On average, 24% of working hours were spent on administrative duties. Primary care physicians and women reported spending more time on administrative duties compared with other physicians. Two-thirds of respondents reported that administrative duties negatively affect their ability to deliver high-quality care. Physicians who reported higher percentages of time spent on administrative duties had lower levels of career satisfaction, higher levels of burnout, and were more likely to be considering seeing fewer patients in the future. Prior authorizations, clinical documentation, and medication reconciliation were rated the most burdensome tasks.

CONCLUSIONS: Administrative duties required substantial physician time and affected physicians' perceptions of being able to deliver high-quality care, career satisfaction, burnout, and likelihood to continue clinical practice. There is variation in administrative burden across specialties, and multiple areas of work contribute to overall administrative workload.

BACKGROUND: Apremilast, an oral phosphodiesterase 4 inhibitor, has an acceptable safety profile and is effective for treatment of plaque psoriasis and psoriatic arthritis.

OBJECTIVES: To evaluate the impact of apremilast on health-related quality of life (HRQOL), general functioning and mental health using patient-reported outcome (PRO) assessments among patients with moderate to severe plaque psoriasis in the ESTEEM 1 and 2 trials.

METHODS: A total of 1255 patients were randomized (2 : 1) to apremilast 30 mg BID or placebo for 16 weeks; all received apremilast through Week 32. PRO assessments included the Dermatology Life Quality Index (DLQI), 36-Item Short-Form Health Survey version 2 mental/physical component summary scores (SF-36v2 MCS/PCS), Patient Health Questionnaire-8 (PHQ-8), EuroQol-5D (EQ-5D) and Work Limitations Questionnaire-25 (WLQ-25). Post hoc analyses examined relationships between Psoriasis Area and Severity Index (PASI) scores and PHQ-8 in the apremilast-treated population at Week 16.

RESULTS: Treatment with apremilast improved all HRQOL PROs at Week 16 (vs. placebo), except the SF-36v2 PCS, and improvements were sustained through Week 32. Mean DLQI and SF-36v2 MCS improvements exceeded minimal clinically important differences. Changes at Week 16 in PHQ-8 and PASI were weakly correlated, and only 35.8% of patients who achieved a ≥75% reduction from baseline in PASI score (PASI-75) with apremilast treatment also achieved PHQ-8 scores of 0-4.

CONCLUSIONS: Apremilast led to improvements in HRQOL PROs vs. placebo in patients with moderate to severe plaque psoriasis.

Biologic agents have become more common to treat patients with psoriasis, but concerns about their effect on pregnancy and lactation often preclude this treatment during these time periods. During the past decade, we have gained a much better understanding of the course of psoriasis during pregnancy and the safety of the use of biologic agents during pregnancy and lactation. Under certain circumstances, biologic agents can be considered appropriate treatment options for patients who are pregnant or lactating.

BACKGROUND: The American Academy of Dermatology recommends dermatologists understand the costs of dermatologic care.

OBJECTIVE: This study sought to measure dermatology providers' understanding of the cost of dermatologic care and how those costs are communicated to patients. We also aimed to understand the perspectives of patients and dermatological trainees on how cost information enters into the care they receive or provide.

METHODS: Surveys were systematically developed and distributed to 3 study populations: dermatology providers, residents, and patients.

RESULTS: Response rates were over 95% in all 3 populations. Dermatology providers and residents consistently underestimated the costs of commonly recommended dermatologic medications but accurately predicted the cost of common dermatologic procedures. Dermatology patients preferred to know the cost of procedures and medications, even when covered by insurance. In this population, the costs of dermatologic medications frequently interfered with patients' ability to properly adhere to prescribed regimens.

LIMITATIONS: The surveyed population was limited to the northwestern United States and findings may not be generalizable. Cost estimations were based on average reimbursement rates, which vary by insurer.

CONCLUSION: Improving dermatology providers' awareness and communication of the costs of dermatologic care might enhance medical decision-making, improve adherence and outcomes, and potentially reduce overall health care expenditures.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. In small studies, inflammatory bowel disease has been associated with the increased prevalence of HS, but the data on the concurrence of inflammatory bowel disease in patients with HS are limited. We therefore investigated the prevalence and risk of inflammatory bowel disease in patients with HS compared with the general population. The study linked all Danish individuals aged ≥18 years in nationwide registers. Adjusted odds ratios and adjusted hazard ratios were estimated by logistic regression and Cox regression, respectively. The study comprised 7,732 patients with HS and 4,354,137 subjects from the general population. The prevalence (HS vs. general population) was 0.8% and 0.3% (odds ratio 2.04; 1.59-2.62) for Crohn's disease and 1.3% and 0.7% (odds ratio 1.75; 1.44-2.13) for ulcerative colitis. The risk of new-onset Crohn's disease (hazard ratio 2.19; 1.44-3.34) and ulcerative colitis (hazard ratio 1.63; 1.18-2.27) was significantly increased among patients with HS. In conclusion, HS was significantly associated with the presence and risk of new-onset inflammatory bowel disease, although the prevalence remained low. Gastrointestinal complaints in patients with HS should warrant further clinical examination.

Hidradenitis suppurativa (HS) is an inflammatory skin disorder with many associated comorbidities, including obesity, metabolic syndrome, smoking, depression, arthritis, autoinflammatory syndromes, inflammatory bowel disease, and genetic syndromes. In addition, HS patients can suffer from a variety of diseases related to the chronic inflammatory nature of their HS such as cardiovascular disease and anemia. An understanding of these comorbidities and associations is essential for the management of HS, and routine screening for these entities should be considered in all HS patients.

IMPORTANCE: Psoriasis is a complex inflammatory skin condition associated with serious medical comorbidities in adults, including obesity, hypertension, dyslipidemia, type 2 diabetes mellitus, psoriatic arthritis, nonalcoholic fatty liver disease, depression, anxiety, and decreased quality of life. Because psoriasis begins in childhood in almost one-third of patients, early identification of risk may be critical to minimizing effects on future health.

OBJECTIVE: To develop the first set of guidelines for comorbidity screening for patients with pediatric psoriasis based on current evidence.

EVIDENCE REVIEW: A literature review was performed using PubMed from January 1999 through December 2015. Limiting the search to human studies published in English and removing reviews and editorials produced 153 relevant manuscripts. An expert panel in psoriasis, pediatric dermatology, pediatric rheumatology, pediatric gastroenterology, pediatric endocrinology, and adult and pediatric cardiology used the patient-centered Strength of Recommendation Taxonomy (SORT) method to evaluate and grade the quality of evidence.

FINDINGS: Because of the limited number of pediatric studies published on these topics, the strength of the panel's recommendations is classified as SORT level C expert consensus recommendations. The majority of recommendations coincide with those endorsed by the American Academy of Pediatrics for the general pediatric patient but with added attention to signs and symptoms of arthritis, depression, and anxiety. The panel also identified key areas for further investigation.

CONCLUSIONS AND RELEVANCE: Patients with pediatric psoriasis should receive routine screening and identification of risk factors for associated comorbidities. These guidelines are relevant for all health care providers caring for patients with pediatric psoriasis, including primary care clinicians, dermatologists, and pediatric specialists. Because these are the first pediatric guidelines, re-review and refinement will be necessary as studies further detail, and possibly stratify, risk in affected children.