Quantitative assessment of female pattern hair loss

AbstractBackground/ObjectiveThe conventional approach to evaluate female pattern hair loss (FPHL) is to visually inspect and score images of balding area (BA). However, visual estimates vary widely among different physicians, and may hinder objective assessment of hair loss and subsequent treatment response. For this reason, we propose a quantitative method using a computer-aided imaging system to help physicians evaluate the severity of FPHL clinically.MethodsWe use a series of digital image processing techniques to measure the width of central balding area of FPHL. A total of 184 photos were collected form 33 Chinese women with FPHL (stages I-2 to II-2 on the Savin scale). Each photograph underwent standardized exposure correction. The balding areas were detected through this computer system and then transformed into an equivalent ellipse by principal component analysis. The width of ellipse [balding width (BW)] was measured. Spearman's rank correlation was used to detect the correlation between our measurements and clinical staging.ResultsExposure correction resulted in a 16.97% (|BWcorrected − BWoriginal|/BWcorrected) difference in BW.‏ The average BW was 54.98 mm in all patients, 25.79 mm in type I-2 patients, 37.41 mm in I-3, 54.08 mm in I-4, 72.10 mm in II-1, and 85.53 mm in II-2. The values of BW were correlated with Savin scale stages clinically (rBW = 0.967), which was significant statistically (p < 0.05).ConclusionA computer-aided imaging system could be a useful tool to assist physicians to evaluate the balding area more precisely for clinical staging in FPHL. The BW instead of the balding area is simple to use clinically to represent the severity of FPHL

The Association between Clinical Response to Ustekinumab and Immunogenicity to Ustekinumab and Prior Adalimumab.

Immunogenicity due to antidrug antibodies (ADA) to tumor necrosis factor (TNF)-α antagonists is known to decrease treatment response. However, few studies have investigated ADA in ustekinumab, an interleukin-12 and -23 antagonist, in a clinical setting. This study aimed to investigate the immunogenicity of ustekinumab and its clinical consequences in psoriasis.This prospective observational study enrolled 76 patients with plaque psoriasis who were treated with ustekinumab for a minimum of 7 months. Blood samples were drawn just prior to scheduled ustekinumab injection during clinic visits. Levels of anti-ustekinumab antibody (AUA) and serum ustekinumab concentration were measured respectively by radioimmunoassays and enzyme-linked immunoassays respectively, and correlated to clinical data and Psoriasis Area and Severity Index (PASI).AUA was detected in 6.5% of patients after a mean of 13 months of treatment. Patients with positive AUA had significantly lower serum ustekinumab concentrations (0.01 vs. 0.2 mg/L, p<0.001) and lower PASI 50 response than patients without AUA (0% vs. 69%, p = 0.004).The percentage of AUA formation was comparable between patients who had failed previous adalimumab with or without anti-adalimumab antibodies (AAA) (14.3% vs. 12.5%, p = 1.00). However, a higher proportion of switchers without AAA obtaining PASI50 (71.4% vs. 37.5%) and PASI75 response (42.9% vs.12.5%) within 7 months of ustekinumab treatment than with AAA though this difference did not reach statistical significance.Our results suggest that presence of AUA was significantly associated with treatment failure for ustekinumab, though limited by a small sample size. Also, determining the presence of ADA to antecedent TNF-α antagonists may assist in choosing an optimized subsequent treatment modality achieving treatment success

Survey of dermoscopy use by Taiwanese dermatologists

Background: Dermoscopy is a useful technique for improving the diagnostic accuracy of various types of skin disorders. Although the technique has been widely adopted by European, Australian, and United States dermatologists, only limited information is available on the prevalence of dermoscopy use in Taiwan. Objectives: We assessed the use and barriers to adoption of dermoscopy among Taiwanese dermatologists to determine the relationship between dermoscopy use and the characteristics of dermoscopy users. Methods: A questionnaire of 20 items regarding demographic characteristics, dermoscopy training, and application was mailed to all dermatologists listed in the 2013 Taiwanese Dermatological Association registry. Results: Of the 950 mailed questionnaires, 202 were returned and 195 were identified to be eligible. Of the valid respondents, 51.8% used dermoscopy and 62.1% had attended courses for dermoscopy training. Dermoscopy use was significantly associated with women (p = 0.018), residents (p < 0.001), young age (p < 0.001), dermoscopy training (p < 0.001), and owning dermoscopy books (p < 0.001). The majority of dermoscopy users practiced in medical centers (p < 0.001) and were involved in resident teaching (p < 0.001). If more convenient programs for dermoscopy training were offered (68.1%), the price of a dermatoscope was lowered (64.9%), or free trials were offered by dermatoscope vendors (58.5%), dermoscopy nonusers might be willing to use this technique. Conclusion: This is the first published survey about the application of dermoscopy in Taiwan. Despite a low response rate and potential selection bias, our study revealed that dermoscopy is increasingly being accepted by Taiwanese dermatologists in daily practice. In addition, the study offered an opportunity to introduce all dermatologists to this technique

Clinical response and associated characteristics of patients with and without anti-ustekinumab antibody.

<p>AUA, anti-ustekinumab antibody; PASI, psoriasis area and severity index</p><p>*P<0.05 (in bold).</p><p>Clinical response and associated characteristics of patients with and without anti-ustekinumab antibody.</p

Ustekinumab trough concentration are shown by responder status and anti-ustekinumab antibody (A) Patients with negative anti-ustekinumab antibody had significantly higher drug trough levels compared with those with positive anti-ustekinumab antibody. (B) Nonresponders attained significantly lower ustekinumab trough levels than responders.

<p>Responders were defined as 50% reduction in psoriasis area and severity index (PASI 50) compared to baseline within 7 months of treatment.</p

The immunogenicity and efficacy of ustekinumab in switchers with and without anti-adalimumab antibody.

<p>AAA, anti-adalimumab antibody; AUA, anti-ustekinumab antibody.</p><p>The immunogenicity and efficacy of ustekinumab in switchers with and without anti-adalimumab antibody.</p

Potential drug interactions in dermatologic outpatient prescriptions—experience from nationwide population-based study in Taiwan

Background: Adverse drug reactions increase morbidity and mortality, and potential drug interactions (DIs) increase the probability of adverse drug reactions. Objectives: To survey the potential DIs of dermatologic outpatient prescriptions from the National Health Insurance Research Database of Taiwan. Methods: All prescriptions written by dermatologists in 2000 were analyzed to identify potential DIs among drugs appearing on the same prescription sheet. Results: Of 150.6 million prescription sheets with 669.5 million prescriptions registered in the National Health Insurance Research Database of Taiwan, we identified 6.6 million (4.4%) dermatology prescription sheets with 19 million (2.8%) prescriptions. The findings of the study showed that 283,458 potential DIs were found in this category, accounting for 1.49% per prescription. The most common significance Level 1 interaction (1.1%) was between the less-sedative antihistamines (terfenadine/astemizole) and azole antifungal agents. Among the category of severity, the most common was terfenadine interacting with cimetidine and ketoconazole (4.4%), followed by astemizole interacting with cimetidine and ketoconazole (2.9%). The most common drug class interaction occurred between corticosteroids and antacids (48.5%). Overall, DI incidence in dermatologic patients was lower than that of the general patient population. Conclusions: Based on the study findings, we concluded that dermatologists need to be reminded of having possible potential DIs when prescribing medications. Introducing information technology into the computerized physician order entry system into the daily practice may reduce potential DIs

Potential drug interactions in dermatologic outpatient prescriptions—experience from nationwide population-based study in Taiwan

[[abstract]]Background Adverse drug reactions increase morbidity and mortality, and potential drug interactions (DIs) increase the probability of adverse drug reactions. Objectives To survey the potential DIs of dermatologic outpatient prescriptions from the National Health Insurance Research Database of Taiwan. Methods All prescriptions written by dermatologists in 2000 were analyzed to identify potential DIs among drugs appearing on the same prescription sheet. Results Of 150.6 million prescription sheets with 669.5 million prescriptions registered in the National Health Insurance Research Database of Taiwan, we identified 6.6 million (4.4%) dermatology prescription sheets with 19 million (2.8%) prescriptions. The findings of the study showed that 283,458 potential DIs were found in this category, accounting for 1.49% per prescription. The most common significance Level 1 interaction (1.1%) was between the less-sedative antihistamines (terfenadine/astemizole) and azole antifungal agents. Among the category of severity, the most common was terfenadine interacting with cimetidine and ketoconazole (4.4%), followed by astemizole interacting with cimetidine and ketoconazole (2.9%). The most common drug class interaction occurred between corticosteroids and antacids (48.5%). Overall, DI incidence in dermatologic patients was lower than that of the general patient population. Conclusions Based on the study findings, we concluded that dermatologists need to be reminded of having possible potential DIs when prescribing medications. Introducing information technology into the computerized physician order entry system into the daily practice may reduce potential DIs