Cutaneous plasmacytosis: a case report and review of pulmonary findings

Primary cutaneous plasmacytosis is an uncommon cutaneous disorder with multiple cutaneous nodules and plaques mainly on face and trunk. This entity is thought to be a reactive process with unknown etiology. Pulmonary involvement could be found as a part of systemic plasmacytosis whereas cutaneous plasmacytosis was also reported with other pulmonary disorders. This report presents the case of cutaneous plasmacytosis and the review of pulmonary findings reported in plasmacytosis

Sequential appearance of four clinical delayed drug hypersensitivity in the same patient

This patient had a two-month history of four clinical manifestations of drug hypersensitivity reactions (DHR): maculo papular eruption, Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), acute generalized exanthematous pustulosis (AGEP) and toxic epidermal necrolysis (TEN). The eliciting drugs were rifampicin, possibly gabapentin, levofloxacin, meropenam and/or colistin. Thus, the patient might develop a multiple drug hypersensitivity syndrome. The TEN-like lesion appeared after stopping drugs for two days. A different manifestation of DHR in dependence of drug use suggests that the distinct manifestations of DHRs are due to the stimulation of T cells with distinct functions. The simultaneous appearance of AGEP and DRESS symptoms might be due to the simultaneous stimulation of two (or more) different T cell subsets, which are functionally dominant. Lastly, the appearance and further propagation of symptoms after therapy-stop is a common but somewhat neglected problem in DHR, which raises questions regarding the cause of persisting T cell activation

Angioedema quality of life questionnaire (AE-QoL) - interpretability and sensitivity to change

BACKGROUND: The Angioedema Quality of Life (AE-QoL) is the first patient reported outcome measure developed for the assessment of quality of life (QoL) impairment in patients with recurrent angioedema (RAE). This study aimed to evaluate the clinimetric properties of the AE-QoL in Thai patients and to establish categories of QoL impairment assessed by the AE-QoL. METHODS: The validated Thai version of the Dermatology Life Quality Index (DLQI) and Patient Global Assessment of Quality of Life (PGA-QoL) were used to comparatively evaluate the Thai version of AE-QoL. Spearman correlations between the Thai AE-QoL and two other standard measurements (DLQI and PGA-QoL) were investigated to determine convergent validity. The Thai DLQI and PGA-QoL were used to categorize patients according to their QoL. Known-group validity of the Thai AE-QoL was later analyzed. The reliability of the Thai AE-QoL was investigated using Cronbach's alpha and intraclass correlation. Three different approaches including the distribution method, receiver operating characteristic curve analysis, and the anchor based-method were used for the interpretability. RESULTS: A total of 86 patients with RAE with a median age of 38.0 ± 15.1 years (range 18-76) were enrolled. Of those, 76 patients (88%) had RAE with concomitant wheals, and 10 patients (11.6%) had RAE only. The AE-QoL assessed RAE-mediated QoL impairment with high convergent validity and known-groups validity, high internal consistency and test-retest reliability, and good sensitivity to change. Although the AE-QoL did not differentiate between patients with moderate and large effect as measured by PGA-QoL or DLQI in this study, AE-QoL total values of 0-23, 24 to 38, and ≥ 39 could define patients with "no effect", "small effect", and "moderate to large effect" of RAE on their QoL, respectively. CONCLUSIONS: This study supports the validity and reliability of the Thai version of the AE-QoL, which is a very different language from the original version. Categories allow to classify the effect of RAE on patients' QoL as "none", "small", and "moderate to large". Further studies are needed to confirm the applicability of AE-QoL in other Asian populations"

Validity, reliability and interpretability of the Thai version of the urticaria control test (UCT)

Background The Long Form and Short Form of the German (original) version of the Urticaria Control Test (UCT) have shown to be valid and reliable instruments for assessing patients with all types of chronic urticaria (CU). The cutoff scores for identifying patients with well-controlled disease were ≥ 24 and ≥ 12 for Long and Short Forms, respectively. However, the sensitivity to change and minimal clinically important difference (MCID) of the UCT have never been systematically evaluated. This study aimed to investigate the validity, reliability, screening accuracy, sensitivity to change and MCID of the linguistically validated translation of the UCT into the Thai language for assessing CU in the Thai population. Methods A structured translation and pre- testing were done to cross-culturally adapt the UCT for the Thai language. All measurement properties of both forms of the Thai UCT were validated in 169 patients with CU. Results There were strong correlations between the Thai UCT score and disease activity, health-related quality of life impairment, and disease control (all correlations ≥ 0.7). Good internal consistency and excellent intra-rater reliability were demonstrated. The same cutoff scores to define patients with well-controlled disease should be used as those recommended for the original UCT version. MCIDs equated to increase in scores of 6 and 3 for the Long and Short Forms, respectively, of the Thai UCT should be used to identify patients who had minimal responses. Score increments of ≥10 and ≥ 6 for Long and Short Forms, respectively, should be used to define patients who had marked responses. Conclusions This study confirmed the applicability of the UCT for use in Thailand, a country that has a very different language and cultural setting than that of Germany and the United States. Further studies are required to examine the suitability of the UCT for use in the pediatric population

Comparison of three methods for measuring psoriasis severity in clinical studies (Part 2 of 2): use of quality of life to assess construct validity of the Lattice System Physician's Global Assessment, Psoriasis Area and Severity Index and Static Physician's Global Assessment

BackgroundSystems for determining psoriasis severity in clinical trials have not been sufficiently validated against patients’ perceived quality of life.ObjectiveTo validate three systems of physician‐determined psoriasis severity (the Lattice System Physician's Global Assessment [LS‐PGA], Psoriasis Area and Severity Index [PASI] and static Physician's Global Assessment [sPGA]).MethodsData were from a 24‐week randomized, double‐blind, placebo‐controlled, multicenter trial of therapy with oral calcineurin inhibitors in 445 patients. Construct validity was measured by correlations of the three severity scores with patients’ self‐reported quality of life (QoL) from the Dermatology Life Quality Index (DLQI) and a DLQI item about psoriasis symptoms.ResultsAll severity systems were moderately and positively correlated with QoL, indicating construct validity. QoL was most consistently related to physicians’ assessments of body surface area involved with psoriasis (iBSA) followed by, in the order of consistency, plaque elevation, erythema and scale.ConclusionsThe LS‐PGA weights iBSA and aspects of plaque morphology in concert with their relative effects on QoL. The LS‐PGA, sPGA and PASI are validated by their relationship to QoL in a clinical trial.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111946/1/jdv12861.pd

Utility of the Siriraj Psoriatic Arthritis Screening Tool, the Thai Psoriasis Epidemiology Screening Tool, and the Early Arthritis for Psoriatic Patients Questionnaire to Screen for Psoriatic Arthritis in an Outpatient Dermatology Clinic Setting, and Identification of Factors Significantly Associated with Psoriatic Arthritis

Objective: To assess the clinical utility of the Psoriasis Epidemiology Screening Tool (PEST), the Early Arthritis for Psoriatic Patients (EARP) questionnaire, and the Siriraj Psoriatic Arthritis Screening Tool (SiPAT) as screening tools for psoriatic arthritis (PsA), and to identify factors significantly associated with PsA. Methods: This cross-sectional study included adult psoriasis patients who attended the outpatient clinic at Siriraj Hospital and had not been diagnosed with PsA during 1 March 2017 to 28 February 2018. Participants completed the EARP, PEST, and SiPAT, after which musculoskeletal history was taken, and examination and radiography were performed. Diagnosis of PsA was based on Classification Criteria for Psoriatic Arthritis. Receiver operator characteristic (ROC) curves, sensitivity, and specificity were used to determine assessment tool performance. Logistic regression analysis was used to identify factors associated with PsA. Results: Eighty-seven patients with a mean age of 45.90±14.75 years were enrolled. Twenty-six (29.88%) patients were diagnosed as PsA. According to ROC values, EARP had the best discriminative power (0.83) for distinguishing between psoriatic patients with and without PsA (SiPAT: 0.78, PEST: 0.77). SiPAT had the highest sensitivity (92.3%), followed by EARP (84.6%) and PEST (50.0%); whereas, PEST had the highest specificity (82.0%), followed by EARP (62.3%) and SiPAT (54.1%) for detecting PsA. Multivariate analysis revealed body surface area involvement >10% to be the only independent predictor of PsA (OR: 2.99, 95% CI: 1.09-8.21). Conclusion: SiPAT is an effective and simple to use tool for screening PsA in psoriasis patients. Body surface area involvement >10% is a significant predictor of PsA

Factors Influencing Willingness to Pay for Teledermatology among Patients with Psoriasis

Objective: To determine the proportion of patients with psoriasis prepared to pay for TD. Attitudes and factors influencing their willingness to pay (WTP) were evaluated. Materials and Methods: This cross-sectional study was conducted from July 2020 to October 2021. Adult patients with psoriasis completed a 2-page self-administered questionnaire. Results: Of 200 patients, 133 (66.5%) were unfamiliar with TD. However, 144 (72%) were prepared to pay for TD if it were introduced. The majority of patients answered that 300 Bath was the maximum price that they were willing to pay for TD service. Compared with traditional in-person visits, the significant positive influencing factors on WTP were TD’s quicker delivery of treatment, lower costs, and non-inferiority to usual care. Multivariate analysis showed that the independent factors for WTP were higher educational levels, elimination of out-of-pocket, in-hospital visit expenses, owning a business, TD options suited to psoriasis, and no adverse effects on the patient-doctor relationship. Conclusion: Knowing patients’ attitudes toward TD and the factors influencing their WTP is essential for developing efficient services. Data from this study can be used to develop successful TD services for patients with psoriasis

A cross-sectional survey of the nature and correlates of sleep disturbance in people with psoriasis

BACKGROUND: Research suggests that sleep disturbance is common in psoriasis. Despite 32 studies conducted in sleep, many demonstrate methodological flaws, often using unvalidated measurement, with no study examining multiple dimensions of sleep-wake functioning. Moreover, research has yet to comprehensively examine the range of physical and psychological factors that may affect sleep in people with psoriasis. OBJECTIVE: To characterise sleep disturbance using validated measures and identify physical and psychological predictors of sleep quality in people with psoriasis. METHODS: An online survey was conducted (n=186;Mage =39.2) comprising validated measures assessing sleep (Pittsburgh Sleep Quality Index [PSQI], Berlin Questionnaire, Pre-Sleep Arousal Scale), chronotype (Morningness-Eveningness Questionnaire), mood (Hospital Anxiety and Depression Scale), itch (5-D Itch Scale) and psoriasis severity (Simplified Psoriasis Index). Group comparisons and regression analyses were used to examine predictors of poor sleep. RESULTS: Mean PSQI score was 9.24 (SD=4.32), with 76.3% scoring above the threshold for poor sleep (≥ 6 on the PSQI) and 32.5% scoring 'positive' for probable obstructive sleep apnoea. Poor sleep and high likelihood of OSA was associated with more severe psoriasis (p<.05; η(2) =.07; η(2) =.005). Cognitive arousal (β=.264, p=.001), itch (β=.260, p<.001) and depression (β=.236, p=.001) were the most robust predictors of poor sleep quality which, together with somatic arousal (β=.168, p=.022), accounted for 43% of variance in PSQI scores. CONCLUSIONS: Poor sleep is common in psoriasis and associated with psychological and physical factors. Rates of probable obstructive sleep apnoea are also high. Given the importance of restorative sleep for health, sleep complaints should receive greater clinical attention in the management of psoriasis. This article is protected by copyright. All rights reserved

A concept for integrated care pathways for atopic dermatitis-A GA2 LEN ADCARE initiative

INTRODUCTION: The integrated care pathways for atopic dermatitis (AD-ICPs) aim to bridge the gap between existing AD treatment evidence-based guidelines and expert opinion based on daily practice by offering a structured multidisciplinary plan for patient management of AD. ICPs have the potential to enhance guideline recommendations by combining interventions and aspects from different guidelines, integrating quality assurance, and describing co-ordination of care. Most importantly, patients can enter the ICPs at any level depending on AD severity, resources available in their country, and economic factors such as differences in insurance reimbursement systems. METHODS: The GA2 LEN ADCARE network and partners as well as all stakeholders, abbreviated as the AD-ICPs working group, were involved in the discussion and preparation of the AD ICPs during a series of subgroup workshops and meetings in years 2020 and 2021, after which the document was circulated within all GAL2 EN ADCARE centres. RESULTS: The AD-ICPs outline the diagnostic procedures, possible co-morbidities, different available treatment options including differential approaches for the pediatric population, and the role of the pharmacists and other stakeholders, as well as remaining unmet needs in the management of AD. CONCLUSION: The AD-ICPs provide a multidisciplinary plan for improved diagnosis, treatment, and patient feedback in AD management, as well as addressing critical unmet needs, including improved access to care, training specialists, implementation of educational programs, assessment on the impact of climate change, and fostering a personalised treatment approach. By focusing on these key areas, the initiative aims to pave the way for a brighter future in the management of AD