Journal of the American Academy of Dermatology最新文献

Background: Clinical characteristics and treatment of generalized pustular psoriasis (GPP) flares are poorly understood.

Objective: To characterize patients by GPP flare status, quantify flare timing/frequency, and understand peri-flare treatment patterns.

Methods: This cohort study utilized electronic health records (2017-2023) from outpatient dermatology clinics in the OMNY Health real-world data platform. Patients were indexed at first GPP diagnosis code; encounter-level GPP flare status was established from previously developed algorithms. Annualized flare rate, time between flares, and peri-flare treatment patterns were described.

Results: 404/638 patients (63%) experienced ≥ 1 flare episode. Patients who experienced a flare were more likely to be female, younger, nonwhite, Hispanic/Latino, have infectious/parasitic disease history, and more active GPP. Mean (median) annualized flare rate was 0.91 (0.51) flares/patient/year; mean (median) time between flares was 5.9 (3.8) months. Prescriptions increased from pre-flare period to flare episode, then decreased during the post-flare period. Frequent treatment alterations of off-label biologics and nonsteroidal systemic agents were observed.

Limitations: Data were from US-based outpatient dermatology practices; documentation of GPP flares may not have been comprehensive or consistent in this setting.

Conclusion: GPP patients continue to experience frequent flares with traditional off-label therapies. Patients' course of treatment was altered frequently, suggesting an unmet need for effective long-term GPP therapies.

Background: Many patients will develop more than one skin cancer, however most research to date has examined only case status.

Objective: Describe the frequency and timing of the treatment of multiple skin cancers in individual patients over time.

Methods: We conducted a longitudinal claims and electronic health record-based cohort study to examine the frequency of skin cancer multiplicity. We used a validated phenotype for counting individual skin cancers.

Results: Our combined cohort included 5,508,374 patients and 13,102,123 total skin cancers treated. 43% of patients treated for skin cancer were treated for more than one skin cancer, most within two years of the initial skin cancer. A subset of 3% of patients were treated for 10 or more skin cancers and contributed 22% of all skin cancers treated in the combined cohort LIMITATIONS: High quality data on skin cancer type were not available. Databases and health records are not designed to capture skin cancer multiplicity well CONCLUSIONS: Nearly half of patients treated for skin cancer will develop at least one more. Better data formatting will allow for improved granularity in identifying individuals at high risk for multiple skin cancers and those unlikely to benefit from continued annual surveillance.

Background: Select patients are diagnosed with both, psoriasis (PSO) and hidradenitis suppurativa (HS), leading to a unique disease pattern. Genetic risk factors remain unidentified.

Methods: The study harnessed an international collection of patients with psoriasis and HS (PSO-SH). Clinical and genetic data was collected and analyzed.

Results: 87 PSO-SH patients (70% female) were identified. They had a high number of comorbidities (89%), and worse general physical health compared to PSO-only (OR 3.09 95%CI 1.56-6.12) or HS-only (OR 2.5, 95%CI 1.23-5.00) patients. PSO-SH patients were at significantly higher risk of having Crohn's disease (OR 4.6-11.9; 95% CI). Data revealed the highest overall genetic risk score for PSO-SH patients (PSO-PRS; 108.22), followed by PSO (101.18), HS (99.84), and healthy controls (98.58). High non-HLA scores were associated with an increased risk for developing both psoriasis and HS, indicating a distinct biological profile compared to HS-only and PSO-only individuals.

Limitations: Some clinical information was collected retrospectively.

Conclusions: This study highlights a shared genetic susceptibility of HS and psoriasis at non-HLA loci. Recognizing PSO-SH patients as a distinct patient group with high morbidity and increased risk for developing Crohn's disease will help to improve patient management.