Seivright, Justine R, Villa, Natalie M, Grogan, Tristan, Parvataneni, Ram K, Thompson, Alyssa M, Shi, Vivian Y, and Hsiao, Jennifer L
Subjects
Reproductive Medicine, Biomedical and Clinical Sciences, Good Health and Well Being, Disease Progression, Female, Hidradenitis Suppurativa, Humans, Odds Ratio, Pregnancy, Hidradenitis suppurativa, Disease course, Postpartum flare, Acne inversa, Clinical Sciences, Dermatology & Venereal Diseases, Clinical sciences
Abstract
BackgroundHormones are thought to play a role in hidradenitis suppurativa (HS). However, data on the HS disease course during pregnancy and the postpartum period has not been well established. The objective of this study is to analyze the available literature to determine HS disease activity during pregnancy and the postpartum period.MethodsThe PubMed and Embase databases were systematically searched for relevant articles from database inception until November 22, 2020. The inclusion criteria were a study population with the diagnosis of HS and discussion of pregnancy impact on the HS disease course or postpartum flare. Study characteristics, patient demographics, HS severity, and HS disease course during pregnancy and the postpartum period were extracted by 2 independent reviewers. The quality of included studies was assessed using the Newcastle-Ottawa Scale for observational studies. Heterogeneity was assessed using Cochran's Q statistic and I2 index. The random-effects meta-analytical model was used. The primary study outcome was the pooled odds ratio of improvement or of worsening of HS disease activity during pregnancy.ResultsThe systematic search identified 8 studies for analysis. There was a total of 672 cases for which data on the patient-reported HS disease course during pregnancy were available, and 164 cases for which data on patient-reported postpartum flare were available. In the meta-analyses, the rate of HS disease improvement was 24% (95% CI 0.13-0.40) and the rate of HS disease worsening was 20% (95% CI 0.11-0.34). Sixty percent (99/164) of patients experienced a postpartum flare.ConclusionWhile about a quarter of women will experience an improvement in HS during pregnancy, the majority will have a stable or worsened disease course, and over half of patients will experience a postpartum flare. Close monitoring of HS patients is needed during pregnancy and postpartum periods, as patients may need continued, or even escalated, disease management.
Ingredients found in facial moisturizers can impact a myriad of skin conditions, including sensitive skin syndrome and contact dermatitis. There is a paucity of evidence on the allergenic potential and marketing claims of facial moisturizers, posing challenges to clinician recommendation and consumer selection. In this study, we systematically evaluate the 100 top-selling sun protective facial moisturizers that claim to be natural, fragrance free, expert-approved, age preventing, beneficial for sensitive skin, and sun protective. Allergenic potential of these moisturizers is evaluated based on ingredients used and prices and consumer ratings are compared. Accordingly, 75 of 100 marketed at least one additional benefit. "Anti-aging" products had the highest average price ($14.99/oz) and "expert-approved" had the lowest ($5.91/oz). Consumer rating was highest for facial moisturizers that were "fragrance-free" (4.35/5.00) whereas products that were "natural" received the lowest ratings (3.49/5.00). The most prevalent allergens found in these moisturizers were ethylenediamine tetraacetic acid (EDTA), phenoxyethanol, and cetyl alcohol. "Expert-approved" products had the fewest average allergens in their ingredient lists (P=0.033), whereas products advertising "SPF" had significantly more (P
Thompson, Alyssa M., primary, Rick, Jonathan W., additional, De, Devea R., additional, Fernandez, Jennifer M., additional, Maarouf, Melody, additional, Seivright, Justine R., additional, Hsiao, Jennifer L., additional, and Shi, Vivian Y., additional
Thompson, Alyssa M., primary, Fernandez, Jennifer M., additional, Shih, Terri, additional, Hamzavi, Iltefat, additional, Hsiao, Jennifer L., additional, and Shi, Vivian Y., additional
Thompson, Alyssa M., primary, Fernandez, Jennifer M., additional, Hendricks, Aleksi J., additional, Mata, Elizabeth M., additional, Hsiao, Jennifer L., additional, and Shi, Vivian Y., additional
Seivright, Justine R., primary, Villa, Natalie M., additional, Grogan, Tristan, additional, Parvataneni, Ram K., additional, Thompson, Alyssa M., additional, Shi, Vivian Y., additional, and Hsiao, Jennifer L., additional
Rick, Jonathan W, primary, Thompson, Alyssa M, additional, Fernandez, Jennifer M, additional, Maarouf, Melody, additional, Seivright, Justine R, additional, Hsiao, Jennifer L, additional, and Shi, Vivian Y, additional
The impact of COVID-19 vaccination on medically vulnerable patients has yet to be determined, however our I a priori i understanding of vaccine theory and immunomodulators suggests that these vaccines will be safe and effective in these patients, though the possibility of a diminished immune response should be considered until more data are available. HT
Drug class
Drug name
Known vaccination interactions (R = Risks; E: Effectiveness)
Response to non-COVID-19 vaccines (V is reduced response, = is normal response)
Anti-CD20
Rituximab
R: Vaccination with live virus vaccines is not recommended.
Pneumococcal: V Tetanus: V
E: Administer non-live vaccines at least 4 weeks prior to a course of rituximab. Therefore, live vaccines should not be given concurrently with anakinra.
Tetanus/Diphtheria: = Influenza: =
E: No difference was detected in anti-tetanus antibody response between the anakinra and placebo treatment groups when the tetanus/diphtheria toxoids vaccine was administered concurrently with anakinra. [Extracted from the article]
Pain is one of the most common and debilitating symptoms of hidradenitis suppurativa (HS). We sought to identify pain management therapies used in HS and assess patient-perceived effectiveness. An anonymous online survey was posted to Facebook HS support groups. Participants selected all that applied from a list of 20 therapies to indicate which ones they have tried for HS pain. For each therapy used, participants were asked to rate effectiveness on a 5-point scale: not successful (1), mildly successful (2), moderately successful (3), very successful (4), and extremely successful (5). Mean effectiveness ratings were calculated by averaging the corresponding numbers. Of the 438 participants, 93.8% were female. Participants classified themselves as Hurley stage I (8.2%), II (53.4%), and III (38.4%). Warm compresses were the most commonly used therapy (82.4%), followed by ibuprofen/naproxen (74.7%), Epsom salt baths (57.8%), cold compresses (45.4%), and acetaminophen (44.7%). Marijuana smoking received the highest mean effectiveness rating (2.92 ± 1.10), followed by marijuana edibles (2.87 ± 1.10), and opioids (2.83 ± 0.98). Mean effectiveness ratings were lowest for bleach baths (1.52 ± 0.80), sitz baths (1.53 ± 0.56), massage (1.61 ± 0.92), gabapentin (1.64 ± 0.73), and acetaminophen (1.71 ± 0.75). Even the highest-rated pain management modalities are considered only moderately effective by HS patients. [ABSTRACT FROM AUTHOR]
Seivright, Justine R., primary, Thompson, Alyssa M., additional, Villa, Natalie M., additional, Shi, Vivian Y., additional, and Hsiao, Jennifer L., additional
Fernandez, Jennifer M., primary, Hendricks, Aleksi J., additional, Thompson, Alyssa M., additional, Mata, Elizabeth M., additional, Collier, Erin K., additional, Grogan, Tristan R., additional, Shi, Vivian Y., additional, and Hsiao, Jennifer L., additional
De, Devea R., Thompson, Alyssa M., Seivright, Justine, Atluri, Swetha, Ederle, Amanda, Swigert, Anna, Jaros, Joanna, Hsiao, Jennifer L., and Shi, Vivian Y.
Fernandez, Jennifer M., primary, Thompson, Alyssa M., additional, Borgstrom, Mark, additional, Orenstein, Lauren A. V., additional, Hsiao, Jennifer L., additional, and Shi, Vivian Y., additional
Fernandez, Jennifer M., primary, Ludwig, Catherine M., additional, Price, Kyla N., additional, Hendricks, Aleksi J., additional, Mata, Elizabeth M., additional, Thompson, Alyssa M., additional, Maarouf, Melody, additional, Agbai, Oma N., additional, Maverakis, Emanual, additional, Shi, Vivian Y., additional, and Hsiao, Jennifer L., additional
Shih, Terri, De, Devea R., Thompson, Alyssa M., Seivright, Justine R., Atluri, Swetha, Ederle, Amanda, Swigert, Anna, Jaros, Joanna A., Hsiao, Jennifer L., and Shi, Vivian Y.
The waxing-and-waning nature of hidradenitis suppurativa (HS), complex treatment plans, along with variable responsiveness to therapy, can create management challenges for patients. In this pilot cross-over randomized controlled trial, we aim to evaluate the effectiveness a HS-written action plan (HSWAP) on patient disease understanding and confidence in recognizing flares and adjusting management. Participants were randomized into a pre-crossover control group that received a verbal consultation (VC)-only, and an intervention group which received the VC + HSWAP. The pre-crossover control group then crossed over (post-crossover control) to also receive the VC + HSWAP (ClinicalTrials.gov Identifier: NCT04600375). Patient comprehension of their disease and management steps was high after both a thorough VC and HSWAPs. However, the majority of patients prefer receiving both a VC and a HSWAP. After the addition of the HSWAP, pre-crossover control group patients' understanding and confidence of their disease and management plan increased across all surveyed questions. [ABSTRACT FROM AUTHOR]
Thompson, Alyssa M., Atluri, Swetha, Price, Kyla N., Hsiao, Jennifer L., and Shi, Vivian Y.
Subjects
*MEDICARE Part B, *IMMUNOMODULATORS, *CONSUMER price indexes, *MEDICAID, *BIOSIMILARS
Abstract
Prices for immunomodulators used in dermatological conditions are rising in the United States. While Medicare Part-D solely covers medication costs, Medicare Part-B covers outpatient infusion and injection costs given by medical professionals. We aim to analyze recent trends in Medicare Part-B spending on immunomodulators and their biosimilars used in the treatment of common chronic inflammatory dermatoses. The 2012–2018 Medicare Part-B spending data on immunomodulators commonly used for dermatologic conditions were extracted from the Centers for Medicare and Medicaid Services database. Inflation was adjusted to reflect 2012-dollar amounts using the Consumer Price Index. Medicare Part-B spending has increased by 27.5% from 2012 to 2018 ($2.5B, $3.2B). Average annual total spending (AATS) is greatest for rituximab ($1,522,757,520), and average annual spending per maintenance dose (AASPMD) is greatest for ustekinumab-90 mg ($12,976). The percent change in AASPMD increased for all immunomodulators with Etanercept-50 mg having the greatest percent change (+64.6%, +$285.70). Infliximab had a greater AATS and AASPMD than its biosimilars. Medicare Part-B spending is often overlooked but plays a big role in federal healthcare spending. Exploring the strategic use of less expensive biosimilars could help mitigate spending. [ABSTRACT FROM AUTHOR]
Thompson, Alyssa M, primary, Newland, Jason G, additional, Newland, Helen, additional, Feldmann, Jennifer, additional, and Liang, Stephen Y, additional