Short Term and Long-Term Efficacy of Calcipotriene/ Betamethasone Dipropionate Foam Combination

Psoriasis is a well-known chronic disease characterized by the development of erythematous, indurated, scaly, pruritic plaques on the skin with cycles of remission and symptom flare-ups. The management of patients with chronic plaque psoriasis has been more challenging since the Covid-19 pandemic as health care professionals have had to adapt to remote consultations for some patients, and patients have had to adapt to the changing health landscape. The rapid resolution of psoriasis symptoms especially those with a substantial impact on quality of life can improve patient satisfaction and adherence, making it an important factor in successful treatment. Cal/BD foam contributes to improved patient adherence and treatment outcome through its rapid action and superior efficacy versus Cal or BD monotherapy, Cal/BD ointment and gel and clobetasol cream in the short-term flare treatment of psoriasis. Moreover, the benefits of proactive long-term management of psoriasis compared to reactive management and its favourable safety profile are higher efficacy and a better health-related quality of life. Cal/BD foam should be considered an effective topical treatment for short-term flare treatment and long-term control of adult psoriatic patients

An exploratory study of community pharmacist diagnosis and management of dermatitis and acne.

BACKGROUND: Dermatitis and acne account for a large number of general practitioner appointments yet are amenable to treatment with products available to purchase from community pharmacies. OBJECTIVES: 1. The clinical appropriateness of community pharmacy interventions for these conditions 2. Patient reported measures of the effectiveness of the pharmacist's management of their condition. METHODS: Nine community pharmacies opportunistically recruited patients presenting with suspected cases of both conditions, taking digital images and audio-recording the consultation. These files were uploaded to a secure site and independently reviewed by three dermatology specialists. Following their consultation, patients received a questionnaire to assess their views on the effectiveness of the treatment provided and their level of satisfaction with pharmacy management. RESULTS: Forty patients (36 dermatitis and 4 acne) were recruited. Of 113 assessments (7 not rated due to missing data) reviewed, specialists agreed with pharmacist's diagnosis in 33.6% of cases, disagreed in 38.9% but were unable to determine the diagnosis in 27% of cases. Treatment was deemed appropriate in 42% of cases, inappropriate in 27% and indeterminate in 31% of cases. Twenty-three patients (58%) returned a questionnaire and 12 of these (54.5%, 1 missing) stated that their condition had cleared completely following pharmacist advised treatment. Almost all (91.3%) were very satisfied or satisfied with the advice and/or treatment provided. CONCLUSION: Specialists judged the clinical appropriateness of pharmacist diagnosis and management as suboptimal yet patients were more positive. This study indicates a possible need for greater assessment-related training in dermatology for study pharmacists and further work to determine the generalisability of findings

Image enhancing drugs: A narrative review on the motivational risk factors influencing skin lightening use

Abstract Introduction In societies that place a great emphasis on physical appearance and body aestheticism, the use of image enhancing drugs (IEDs) has become increasingly widespread. Of particular concern is the use of skin lightening drugs, which might contain undisclosed and harmful ingredients of potential adulterated nature. These products are frequently advertised on social media platforms and elsewhere and used without medical consultation. Methods An explorative literature search was carried out in PubMed, Scopus, CINHAL, and ProQuest to better understand the motivational risk factors associated with skin lightening and assess their relation to body image, self-esteem, and other psychological disorders. All studies published until December 2020 were included in the review. Results A number of non-psychological factors can be associated with this practice. These include: (a) sociocultural i.e., achieve different social and cultural benefits, and (b) skin conditions such as hyperpigmentation lesions. Conversely, psychological factors can be correlated to (a) low self-esteem, (b) body image disturbances, and (c) other psychological factors like history of trauma and depressive symptoms. Conclusion Skin lightening remains a poorly studied and understood multifactorial phenomenon. More extensive research is needed to improve current clinical practice and raise public awareness on this dangerous practice

Freedom from disease in plaque psoriasis: Comparing the perceived importance of voting round 2 statements from a Delphi consensus of patients, physicians and nurses

© 2023 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology. This is an open access article under the terms of the Creative Commons Attribution-Non Commercial License. https://creativecommons.org/licenses/by-nc/4.0/Peer reviewe

Body dysmorphia in common skin diseases: Results of an observational, cross-sectional multi-centre study among dermatological out-patients in 17 European countries

Background: Body dysmorphic disorder (BDD) is a common psychiatric disorder associated with high costs for healthcare systems as patients may repeatedly ask for different, often not effective interventions. BDD symptoms are more prevalent in patients with dermatological conditions than the general population, but there are no large sample studies comparing the prevalence of BDD symptoms between patients with dermatological conditions and healthy skin controls. Objectives: To compare the prevalence of BDD symptoms between patients with different dermatological conditions and healthy skin controls and to describe sociodemographic, physical and psychological factors associated with BDD symptoms to identify patients who may have a particularly high chance of having this condition. Methods: This observational cross-sectional, comparative multi-centre study included 8295 participants: 5487 consecutive patients with different skin diseases (56% female) recruited among dermatological out-patients at 22 clinics in 17 European countries and 2808 healthy skin controls (66% female). All patients were examined by a dermatologist. BDD symptoms were assessed by the Dysmorphic Concern Questionnaire (DCQ). Sociodemographic data, information on psychological factors and physical conditions were collected. Each patient was given a dermatological diagnosis according to ICD-10 by a dermatologist. Results: The participation rate of invited dermatological patients was 82.4% on average across all centres. BDD symptoms were five times more prevalent in patients with dermatological conditions than in healthy skin controls (10.5% vs. 2.1%). Patients with hyperhidrosis, alopecia and vitiligo had a more than eleven-fold increased chance (adjusted Odds Ratio (OR) > 11) of having BDD symptoms compared to healthy skin controls, and patients with atopic dermatitis, psoriasis, acne, hidradenitis suppurativa, prurigo and bullous diseases had a more than six-fold increased chance (adjusted OR > 6) of having BDD symptoms. Using a logistic regression model, BDD symptoms were significantly related to lower age, female sex, higher psychological stress and feelings of stigmatisation. Conclusions: This study reveals that clinical BDD symptoms are significantly associated with common dermatological diseases. As such symptoms are associated with higher levels of psychological distress and multiple unhelpful consultations, general practitioners and dermatologists should consider BDD and refer patients when identified to an appropriate service for BDD screening and managementpublishedVersio

Effectiveness and persistence of acitretin, ciclosporin, fumaric acid esters and methotrexate for patients with moderate-to-severe psoriasis: a cohort study from BADBIR

Background Real-world data evaluating effectiveness and persistence of systemic therapies for patients with psoriasis are limited. Objectives To determine the effectiveness and persistence of acitretin, ciclosporin, fumaric acid esters (FAEs) and methotrexate in patients with moderate-to-severe psoriasis. Methods Data from The British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR), a prospective, multi-centre pharmacovigilance register of patients with moderate-to-severe psoriasis receiving biologic and/or conventional systemic therapies, were analysed. Eligible patients were ≥16 years of age receiving a first course of acitretin, ciclosporin, FAEs or methotrexate between 2007 and 2021 with ≥6 months’ follow-up. Effectiveness was defined as achieving absolute Psoriasis Area and Severity Index (aPASI) ≤ 2 reported ≥4 weeks after treatment start date until stop date. To identify baseline clinical variables associated with treatment effectiveness, we used multivariable logistic regression models estimating the adjusted odds ratio (aOR) of achieving aPASI ≤2. To describe drug persistence associated with ineffectiveness, occurrence of adverse events or other reasons of discontinuation, survival estimates with 95% confidence interval (CI) were obtained using a flexible parametric model. Results were obtained using multiple imputed data. Results In total, 5430 patients were included in the analysis: 1023 (19%) on acitretin, 1401 (26%) ciclosporin, 347 (6%) FAEs and 2659 (49%) methotrexate at registration. The proportion of patients who achieved aPASI ≤ 2 was lower with acitretin 118 (21%) compared with those on ciclosporin 233 (34%), FAEs 43 (30%) and methotrexate 372 (32%). Factors associated with ineffectiveness included prior experience to previous non-biologic systemic therapies (acitretin) [(aOR, (95% CI) 0.64 (0.42, 0.96)], male sex (methotrexate) 0.58 (0.46, 0.74), co-morbidities 0.70 (0.51, 0.97) and alcohol consumption (≤14 units per week) (ciclosporin) 0.70 (0.50, 0.98). Persistence associated with all reasons of discontinuation showed better survival for methotrexate compared with acitretin, ciclosporin and FAEs cohorts at 12 months [(Survival estimate (95% CI), 46.1 (44.0, 48.3), 31.9 (29.4, 34.7), 30.0 (27.5, 32.4) and 35.0 (29.9, 40.9)], respectively. Conclusions The real-world effectiveness and persistence of acitretin, ciclosporin, FAEs and methotrexate were generally low. Previous non-biologic systemic therapies, male sex, comorbidities and alcohol consumption were risk factors associated with treatment ineffectiveness