Search

Background: Phase 3 PRIME/PRIME2 trials independently demonstrated efficacy and an acceptable safety profile of dupilumab adults with moderate-to-severe prurigo nodularis. Objective: To obtain a more precise estimate of onset and magnitude of treatment effect using PRIME/PRIME2 pooled data. Methods: In PRIME/PRIME2, patients were randomized to dupilumab or placebo for 24 weeks. Pooled analysis assessed proportion of patients achieving clinically meaningful improvement in itch, clear/almost-clear skin, or both; at weeks 12 and 24; overall and by demographic subgroups and changes from baseline to week 24 in symptoms, signs, and quality of life. Results: Patients receiving dupilumab (n = 153) vs placebo (n = 158) experienced significant improvements in all tested endpoints. At week 24, 90 (58.8%) dupilumab-treated vs 30 (19.0%) placebo-treated patients achieved clinically meaningful improvement in itch, 71 (46.4%) vs 27 (17.1%) clear/almost clear skin, and 54 (35.3%) vs 14 (8.9%) achieved both (P

Background: Chronic urticaria (CU) is a persistent condition characterized by recurrent hives and itching, often resistant to standard treatments. Subcutaneous Histaglobulin, an immunomodulatory agent, has emerged as a potential therapeutic option for refractory CU. This study aims to evaluate the efficacy and safety of SC Histaglobulin in managing patients with refractory chronic urticaria. Methods: A clinical evaluation was conducted with 50 patients diagnosed with refractory CU. Participants received SC Histaglobulin (2 mL weekly) for 8 weeks. Outcomes were assessed using the Urticaria Activity Score (UAS7), Dermatology Life Quality Index (DLQI), and visual analog scale (VAS) for pruritus. Data were collected at baseline, during treatment, and at 4 weeks post-treatment. Statistical analyses included paired t-tests and Wilcoxon signed-rank tests. Results: The mean UAS7 score decreased significantly from 31.4 ± 6.2 at baseline to 12.1 ± 5.4 at the end of the treatment (p < 0.001), with 40% of patients achieving complete symptom resolution. DLQI scores improved from 15.8 ± 4.3 to 6.4 ± 3.1 (p < 0.001), and VAS scores for pruritus reduced from 7.6 ± 1.4 to 2.5 ± 1.1 (p < 0.001). SC Histaglobulin was well-tolerated, with mild adverse events reported. Conclusion: SC Histaglobulin is an effective and well-tolerated treatment for refractory chronic urticaria, significantly improving symptoms and quality of life. The study supports the use of SC Histaglobulin as a viable therapeutic option in this challenging patient population, although further research is needed to confirm these findings and explore long-term outcomes. [ABSTRACT FROM AUTHOR]

Background: In the contemporary world, a cult of perfection is being created, and deviations from such an ideal image are becoming socially unacceptable. A particular situation arises when a defect or symptoms of a disease appear on the skin, which, in the case of people suffering from psoriasis, are a source of stress, dissatisfaction with the disease, and a reduction in quality of life. The aim of this study was to assess whether the quality of life related to the occurrence of psoriasis and the level of acceptance of the disease affect coping strategies in stressful situations. Methods: The study involved 111 people with common psoriasis (46.8% women and 53.2% men). Inclusion criteria were as follows: a diagnosis of common psoriasis for at least 0.5 years, no other types of psoriasis, no mental illnesses, and an informed consent of the respondent to participate in the study. In order to compile the research input, a proprietary questionnaire was used along with the following standardised tools: the Dermatology Life Quality Index (DLQI), the Acceptance of Illness Scale (AIS), and the Coping Inventory for Stressful Situations (CISS). Results: The duration of the disease in the studied population varied and ranged from 0.5 years to over 50 years. Most respondents showed relatively low DLQI scores, with an average value of 10.8 points. In stressful situations (CISS), the respondents primarily used a strategy based on rational thinking (Task-oriented coping), with approximately 54 points on average; followed by an avoidant style (Avoidance-oriented coping), with approximately 50 points on average; and least often an emotional style (Emotion-oriented coping), with approximately 46 points on average. The average level of disease acceptance (AIS) in the studied group equalled approximately 26 points. Conclusions: Psoriatic lesions on the torso caused less rational behaviour in stressful situations (a decrease in the Task-oriented coping) in women but had the opposite result in men, whereas psoriatic lesions on the head stimulated the use of Task-oriented coping in women but had the opposite result in men. The higher the acceptance of the disease (AIS) presented by the respondents, the less often they used an emotional strategy (Emotion-oriented coping) in stressful situations. The higher the quality of life (DLQI) was, the lower the values of Emotion-oriented coping were noted. [ABSTRACT FROM AUTHOR]

Background: Individuals with Acne vulgaris experience significant psychological and social disability, struggling with self-consciousness and personal relationships. Aim & Objective: to determine the psychological influence of acne on QOL (quality of life) of adolescents in both rural and urban areas. Settings and Design: tertiary care hospital and cross-sectional study design Methods and Material: Total 229 study participants were selected using a purposive sampling method from the Dermatology OPD. A pretested semi-structured questionnaire was used as the study tool, which included CADI, DLQI. Data was collected by interviewing the study participants. Statistical analysis used: Descriptive statistics and kruskal wallis test were applied Results: Most common type of acne was facial acne observed in 88.7% of study participants. The majority fell into the low-grade category of the CADI, comprising 53.04% of the study participants. 25.65% reported a very large effect on their life as indicated by the DLQI grades [ABSTRACT FROM AUTHOR]

Introduction: Certolizumab pegol (CZP) is an anti-tumor necrosis factor alpha (TNFα) approved for the treatment of moderate to severe plaque psoriasis (PSO). However, data on its real-world use is currently limited. The objective of this study was to describe the 1-year real-world effectiveness of CZP, its impact on health-related quality of life (HRQoL), and safety outcomes in patients with moderate to severe PSO in multi-country settings. Methods: CIMREAL, a prospective, noninterventional study, was conducted across Europe and Canada from August 2019 to December 2022. Patients were followed for 1-year, receiving CZP 400 mg initial doses at weeks 0, 2, and 4, followed by CZP 200 mg every 2 weeks (Q2W) or CZP 400 mg Q2W maintenance dosing. Effectiveness was assessed using the Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI). Safety was also evaluated. Results: Overall, 399 patients with moderate to severe PSO were included. Of these, 93.7% (374/399) and 77.9% (311/399) completed months 3 and 12, respectively. Mean age (± standard deviation) was 42.9 ± 13.5 years and body mass index was 28.5 ± 6.8 kg/m2, with the majority of patients being female (68.2%). At 12 months, CZP showed substantial effectiveness, achieving PASI 75 and PASI 90 response rates (≥ 75% and ≥ 90% improvement from baseline, respectively) of 77% and 56.5%, respectively. Patients with PASI score of ≤ 3 and ≤ 2 experienced improvement from 3 months (49.8% and 41.1%, respectively) to 12 months (82.0% and 75.3%, respectively). HRQoL considerably improved, with mean DLQI scores decreasing from 12.4 to 2.3 after 12 months of treatment, and the proportion of patients with DLQI 0/1 increased from 28.6% at 3 months to 59.4% at 12 months. The 1-year probability of persistence was approximately 85%. Overall, 30.6% of the patients experienced any adverse events and 9.3% had serious adverse events. Conclusion: In routine clinical practice, CZP exhibited consistent effectiveness, positively impacting both skin psoriasis activity and HRQoL. The 1-year persistence of CZP was high, and no new safety signals were identified. Trial Registration Number: ClinicalTrials.gov Identifier: NCT04053881 https://www.clinicaltrials.gov/study/NCT04053881. [ABSTRACT FROM AUTHOR]

This study systematically analysed peer-reviewed publications describing validation aspects of the Dermatology Life Quality Index (DLQI) and used Naicker’s Critically Appraising for Antiracism Tool to assess risk of racial bias. Seven online databases were searched from 1994 until 2022 for articles containing DLQI validation data. Methodology followed PRISMA guidelines, the protocol was registered in PROSPERO, and articles reviewed independently by two assessors. Of 1,717 screened publications, 207 articles including 58,828 patients from > 49 different countries and 41 diseases met the inclusion criteria. The DLQI demonstrated strong test–retest reliability; 43 studies confirmed good internal consistency. Twelve studies were performed using anchors to assess change responsiveness with effect sizes from small to large, giving confidence that the DLQI responds appropriately to change. Forty-two studies tested known-groups validity, providing confidence in construct and use of the DLQI over many parameters, including disease severity, anxiety, depression, stigma, scarring, well-being, sexual function, disease location and duration. DLQI correlation was demonstrated with 119 Patient Reported Outcomes/Quality of Life measures in 207 studies. Only 15% of studies explicitly recruited minority ethnic participants; 3.9% stratified results by race/ethnicity. This review summarizes knowledge concerning DLQI validation, confirms many strengths of the DLQI and identifies areas for further validation.

Abstract Introduction Certolizumab pegol (CZP) is an anti-tumor necrosis factor alpha (TNFα) approved for the treatment of moderate to severe plaque psoriasis (PSO). However, data on its real-world use is currently limited. The objective of this study was to describe the 1-year real-world effectiveness of CZP, its impact on health-related quality of life (HRQoL), and safety outcomes in patients with moderate to severe PSO in multi-country settings. Methods CIMREAL, a prospective, noninterventional study, was conducted across Europe and Canada from August 2019 to December 2022. Patients were followed for 1-year, receiving CZP 400 mg initial doses at weeks 0, 2, and 4, followed by CZP 200 mg every 2 weeks (Q2W) or CZP 400 mg Q2W maintenance dosing. Effectiveness was assessed using the Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI). Safety was also evaluated. Results Overall, 399 patients with moderate to severe PSO were included. Of these, 93.7% (374/399) and 77.9% (311/399) completed months 3 and 12, respectively. Mean age (± standard deviation) was 42.9 ± 13.5 years and body mass index was 28.5 ± 6.8 kg/m2, with the majority of patients being female (68.2%). At 12 months, CZP showed substantial effectiveness, achieving PASI 75 and PASI 90 response rates (≥ 75% and ≥ 90% improvement from baseline, respectively) of 77% and 56.5%, respectively. Patients with PASI score of ≤ 3 and ≤ 2 experienced improvement from 3 months (49.8% and 41.1%, respectively) to 12 months (82.0% and 75.3%, respectively). HRQoL considerably improved, with mean DLQI scores decreasing from 12.4 to 2.3 after 12 months of treatment, and the proportion of patients with DLQI 0/1 increased from 28.6% at 3 months to 59.4% at 12 months. The 1-year probability of persistence was approximately 85%. Overall, 30.6% of the patients experienced any adverse events and 9.3% had serious adverse events. Conclusion In routine clinical practice, CZP exhibited consistent effectiveness, positively impacting both skin psoriasis activity and HRQoL. The 1-year persistence of CZP was high, and no new safety signals were identified. Trial Registration Number ClinicalTrials.gov Identifier: NCT04053881 https://www.clinicaltrials.gov/study/NCT04053881 .

Atopic dermatitis (AD) is severely burdensome, and there has been poor characterization of any differences in impact based on the area affected. To estimate the prevalence and HRQoL impact of head/face/neck/hand (HFNH) involvement among patients with moderate-to-severe atopic dermatitis. All TARGET-DERM AD registry patients with moderate/severe Investigator Global Assessment (vIGA-AD) were assessed using the Patient Oriented SCORing Atopic Dermatitis, Patient Oriented Eczema Measure (POEM) and the (Children's) Dermatology Life Quality Index ((C)DLQI). 541 participants met the criteria (75.0% adults) and 84% (N = 453) reported HFNH involvement. HFNH and non-HFNH involved participants had similar characteristics; 55.2% female and 46.9% White. Compared to the non-HFNH involved, the involved had severe vIGA-AD (28.5% vs 16.3%, P =.02) and higher median body surface area affected (15% vs 10%, P ≤.01) and were twice as likely to have higher (C)DLQI and POEM scores. This was an analysis of real-world and patient reported outcome data. Real-world HFNH involved AD patients were associated with significantly worse quality of life, POEM/(C)DLQI, and more severe disease. Detailed assessments of specific areas affected by AD are needed to personalize treatment. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to introduce compound glycyrrhizin injection for the treatment of rosacea by mesoderm therapy, and further analyze the therapeutic and aesthetic effects of this treatment method and its impact on the dermatological quality of life index, which provides new ideas and methods for cosmetic dermatology treatment of rosacea. Methods: The recruited rosacea patients were divided into Control group (n = 58) and observation group (n = 58) according to the random number table. The control group was treated with topical metronidazole clindamycin liniment, and the study group was additionally used mesoderm introduction of compound glycyrrhizin injection. The transepidermal water loss (TEWL), water content in corneum, and dermatology life quality index (DLQI) in rosacea patients were evaluated. Results: Our results showed that the scores of erythema, flushing, telangiectasia, and papulopustule were significantly reduced in the observation group. In addition, the observation group significantly decreased TEWL and increased the water content of the stratum corneum. Furthermore, the observation group significantly reduced the DLQI of rosacea patients compared to the control group. Conclusion: The use of mesoderm therapy combined with compound glycyrrhizic acid has a therapeutic effect on facial rosacea and improves patient satisfaction. [ABSTRACT FROM AUTHOR]

Objective To assess the impact of vitiligo on psychosocial health of patients by applying Dermatology Life Quality Index (DLQI) score and to estimate the frequency of patients having significant effect of vitiligo on their life. Methods This descriptive survey was conducted at the Department of Dermatology, Services Hospital, Lahore over six months. Physical examination of the patients was done and patients were asked to fill DLQI questionnaires in Urdu. Final scores were analysed and impact on psychological and social well-being of patients was noted. The higher the score, the more the quality of life impaired. Outcome variables i.e. mean DLQI score and frequency of significant effect on quality of life was recorded on proforma. Data was entered and analyzed using SPSS version 21. Results The mean age of patients was 33.45±10.21 years. Out of 200, there were 91 (45.5%) males and 109 (54.5%) females. The mean duration of symptoms was 2.88±1.34 years. The mean DLQI score was 16.78±8.31. Out of 200, quality of life of 177 (88.5%) patients was significantly affected by vitiligo. Conclusion Vitiligo profoundly effects daily life of majority of patients. The disease has a tremendous impact on everyday life and self-esteem of most of the patients. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of melasma on the Quality of Life (QoL) of patients using the Dermatology Life Quality Index (DLQI). Study Design: Cross-sectional study. Place and Duration of Study: Department of dermatology PAF Hospital, Jacobabad Pakistan, from Jun 2019 to 2020. Methodology: A total of 103 patients with melasma were enrolled in the study from the dermatology outpatient department after written informed consent. Patients of either gender aged 15 years and above were included in the study. Melasma Area and Severity Index assessed melasma severity. In addition, the impact on Quality of Life was assessed using the Dermatology Life Quality Index questionnaire. Results: Among the 103 patients, 67 (65%) were females, and 36 (35%) were male. The mean age of patients was 29.50±7.94 years and included 78 (75.7%) married and 25 (24.3%) unmarried individuals. Mean Melasma Area and Severity Index was 22.04±11.23, including 36 (35%) patients with mild, 43 (41.7%) moderate and 24 (23.3%) patients with severe disease, respectively. Overall mean Dermatology Life Quality Index of the sample was 11.25±7.78, while mean scores for the mild, moderate and severe diseases were 5.89±.58, 10.33±5.75 and 20.96±6.62, respectively (p=0.001), indicating that Quality of Life is significantly more impaired with increased disease severity. Conclusion: Melasma significantly affects the Quality of Life of the patients as measured by Dermatology Life Quality Index. The impact on Quality of Life is directly proportional to the severity of melasma assessed by the Melasma Area Severity Index. [ABSTRACT FROM AUTHOR]

Background: Acne confers an increased risk of physical, psychiatric, and psychosocial sequelae, potentially affecting multiple dimensions of health-related quality of life (HRQoL). Morbidity associated with truncal acne is poorly understood. Objective: To determine how severity and location of acne lesions impact the HRQoL of those who suffer from it. Methods: A total of 694 subjects with combined facial and truncal acne (F+T) and 615 with facial acne only (F) participated in an online, international survey. Participants self-graded the severity of their acne at different anatomical locations and completed the dermatology life quality index (DLQI). Results: The F+T participants were twice as likely to report “very large” to “extremely large” impact on HRQoL (ie, DLQI > 10 and children's DLQI [CDLQI] > 12) as compared with the F participants (DLQI: odds ratio [OR] 1.61 [95% confidence interval {CI} 1.02-2.54]; CDLQI: OR 1.86 [95% CI 1.10-3.14]). The impact of acne on HRQoL increased with increasing acne severity on the face (DLQI and CDLQI P values = .001 and .017, respectively), chest (P = .003; P = .008), and back (P = .001; P = .028). Limitations: Temporal evaluation of acne impact was not estimated. Conclusions: Facial and truncal acne was associated with a greater impact on HRQoL than facial acne alone. Increasing severity of truncal acne increases the adverse impact on HRQoL irrespective of the severity of facial acne.

Background: Psoriasis is linked with social stigmatization, pain, discomfort, physical disability and psychological distress. It has a significant negative impact on quality of life. Since there is paucity of the data related to quality of life assessment in Indian psoriatic patients, this study was an earnest attempt in this direction The aim of this study was to evaluate the impact of psoriasis on the quality of life in patients with psoriasis. Materials and Methods: A cross sectional study was carried out in 60 patients at Dermatology outpatient department of a tertiary care teaching hospital. The quality of life assessment was done by DLQI questionnaire in patients above the age of 16 years. Results: The Health related Quality of Life was assessed by DLQI questionnaire in 60 patients at Dermatology outpatient department. The M: F ratio was 2.16:1. The mean DLQI score was 8.95 ± 8.48 (Mean ± SD) and 66.7% of the patients had moderate to extremely large impact on the quality of life. Highest DLQI Mean score 15.21 was noted in younger (20-29 yrs) age group. Conclusion: Psoriasis is chronic recurring disease and has significant negative impact on patients' quality of life. These findings provide significant new insights into factors that affect the life quality of patients with psoriasis.

Objective: To assess the quality of life in Pakistani melasma patients. Study Design: Cross-sectional study. Place and Duration of Study: Department of Dermatology, Combined Military Hospital Lahore, from Oct 2020 to May 2021. Methodology: The study was conducted on 126 adult patients of both genders by non-probability, consecutive sampling technique. Melasma severity was assessed by 'melasma area severity index (MASI) and quality of life impairment by 'dermatology life quality index (DLQI). Results: A total of 126 patients participated in the study, out of which 85.7% were females, and 14.3% were males. Mean MASI score was 12.21 ± 6.87, and mean DLQI score was 8.22 ± 7.46. Male patients had higher MASI scores and statistically signifycant DLQI than female patients (p=0.016). Employed people and those from the higher socio-economic group showed a more significant impairment of their quality of life. Conclusion: There was moderate impairment of quality of life in melasma patients. Healthcare givers need to recognize the effect of melasma on mental health while counselling patients and devising management strategies. [ABSTRACT FROM AUTHOR]

Objective: Safe, effective, long-term oral therapies are needed for plaque psoriasis. This study aimed to assess the safety and effectiveness of tepilamide fumarate (a fumaric acid ester) extended-release tablets.Methods: This Phase IIb, randomized, double-blind, placebo-controlled, 24-week, multicenter study treated adults with moderate-to-severe plaque psoriasis with tepilamide fumarate 400 mg once (QD) or twice daily (BID), 600 mg BID, or placebo. Coprimary endpoints were the proportion of patients achieving ≥75% reduction in the Psoriasis Area and Severity Index (PASI-75) and Investigator's Global Assessment (IGA) of clear or almost clear (≥2 points' reduction).Results: A total of 426 patients were randomized (mean age 49.6 [±13.0] years). There was a ≥75% PASI reduction in 39.7%, 47.2%, 44.3%, and 20.0% in the 400 mg QD, 400 mg BID, 600 mg BID, and placebo groups, respectively; IGA treatment success was 35.7%, 41.4%, 44.4%, and 22.0%, respectively. Between 50%-66% of tepilamide fumarate and 48% of placebo patients experienced ≥1 treatment-emergent adverse event. Gastrointestinal intolerance (20%-42%), infection (6%-18%), and decreased lymphocyte count (4%-9%) were more common with tepilamide fumarate.Limitations: High placebo response somewhat limits the utility of these findings.Conclusion: Patients with moderate-to-severe plaque psoriasis treated with oral tepilamide fumarate demonstrated positive response. [ABSTRACT FROM AUTHOR]

Objective To analyze the effect of vitiligo on psychosocial well-being of patients using Dermatology Life Quality Index (DLQI) score. Methods This cross-sectional survey was conducted in the Department of Dermatology, Allied/D.H.Q Hospitals, Faisalabad Medical University over six months. 125 patients of vitiligo were enrolled. The location and type of disease (localized, generalized, segmental, universal and acrofacial) was noted by physical examination and DLQI questionnaires in Urdu were filled in by the patients. Total scores were calculated and effect on psychosocial well-being of patients was noted as No impact (0-1), minimal impact (2-5), Moderate impact (6-10), Very huge impact (11-20) and Extremely huge impact (21-30). Results Mean age of patients was 29.2±9.1 years and mean of DLQI score was 9.7±5.9. Out of 125 patients 73(58.4%) were male while 52 patients (41.6%) were female. Impact of the illness on psychosocial well-being was noted as: No impact on 13 patients (10.4%), Small effect on 30 patients (24.0%), Moderate effect on 43 patients (34.4%), Very large effect on 22 patients (17.6%) and Extremely huge effect on 17 patients (13.6%). Conclusion Vitiligo can significantly alter everyday life of sufferers. It can have profound psychosocial implications as most of the patients reported moderate to severe impairment of quality of life. [ABSTRACT FROM AUTHOR]

Background: The impact of acne on quality of life (QoL) may vary between patients from different age groups. There are limited data in the literature on QoL of young adults with acne and acne scars. Objectives: To assess the QoL of young adults (age 18 to 25) with acne by using dermatology life quality index (DLQI) and Cardiff acne disability index (CADI), to assess the scores of individual items on DLQI and CADI, and to compare the two scales. Methods: In this cross‐sectional questionnaire study of 1392 subjects with acne, each subject completed two questionnaires: DLQI and CADI. Mean values of DLQI and CADI, and those of individual items on DLQI and CADI were calculated; t‐test was used for testing mean values and Spearman's rho coefficient for correlation between two questionnaires. Results: Mean DLQI (4.50) and CADI (3.60) scores were low. However, scores were significantly higher in females and in those with acne scars. "Feelings of embarrassment" and "interference with social activities" scored significantly higher for females across both questionnaires. There was no correlation between severity (as well as duration) of acne and HRQoL scores. Spearman's rho coefficient of correlation between DLQI and CADI was 0.71. Conclusions: Acne impaired the QoL of young adults, acne scars more so. Females felt worse about their appearance with greater embarrassment and impaired social activities. QoL scores seem to depend on patients' perceptions, which may depend on factors other than objective severity of acne. We found good correlation between the two scales. [ABSTRACT FROM AUTHOR]

Background: Psoriasis is a chronic autoimmune disease characterized by significant dermatological manifestations and systemic implications. While much of the research has focused on the clinical and systemic aspects of psoriasis, the impact of lesion localization on the quality of life remains underexplored. Objective: This study aims to elucidate the relationship between the localization of psoriasis lesions and the quality of life among patients with moderate to severe forms of the disease, providing insights into the nuanced ways in which different lesion sites affect daily living and psychological well-being. Material and methods: The study analyzed data from 29 patients with moderate to severe psoriasis, focusing on the Dermatology Life Quality Index (DLQI), Psoriasis Area and Severity Index (PASI), Psoriasis Scalp Severity Index (PSSI), Nail Psoriazis Severity Index(NAPSI), Erythema, Scaling, Induration, Fissuring Scale(ESIF). A detailed categorization approach was utilized to examine the correlation between specific lesion sites and their impact on the QoL. The statistical analyses conducted included the Mann-Whitney U test, t-test, and Pearson's correlation coefficient. Results : Of the patients considered, almost all presented with special area involvement; specifically, ESIF scores were noted in 28 patients, PSSI in 27 and NAPSI in 3. Average scores observed were 9.67 for PASI, 2.21 for PSSI, 4.07 for ESIF, and 7.9 for DLQI. Gender distribution was nearly equal, with 15 females and 14 males, and an average age of 53 years. Average scores for males were 11.19 (PASI), 2.4 (PSSI), 1.31 (ESIF), and 5.29 (DLQI), while for females, they were 8.35 (PASI), 2.04 (PSSI), 6.47 (ESIF), and 10.33 (DLQI). No statistically significant differences were found between genders for PASI(p-value=0.365), PSSI(p-value=0.853), ESIF(p-value=0.153), based on t-test results. According to Pearson's correlation coefficient, correlations between PASI, PSSI, ESIF, and DLQI scores were mostly weak, with a moderate positive correlation between PSSI and DLQI (0.441), indicating that higher PSSI scores correlate with higher DLQI scores. Asessing the relationship between DLQI scores and genders, a ttest showed no statistically significant difference(p-value = 0.089). Conclusions: The study underscores the significance of lesion localization as a crucial factor influencing the quality of life in patients with moderate to severe psoriasis. It advocates for personalized treatment plans that address both the physical manifestations and the psychological and social implications of the disease, aiming to improve patient outcomes and QoL. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to observe the impact of laser-assisted hair removal (LAHR) on the quality of life in women with polycystic ovary syndrome (PCOS)-associated hirsutism., Methodology: An observational study was conducted on 172 women living with PCOS at a specialized clinic. The Dermatology Life Quality Index (DLQI) and Ferriman-Gallwey (FG) score were employed to assess the quality of life and severity of hirsutism, respectively. Laser therapy was administered using ruby diode or alexandrite lasers. Follow-up on the DLQI and FG score assessment was done at 12-, 18-, and 24-week post-treatment., Results: The number of cases that reported stress, anxiety, and depression reduced over time. However, there was no correlation between the patient-reported decrease and DLQI scores. The FG score was significantly related to mental health. The severity of the hirsutism impacted mental health. The regrowth of hair at six months indicated limited long-term efficacy LAHR., Conclusion:  LAHR significantly improves the quality of life in the short term for women living with PCOS. However, the short-term benefit of the therapy indicates a need for research to find new treatment strategies., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Sakina et al.)

Objective: To investigate the effect of cosmetic camouflage in health-related quality of life (HRQoL) in women with systemic lupus erythematosus (SLE) and permanent facial skin damage. Methods: This is a randomized controlled clinical trial (Universal Trial Number: U1111-1210-2554e) with SLE women from outpatients using ACR/1997 and/or SLICC/2012 criteria, aged over 18 years old, with modified SLEDAI 2k < 4 and permanent facial skin damage, recruited in two tertiary centers to use cosmetic camouflage (n = 36) or no intervention (n = 20). Endpoints were score variations in SLE Quality of Life (SLEQoL) (total and each domain), Dermatology Life Quality Index (DLQI), Rosenberg self-esteem scale and Hospital Anxiety and Depression Scale (HADS), after daily use of cosmetic camouflage for 12 +/−2 weeks (Phase I), "as needed" use of cosmetic camouflage for another 12 +/−2 weeks (Phase II), and during total follow up (24 +/−2 weeks). Univariate and multivariate linear regressions were conducted by protocol analysis. Results: Both groups were similar at baseline regarding age, disease duration, socio-demographic, clinical, laboratory and treatment characteristics. The comparison of score variations between intervention and control groups showed an independent HRQoL improvement in total SLEQoL score after using cosmetic camouflage in Phase I [β −27.56 (CI 95% −47.86 to −7.27) p = 0.009] and total follow up [β −28.04 (CI 95% −48.65 to −7.44) p = 0.09], specifically in mood, self-image and physical functioning domains. Also, there was an improvement in DLQI scores during Phase I [β −7.65 (CI 95% −12.31 to −3.00) p = 0.002] and total follow up [β −8.97(CI95% −12.99 to −4.94) p < 0.001). Scores for depression [β −1.92 (CI 95% −3.67 to −0.16) p = 0.033], anxiety [β −2.87 (CI 95% −5.67 to −0.07] p = 0.045] and self-esteem [β 2.79 (CI 95% 0.13 to 5.46) p = 0.041] improved considering the total follow up. No significant changes occurred in the control group scores. Conclusion: The use of cosmetic camouflage improved the HRQoL in female SLE patients with permanent facial skin damage. [ABSTRACT FROM AUTHOR]

Purpose: To develop a mapping algorithm for generating EQ-5D-5-level (EQ-5D-5L) utility scores from the Dermatology Life Quality Index (DLQI) in patients with atopic dermatitis (AD). Methods: The algorithm was developed using data from 1232 patients from four countries participating in the National Health and Wellness Study. Spearman's rank correlation coefficient was used to evaluate the conceptual overlap between DLQI and EQ-5D-5L. Six mapping models (ordinary least squares [OLS], Tobit, three different two-part models, and a regression mixture model) were tested with different specifications to determine model performance and were ranked based on the sum of mean absolute error (MAE), and root mean squared error (RMSE). Results: The mean DLQI score was 7.23; mean EQ-5D-5L score was 0.78; and there were moderate negative correlations between DLQI and EQ-5D-5L scores (p = − 0.514). A regression mixture model with total DLQI, and age and sex as independent variables performed best for mapping DLQI to EQ-5D-5L (RMSE = 0.113; MAE = 0.079). Conclusion: This was the first study to map DLQI to EQ-5D-5L exclusively in patients with AD. The regression mixture model with total DLQI, and age and sex as independent variables was the best performing model and accurately predicted EQ-5D-5L. The results of this mapping can be used to translate DLQI data from clinical studies to health state utility values in economic evaluations. [ABSTRACT FROM AUTHOR]

Background: Phase 3 PRIME/PRIME2 trials independently demonstrated efficacy and an acceptable safety profile of dupilumab adults with moderate-to-severe prurigo nodularis., Objective: To obtain a more precise estimate of onset and magnitude of treatment effect using PRIME/PRIME2 pooled data., Methods: In PRIME/PRIME2, patients were randomized to dupilumab or placebo for 24 weeks. Pooled analysis assessed proportion of patients achieving clinically meaningful improvement in itch, clear/almost-clear skin, or both; at weeks 12 and 24; overall and by demographic subgroups and changes from baseline to week 24 in symptoms, signs, and quality of life., Results: Patients receiving dupilumab ( n  = 153) vs placebo ( n  = 158) experienced significant improvements in all tested endpoints. At week 24, 90 (58.8%) dupilumab-treated vs 30 (19.0%) placebo-treated patients achieved clinically meaningful improvement in itch, 71 (46.4%) vs 27 (17.1%) clear/almost clear skin, and 54 (35.3%) vs 14 (8.9%) achieved both ( P  < .0001 for all). Treatment benefits were independent of baseline demographics. Safety to week 36 was generally consistent with the known dupilumab safety profile., Limitations: On-treatment data limited to 24 weeks., Conclusions: Pooled analysis confirmed improvements reported in individual trials and revealed earlier effect onset in itch and skin pain. Dupilumab treatment showed benefits across demographics., Competing Interests: Yosipovitch G: AbbVie, Arcutis Biotherapeutics, Bellus Health, Celldex, Eli Lilly, Escient Pharmaceuticals, Galderma, GSK, Kiniksa Pharmaceuticals, LEO Pharma, Novartis, Pfizer, Pierre Fabre, Regeneron Pharmaceuticals Inc, Sanofi, Trevi Therapeutics – advisory board member/consultant; Eli Lilly, Kiniksa Pharmaceuticals, LEO Pharma, Novartis, Pfizer, Regeneron Pharmaceuticals Inc, Sanofi – grants/research funding; Regeneron Pharmaceuticals Inc, Sanofi – investigator. Kim BS: Klirna Biotech – co-founder; 23andMe, Abrax Japan, AbbVie, Almirall, Amagma, Amgen, Arcutis Biotherapeutics, Arena Pharmaceuticals, Argenx, AstraZeneca, Bellus Health, Blueprint Medicines, Boehringer Ingelheim, Bristol Myers Squibb, Cara Therapeutics, Clexio Biosciences, CymaBay Therapeutics, Eli Lilly, Escient Pharmaceuticals, Evommune, Galderma, Genentech, Granular Therapeutics, GSK, Guidepoint Global, Incyte, Innovaderm Research, Janssen Pharmaceuticals, Kiniksa Pharmaceuticals, LEO Pharma, Medicxi, Micreos, Novartis, OM Pharma, Pfizer, RecensMedical, Regeneron Pharmaceuticals Inc, Sanofi, Septerna, Shaperon, Teva, Third Harmonic Bio, Third Rock Ventures, Trevi Therapeutics, Triveni, Vial, WebMD – consultant; Cara Therapeutics, Celgene, Kiniksa Pharmaceuticals, Menlo Therapeutics, Regeneron Pharmaceuticals Inc, Sanofi, Theravance Biopharma – advisory board member; Abrax Japan, Klirna Biotech, Locus Biosciences, Nuogen Pharma, RecensMedical – stockholder; patent holder for the use of JAK1 inhibitors for chronic pruritus; patent pending for the use of JAK inhibitors for interstitial cystitis; Nuogen Pharma – founder, chief scientific officer; Cara Therapeutics, LEO Pharma – research grants. Kwatra SG: AbbVie, Arcutis Biotherapeutics, Aslan Pharmaceuticals, Celldex Therapeutics, Galderma, Genzada Pharmaceuticals, Incyte, Johnson & Johnson, Kiniksa Pharmaceuticals, Novartis, Pfizer, Regeneron Pharmaceuticals Inc, Sanofi, Trevi Therapeutics – advisory board member/consultant; Galderma, Incyte, Pfizer, Sanofi – investigator. Mollanazar NK: AbbVie, Boehringer Ingelheim, Galderma, Janssen, LEO Pharma, Novartis, Regeneron Pharmaceuticals Inc, Sanofi, Trevi Therapeutics – advisory board member; Regeneron Pharmaceuticals Inc, Sanofi – investigator. Ständer S: Celldex Therapeutics, Clexio Biosciences, Dermasence, Galderma, GSK, Incyte, Kiniksa Pharmaceuticals, Menlo Therapeutics, Novartis, Sanofi, Trevi Therapeutics – investigator; AbbVie, Almirall, Beiersdorf, Bellus Health, BenevolentAI, Bionorica, Bristol Myers Squibb, Cara Therapeutics, Cello Health, Clexio Biosciences, DS Biopharma, Eli Lilly, Escient Pharmaceuticals, Galderma, Incyte, Integrity CE, Grünenthal, Kiniksa Pharmaceuticals, Klinge Pharma, Klirna Biotech, Menlo Therapeutics, Perrigo, Pfizer, Professor Paul Gerson Unna Academy, Sanofi, Siena Biopharmaceuticals, Touch IME, Trevi Therapeutics, Vanda Pharmaceuticals, Vifor Pharma, WebMD – consultant/advisory board; AbbVie, Almirall, Beiersdorf, Bristol Myers Squibb, Eli Lilly, FOMF, Galderma, LEO Pharma, L’Oréal, MEDahead, Menlo Therapeutics, Novartis, Omnicuris, Pfizer, Pierre Fabre, Professor Paul Gerson Unna Academy, Sanofi, UCB, Vifor Pharma – speaker. Satoh T: AbbVie, Asahi Kasei, Bristol Myers Squibb, Eli Lilly, Hisamitsu Pharmaceutical, Kracie, Kyorin Pharmaceutical, Maruho, Mitsubishi Tanabe Pharma, Otsuka Pharmaceutical, Pfizer, Sanofi, Torii Pharmaceutical – speaker; AbbVie, Daiichi Sankyo, Eli Lilly Japan K. K., Kaken Pharmaceutical, Kyowa Hakko Kirin, Nippon Zoki Pharmaceutical, Otsuka Pharmaceutical, Sato Pharmaceutical, Sun Pharma, Taiho Pharmaceutical, Torii Pharmaceutical – research grants; Nankodo – other fees; Sanofi – investigator. Mendes-Bastos P: AbbVie, Bayer, Cantabria Labs, CS Laboratórios, Eli Lilly, Evelo Biosciences, Janssen-Cilag, LEO Pharma, L’Oréal, Novartis, Organon, Pfizer, Pierre Fabre, Sanofi, Teva, Viatris – speaker/advisor/consultant; AbbVie, Janssen-Cilag, Novartis, Pfizer, Sanofi – Principal Investigator in clinical trials. Tsai TF: AbbVie, AnaptysBio, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Galderma, GSK, Janssen-Cilag, LEO Pharma, Merck Sharp & Dohme, Novartis, Pfizer, PharmaEssentia, Sanofi, Sun Pharma, UCB Pharma – investigator/consultant. Laws E, Shi G, Dubost-Brama A: Sanofi – employees, may hold stock and/or stock options in the company. Nivens MC, Maloney J, Bansal A: Regeneron Pharmaceuticals Inc – employees and shareholders., (© 2024 by the American Academy of Dermatology, Inc. Published by Elsevier Inc.)

Background: Psoriasis vulgaris is a common chronic dermatological disease that has a negative impact on the psychological status and the social interaction of the patient. Objective: To correlate the quality of life and clinical severity of psoriasis vulgaris in patients using different types of treatment. Materials and methods: This is a prospective observational cross-sectional study that took place over a 4 month period, from January to April 2014, at the King Abdul Aziz Medical City, Jeddah, Saudi Arabia. All patients with psoriasis vulgaris attending the dermatology clinics during this period were included. Results: Of the total 41 Saudi patients, 25 were males and 16 were females. 21 were on combined (i.e. topical with either systemic or NB-UVB) and 20 were on topical treatments only. PASI score was moderate in the majority for both groups, that is, patients on topical (70%) and combined treatment (80%). DLQI score shows only a small effect on the patient’s quality of life for the majority (14/20) in the topical group and (16/21) for those on combined therapy. Conclusion: There is no significant difference in terms of the effect of the type of treatment between the two groups.

Atopic dermatitis is a chronic skin condition that has significant psychosocial and quality-of-life impact. The condition causes physical discomfort, emotional distress, embarrassment, social stigma, and daily activity limitation. In an effort to assess these aspects of disease burden, quality-of-life measurement tools were developed. Through use of these tools, we have expanded our knowledge of the psychosocial and quality-of-life burden of this condition. A variety of quality of assessment tools exist, yet there is no consensus on which tool is best suited to assess the quality-of-life impact of atopic dermatitis. Research studies assessing quality-of-life in atopic dermatitis patients utilize a variety of quality-of-life measurement tools; this complicates comparisons across research studies. Though comparison across studies is difficult, the data echoes tremendous overall burden of disease, especially pertaining to psychosocial status and life quality., (© 2024. The Author(s), under exclusive license to Springer Nature Switzerland AG.)

Introduction: Psoriasis is a common, immune-mediated skin disease often associated with significant physical and psychosocial impairment. Antipsoriatic biologic agents offer patients unparalleled treatment potential in regard to greater skin clearance and overall improved quality of life. Evaluation of the therapeutic efficacy of biologic agents on the full psoriasis disease burden must account for their impact on both physical symptoms, as well as patient-reported, health-related quality of life (HRQoL) measurements. Areas covered: Results from numerous clinical trials demonstrate the significant clinical efficacy of biological agents targeting tumor necrosis factor-α (TNF-α) and the interleukin (IL)-12/23 and IL-17 immune pathways. However, relatively limited data is available evaluating their full effect on quality of life outcomes. This review will discuss the most relevant and up-to-date clinical data on HRQoL measurements related to treatment with these aforementioned biologic agents. Expert commentary: Patient-reported outcomes (i.e. Dermatology Life Quality Index) are being used with increasing frequency in clinical trials, and provide valuable information on the impact of psoriasis on numerous aspects of day-to-day living. These outcomes must also be incorporated in clinical practice, in addition to physical assessment of disease severity, treatment decisions, and therapeutic response in the psoriasis patient population. [ABSTRACT FROM AUTHOR]

Background: Obesity, metabolic syndrome (MetS), and psoriasis, largely driven by environmental factors, show multiple bidirectional associations, with important metabolic implications in psoriatic patients. Besides body mass index (BMI) as a measure of obesity, data on phase angle (PhA), a direct measure by bioelectrical impedance analysis (BIA), used as a marker of cellular health and a predictor of morbidity and mortality in various diseases, are still lacking in psoriasis. In this case-control, cross-sectional study, we investigated the PhA in 180 pairs of adult psoriatic patients and healthy controls, evaluating also the potential use of the PhA as marker of the clinical severity, the quality of life, and the presence of the MetS in psoriatic patients.Methods: Anthropometric measures, metabolic profile and bioelectrical variables were evaluated. The clinical severity was assessed by standardized psoriasis area and severity index (PASI) score and c-reactive protein (CRP) levels, and the quality of life was evaluated by dermatology life quality index (DLQI). MetS was diagnosed according to Adult Treatment Panel III.Results: Psoriatic patients presented smaller PhA (p < 0.001) and higher prevalence MetS compared with controls. The PhA was significantly associated with number of parameters of MetS in both groups (p < 0.001). After adjusting for BMI, this association remained significant in psoriatic patients only (p < 0.001). Among psoriatic patients, the PhA was the major index value for the diagnosis of MetS (OR 5.87, 95 % CI 5.07-6.79) and was inversely associated with both PASI score and DLQI, independently of BMI (p < 0.001). At multiple regression analysis, the PhA well predicted the PASI score and DLQI. Based on ROC curves, the most sensitive and specific cutoffs of PhA to predict the highest PASI score and the lowest DQLI were ≤4.8° and ≤4.9°, respectively.Conclusions: We reported that psoriatic patients presented small PhAs, with a novel association between PhA, clinical severity, quality of life in psoriatic patients, and MetS. Further studies are required to validate the PhA's prognostic ability in assessing the clinical severity and MetS in psoriatic patients. [ABSTRACT FROM AUTHOR]

Background: The Dermatology Life Quality Index (DLQI) is the most widely used measure of health-related quality of life (HRQoL) associated with skin disease. Recently, the psychometric properties of the DLQI have caused some controversy because the instrument appears not to meet the requirements of modern test theory. The purpose of this study was to assess whether these psychometric issues also occur in Chinese patients with neurodermatitis.Methods: One hundred fifty consecutive outpatients (83 males and 67 females) seeking treatment for neurodermatitis were assessed for eligibility for this prospective study between July 1, 2011 and September 30, 2011. The DLQI and a demographic questionnaire were completed. One female participant who incompletely answered the DLQI was excluded. Data were analyzed using the Rasch model in order to obtain meaningful scores for the DLQI. Scale assessment included analysis of rating scale function, item fit to the Rasch model, aspects of person-response validity, unidimensionality, person-separation reliability, and differential item function.Results: The rating scale advanced monotonically for all items in the DLQI, but item 9 did not demonstrate acceptable goodness-of-fit (Infit MnSq values >1.3) to the Rasch model. The 10 items of the DLQI met the criteria for person-separation reliability (PSI = 2.38) and the first latent dimension (general QoL) accounted for 50.8 % of the variance; but the variance explained by the second dimension (7.1 %) exceeded the criterion of 5 %. There were also limitations related to person-response validity, because ≥ 5 % (18.1 %) of cases demonstrated unacceptable fit. There was no uniform differential item functioning.Conclusions: For neurodermatitis patients, the DLQI seems to have poor fit to the Rasch model; therefore, we recommend against using this instrument with neurodermatitis patients. [ABSTRACT FROM AUTHOR]

Summary: Background & aims: Low-grade systemic inflammation associated with obesity may worsen the clinical course of psoriasis. This study aimed to assess the effectiveness of an energy-restricted diet, enriched in n-3 polyunsaturated fatty acids (PUFAs) and poor in n-6 PUFAs, on metabolic markers and clinical outcome of obese patients with psoriasis. Methods: Forty-four obese patients with mild-to-severe plaque-type psoriasis treated with immuno-suppressive drugs were randomized to assume for six months either their usual diet or an energy-restricted diet (20 kcal/kg/ideal body weight/day) enriched of n-3 PUFAs (average 2.6 g/d). All patients continued their immuno-modulating therapy throughout the study. Results: At 3 and 6 months, a significant clinical improvement was observed in patients assuming the low-calorie high n-3 PUFAs diet respect to controls. Specifically Psoriasis Area Score Index (7.7 ± 3.7, 5.3 ± 4.3 and 2.6 ± 3.0, respectively; p < 0.05), itch scores (15.4 ± 13.5, 12.3 ± 12.1 and 1.8 ± 5.9, respectively; p < 0.05) and Dermatological Life Quality Index (19.5 ± 1.9, 11.4 ± 3.5 and 5.1 ± 1.6; respectively, p < 0.05) all decreased respect to baseline. In these subjects but not in controls, a significant decrease in body weight (93.8 ± 10.1, 85.8 ± 11.4 and 83.1 ± 12.1 kg, respectively; p < 0.05), waist circumference (112.7 ± 7.2, 106.1 ± 10.3 and 101.9 ± 10.4 cm; p < 0.05), serum triglycerides (141.8 ± 51.1, 100.5 ± 26.6 and 90.2 ± 34.5 mg/dL; respectively, p < 0.05), serum total cholesterol (198.3 ± 31.7, 171.4 ± 29.0 and 176.5 ± 20.5 mg/dL; respectively, p < 0.05) and n-6/n-3 ratio intake also occurred (5.1 ± 0.9, 2.0 ± 0.9 and 2.3 ± 1.1; respectively, p < 0.05). Conclusions: In obese psoriatic patients, an energy-restricted diet designed to increase n-3 and reduce n-6 PUFAs, ameliorated the metabolic profile and, by increasing the response to immuno-modulating therapy, improved the clinical outcomes of the disease (ClinicalTrials.gov identifier: NCT01876875). [Copyright &y& Elsevier]

Background Acne is a very common skin condition during adolescence and adulthood. Patients with uterovaginal agenesis (Mayer-Rokitansky-Küster-Hauser syndrome, MRKH) treated at the Tübingen University Center for Rare Female Genital Malformations, however, clinically appeared to be less frequently affected by acne. The etiology of MRKH syndrome remains unknown. The only known MRKH-associated mutations are located within the WNT4 gene and lead to an atypical form of MRKH syndrome associated with clinical and biochemical hyperandrogenism. Our study aimed to assess the frequency, severity, and self-evaluation of acne in MRKH patients and to correlate the clinical findings with hormone analyses. Methods As part of a cross-sectional longterm follow-up study after laparoscopic assisted creation of a neovagina a questionnaire was sent to 149 MRKH patients aged 16-44 years comprising 26 items concerning prevalence and self-evaluation of acne, and the effects of acne on quality of life. The questionnaire was derived from one used in a former epidemiological study of acne in 4,000 women. Blood for hormone analyses was collected routinely during the clinical visit. Results Fully completed, evaluable questionnaires were returned by 69/149 (46%) women. Of these respondents, 42 (60.1%) showed hyperandrogenemia without other clinical signs of virilization but only 17 (24.6%) reported acne (8 (11.6%) had physiological acne and 9 (13.0%) clinical acne) and only 10 (14.5%) reported receiving medical treatment for their acne. Effects of acne on quality of life were minor. Only 4 patients (5.8%) with PCOS were identified, among them one with physiological acne, the other three within the acne-free group. Conclusions Although hyperandrogenemia is common, acne is significantly less frequent in women with MRKH than reported in the literature for non-MRKH women, and is seldom treated medically. Patients in this study appeared resistant to acne to some extent, possibly due to the sebaceous glands in the acne regions being less sensitive to androgens compared to the normal population. A WNT4 mutation is unlikely to be the main cause of MRKH syndrome in our hyperandrogenemic patients. [ABSTRACT FROM AUTHOR]

Background: Determining a disease's impact on life quality is important in clinical decision making, research, and resource allocation. Determinants of quality of life (QOL) in morphea are poorly understood. Objective: We sought to ascertain demographic and clinical variables correlated with negative impact on self-reported QOL in morphea. Methods: We conducted a cross-sectional survey of the Morphea in Adults and Children cohort. Results: Symptoms (pruritus and pain) and functional impairment were correlated with decreased QOL in children and adults. This was true in both sexes and was independent of subtype and age. Patient-reported QOL correlated with physician-based measures of disease severity in adults, but not in children. Patients with linear and generalized morphea had the greatest impact on QOL. Limitations: Small sample size is a limitation. Conclusion: Symptoms and functional impairment were determinants of impaired life quality in both children and adults independent of morphea subtype. These results suggest that clinicians should consider suppressing the accumulation of new lesions (when rapidly accumulating) and symptoms (pain and pruritus) in the treatment of patients with morphea. [Copyright &y& Elsevier]

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory disorder characterized by sterile abscesses and fistulae predominantly affecting the axillae and groin. Various biologic agents have been attempted for HS, but there is still no definitive treatment. Objectives: We sought to evaluate the efficacy, safety, and tolerability of anakinra in the treatment of moderate to severe HS. Methods: Six patients with moderate to severe HS were enrolled in an open-label study with all patients receiving active treatment for 8 weeks with an additional 8 weeks of follow-up off therapy. Results: The 5 patients who completed the 8-week therapy showed a significant mean decrease in their modified Sartorius score of 34.8 points. The physician and patient global assessment of overall activity showed significant reductions between baseline and 8 weeks of therapy: 45.8 points and 35.6 points, respectively. The Dermatology Life Quality Index showed a significant reduction after 8 weeks of treatment with anakinra. Functional T-cell analysis revealed that patients had increased percentages of CD3+ T cells in lesional skin compared with nonlesional skin before therapy. Limitations: The limited number of patients and lack of control group are limitations. Conclusions: Anakinra demonstrated decreased HS disease activity by both objective and subjective measures. [Copyright &y& Elsevier]

Atopic dermatitis (AD) is a chronic, pruritic, inflammatory dermatosis that affects up to 25% of children and 2% to 3% of adults. This guideline addresses important clinical questions that arise in the management and care of AD, providing updated and expanded recommendations based on the available evidence. In this first of 4 sections, methods for the diagnosis and monitoring of disease, outcomes measures for assessment, and common clinical associations that affect patients with AD are discussed. Known risk factors for the development of disease are also reviewed. [Copyright &y& Elsevier]

Background: Ultraviolet (UV) B radiation increases serum 25-hydroxyvitamin-D3 [25(OH)D], but the influence of UVA1 and UVA/narrowband UVB (UVBnb) phototherapy on serum vitamin D is unknown. Objective: We sought to investigate the influence of UVBnb, UVA1, and UVA/UVBnb phototherapy on serum levels of 25(OH)D and related parameters in patients with an inflammatory skin condition. Methods: 25(OH)D, as well as calcium, parathormone, phosphate, and albumin were measured before therapy, 2 weeks after start, and after completion of the phototherapy. Diagnoses were divided in 4 groups: atopic dermatitis, psoriasis, morphea, and others. Results: We surveyed 116 dermatologic patients undergoing phototherapy with UVA1 (n = 38), UVA/UVBnb (n = 30), or UVBnb (n = 48) 2 to 3 times a week for 53 to 90 days. UVBnb phototherapy increased serum 25(OH)D from 22.1 to 39.5 ng/mL after the therapy (P < .001). The lower the baseline 25(OH)D level was, the steeper the increase in 25(OH)D was upon application of UVBnb phototherapy. UVA/UVBnb therapy also increased serum 25(OH)D, from 23.9 to 50.3 ng/mL (P = .003). Conversely, in the UVA1 therapy group, 25(OH)D serum levels decreased significantly from 21.9 to 19.0 ng/mL (P < .001). Limitations: The study design was open trial without randomization. An influence of a precise skin disease cannot be excluded because of the heterogeneous diagnoses. Bias may have arisen from patient preference for treatment at our center, referral, unrecognized differences in underlying skin disease, and other factors. Conclusion: Phototherapy with UVBnb and UVA/UVBnb increased 25(OH)D serum level significantly. UVA1 therapy alone induced a reduction in serum 25(OH)D concentrations. [Copyright &y& Elsevier]

Background: Inherited ichthyoses are associated with impaired quality of life (QoL). Objectives: The aim of this study was to create and validate a QoL questionnaire specifically dedicated to patients with ichthyosis. Methods: A prequestionnaire was drawn after selecting items from a verbatim transcript. It was then subjected to a cognitive debriefing. During the validation step, this questionnaire was sent to patients with the Dermatology Life Quality Index, Short Form-12 health-related questionnaire, and severity scores (global severity: mild/moderate/severe/very severe; clinical severity evaluated by 6 visual analog scales). A shortened version of the questionnaire was designed. The validity of the tool was confirmed: for its structure and 1-dimensional nature (Cronbach α), convergent (Spearman correlation) and discriminating (Tukey test) validity; α risk was fixed at 5%. Results: The initial questionnaire included 60 items. During the validation phase, 59 subjects were tested. The shortened version included 32 items (IQoL-32) and 7 dimensions (Cronbach α: 0.94). The higher the score, the more impacted the QoL. IQoL-32 was positively correlated to Dermatology Life Quality Index (P < .0001) and negatively to Short Form-12 health-related questionnaire (P < .0001). IQoL-32 was highly correlated to clinical severity: overall analysis (Spearman ranking: 0.72; P < .0001) or analysis per dimension (highest correlations: discomfort, pain, interpersonal relations). IQoL-32 demonstrated a higher correlation with visual analog scale compared with Dermatology Life Quality Index and Short Form-12 health-related questionnaire. It also showed a good discriminating power (P < .0001) according to overall severity levels. Limitations: Only patients residing in France were included. Conclusion: IQoL-32 is a specific and validated questionnaire for inherited ichthyosis. It will be very useful for patient care and research. [Copyright &y& Elsevier]

Background: Patients with chronic idiopathic urticaria/chronic spontaneous urticaria (CIU/CSU) often continue to experience symptoms despite receiving standard-of-care therapy with H1-antihistamines along with 1 or more add-on therapies. Objectives: We sought to evaluate the safety and efficacy of 24 weeks of treatment with omalizumab in patients with persistent CIU/CSU despite treatment with H1-antihistamines at up to 4 times the approved dose plus H2-antihistamines, leukotriene receptor antagonists, or both. Methods: In this phase III study patients were randomized to receive 6 subcutaneous injections at 4-week intervals of either 300 mg of omalizumab or placebo, followed by a 16-week observation period. The primary objective of the study was to evaluate the overall safety of omalizumab compared with placebo. Efficacy (itch severity, hive, and urticaria activity scores) was evaluated at weeks 12 and 24. Results: The overall incidence and severity of adverse events and serious adverse events were similar between omalizumab and placebo recipients; the safety profile was consistent with omalizumab in patients with allergic asthma. At week 12, the mean change from baseline in weekly itch severity score was −8.6 (95% CI, −9.3 to −7.8) in the omalizumab group compared with −4.0 (95% CI, −5.3 to −2.7) in the placebo group (P < .001). Significant improvements were seen for additional efficacy end points at week 12; these benefits were sustained to week 24. Conclusion: Omalizumab was well tolerated and reduced the signs and symptoms of CIU/CSU in patients who remained symptomatic despite the use of H1-antihistamines (up to 4 times the approved dose) plus H2-antihistamines, leukotriene receptor antagonists, or both. [Copyright &y& Elsevier]

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Abstract: This cross-sectional study was done to determine the impact of acne vulgaris on the quality of life in Sarawak, Malaysia and to examine its relationship with acne severity. Quality of life was measured in 173 patients using Dermatology Life Quality Index (DLQI). The mean DLQI score was 4.1 which was not dissimilar to that of psoriasis locally. Patients with family income

The development of ustekinumab as a first-in-class anti-interleukin (IL) 12/23p40 therapeutic agent for psoriasis represents an important example of modern and rational drug design and development. Psoriasis is a chronic, systemic, immune-mediated skin disorder with considerable clinical, psychosocial, and economic burden. Ustekinumab is a human monoclonal antibody (mAb) that binds the p40 subunit common to IL-12 and IL-23, key cytokines in psoriasis pathogenesis. The therapeutic mAb was developed using human gamma-1 immunoglobulin (IgG)-expressing transgenic mice, which created a molecule with endogenous IgG biologic properties and low immunogenicity. Ustekinumab was well tolerated in clinical studies and yielded rapid, significant, and sustained efficacy plus improved quality of life/work performance and reduced depression/anxiety. Its pharmacologic properties afford the most convenient dosing regimen among approved biologics, representing a significant advancement in the treatment of moderate to severe psoriasis. Ustekinumab also holds promise for other immune-mediated disorders with significant unmet need. [ABSTRACT FROM AUTHOR]

Epidermal thickness (ET) has been suggested as a surrogate measure of psoriasis severity. Optical coherence tomography (OCT) is a recent imaging technology that provides real-time skin images to a depth of 1.8 mm with a micrometre resolution. OCT may provide an accurate in vivo measure of ET. It is, therefore, speculated that OCT may be used in the assessment of psoriasis vulgaris. A total of 23 patients with psoriasis vulgaris were systematically evaluated by OCT imaging and skin biopsy during treatment. Biopsies were graded for disease severity, and additional evaluation was done by the physician via psoriasis area and severity index (PASI) score, and by the patient through measures such as self-administered PASI, psoriasis life stress inventory index and dermatology life quality index. ET was calculated from OCT images. In comparison to normal skin, psoriasis appeared with a more irregular surface with a stronger entrance signal, a serrated dermo-epidermal junction was found and a less signal intensity in the dermis as shown in OCT images. ET measured in untreated plaques was thicker reflecting epidermal hyperproliferation and inflammation. The changes were significantly correlated with the biopsy grading ( r2 = 0.41, p = 0.001) and ET significantly decreased with treatment ( p = 0.0001). ET correlated significantly with self-reported measures of disease severity, but not with physician-assessed global PASI. The data suggest that OCT may be used to measure ET in psoriasis and the measurements correlate with several other parameters of disease severity. This implies that OCT assessment of psoriatic plaques may provide a useful method for non-invasive in vivo method to follow the evolution of psoriasis lesions. [ABSTRACT FROM AUTHOR]

Background Fumaric acid esters (FAE) are used in Germany as a first-line systemic treatment for chronic plaque psoriasis, with proven efficacy and low toxicity. Their use in the U.K. is variable, and they remain unlicensed. Consequently, efficacy and safety data from U.K. patients is limited and their place in the psoriasis treatment armamentarium is unclear. Objectives To examine the efficacy and safety of FAE in a prospective cohort of U.K. patients with severe, treatment-recalcitrant, chronic plaque psoriasis. Methods A single-centre, open, nonrandomized, prospective study was performed in a regional referral centre for patients with severe psoriasis. Outcomes were measured by the Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), blood investigations and adverse events monitoring. Results Eighty patients were recruited. Fifty-nine per cent were taking a concomitant oral antipsoriatic agent; 20% achieved a PASI-50, 8% a PASI-75 and 4% a PASI-90 on intention-to-treat analysis at 3 months with an overall, statistically significant, reduction in PASI from 13·9 ± 9·0 to 11·3 ± 9·2 ( P < 0·0001). At 3 months, lymphopenia was seen in 33% of the cohort with significantly lower counts in patients responsive to FAE ( P = 0·008). In addition, by 3 months, 36% of concomitant antipsoriatic medication had been stopped and 25% of doses had been reduced without loss of disease control. Side-effects (most commonly diarrhoea, abdominal pain and flushing) were reported by 74% of patients resulting in cessation of FAE in 36%. Conclusions FAE is a useful alternative treatment option in patients with severe, treatment-resistant, chronic plaque psoriasis and can allow dose reduction, and subsequent cessation, of other, potentially more toxic agents. [ABSTRACT FROM AUTHOR]

Background: Leflunomide has shown promise in the treatment of psoriasis. Objective: To provide an in-depth analysis of the effect of leflunomide on psoriasis in patients with psoriatic arthritis (PsA). Methods: 190 patients with plaque psoriasis (at least 3% skin involvement) and active PsA were randomized to double-blind treatment with leflunomide (100 mg/day loading dose for 3 days followed by 20 mg/day orally) or placebo for 24 weeks. Results: As previously reported, leflunomide resulted in a significantly higher Psoriatic Arthritis Response Criteria response rate than placebo (58.9 vs. 29.7%; p < 0.0001). Significant differences in favor of leflunomide were also observed in the Psoriasis Area and Severity Index (PASI 50 in 30.4% of patients vs. 18.9% for placebo; p = 0.05), target lesion response (46.4 vs. 25.3%; p = 0.0048), combined skin and joint response (27.2 vs. 8.9%; p < 0.0001), Dermatology Life Quality Index (improvement of 1.9 points vs. 0.2; p = 0.0173) and certain SF-36 subdomains. Dermatological responses were observed at the earliest examination (4 weeks) and increased throughout the 24-week study. Conclusion: Once-daily oral leflunomide is an effective and convenient treatment for PsA and plaque psoriasis. Copyright © 2006 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Focal hyperhidrosis is a condition that may disturb emotional, social and professional life. Treatment options for severe cases are surgical sympathectomy and local chemical sweat gland denervation by intradermal injections of botulinum toxin A (Btx A). The Dermatology Life Quality Index (DLQI) is a simple validated questionnaire designed to measure and compare disability in different skin diseases. The aim of this study was to assess quality of life with the DLQI before and after treatment with botulinum toxin injections in a group of patients with severe hyperhidrosis. DLQI was administered to 58 randomly chosen patients before and after treatment. All patients answered the DLQI questionnaire prior to treatment and 53/58 at mean 5.2 months after treatment. The mean DLQI score in the 58 patients before treatment was 10.3 (2–23). In the group of 16/53 patients who had a relapse of sweating when answering the DLQI a second time, no significant improvement was seen [score 10.6 before and 8.8 after treatment (P=0.21)]. In patients without relapse, a 76% improvement was obtained (DLQI was reduced from 9.9 to 2.4; P < 0.0001). The study showed that focal hyperhidrosis may considerably reduce life quality and the disability experienced by the patients can be largely reversed by botulinum toxin injections. [ABSTRACT FROM AUTHOR]