Supplementary Material for: Detection of Small Changes in Psoriasis Intensity with PrecisePASI

<b><i>Background:</i></b> The Psoriasis Area and Severity Index (PASI) is the score of choice to grade psoriasis severity and detect clinical changes. Due to low resolution based on the calculation of the score by fixed area classes, PASI scores <10 have little value. <b><i>Methods:</i></b> At 756 patient examinations, psoriasis activity was measured with both PASI and PrecisePASI. <b><i>Results:</i></b> PrecisePASI has a linear increase while PASI has a staircase pattern. Both scores meet at the endpoint-relevant values of body surface area (BSA) 10, 30, 50, 70 and 90%. PASI and PrecisePASI correlate significantly over the whole range of BSA. In the region of BSA <5%, PrecisePASI shows a significantly higher resolution (p < 0.0001). <b><i>Conclusion:</i></b> The calculation of PrecisePASI corrects the undesired inaccuracies of PASI in the lower BSA ranges and is a tool to use as an endpoint in trials aiming to detect differences in the lower ranges of BSA

Supplementary Material for: Inpatient Treatment for Severe Nonsurgical Dermatological Disorders: Prevalence, Care Infrastructure and Reimbursement in Switzerland

<b><i>Background:</i></b> Since 2012, Swiss inpatient dermatology is funded through a flat rate payment system based on diagnosis-related groups (DRGs). <b><i>Objective:</i></b> To analyze the reimbursement of nonsurgically treated severe disorders of the skin under the system called SwissDRG. <b><i>Methods:</i></b> Three retrospective, cross-sectional cohort studies were performed. Data sets were received from the Swiss Federal Office of Statistics (1,285,685 retained records), the five Swiss university hospitals (370,964 retained records) and our center (72,211 retained records). <b><i>Results:</i></b> Cases accounted for 0.04% of all hospitalizations nationwide, with 43.7% treated at university hospitals. Treatment at university hospitals produced a mean loss of USD 3,711 per case. Lyell syndrome cases were especially underfunded (mean loss USD 31,906). Extra-county admissions and direct referrals were significant predictors of total inpatient costs (p = 0.019 and p < 0.001, respectively). <b><i>Conclusions:</i></b> We suggest grouping Lyell syndrome cases into burn DRGs and evaluating extra-county admissions and direct inpatient referrals as DRG split criteria

Supplementary Material for: Acutely Ill Patients in Internal Medicine Departments Want Treatment for Undiagnosed, Symptomatic Skin Conditions

<b><i>Objective:</i></b> Concomitant skin conditions may be neglected in internal medicine patients due to lack of knowledge or resources. Thus, we investigated the prevalence of undiagnosed skin conditions in this population. <b><i>Methods:</i></b> 200 patients in a university medical center’s internal medicine division were examined clinically for dermatoses and quality of life in a prospective, 2-month, single-center study. <b><i>Results:</i></b> All patients had several dermatological problems (mean per patient: 13; range: 3–25). There was no relationship between the patient’s main medical problem and the number or nature of dermatological conditions. Most patients (84%) requested treatment for their skin condition during hospitalization, especially for xerosis (76%), warts (69%), seborrheic eczema (67%) and onychorrhexis (53%) but not for asymptomatic dermatoses. The impairment in skin-related quality of life was mild but significant, with a mean ± SD Dermatology Life Quality Index of 3 ± 4 (p < 0.001), and global quality of life impairment was severe (p < 0.001). <b><i>Conclusions:</i></b> Inpatients suffered from many different, mostly age-related, skin conditions that remained undiagnosed. When prompted, however, patients requested treatment, particularly for symptomatic dermatological conditions such as xerosis, revealing an unmet need that needs to be addressed by qualified evaluation and care

Supplementary Material for: Evaluation of the National Swiss Skin Cancer Screening Campaign 2013: Do We Do the Right Thing?

<p><b><i>Background:</i></b> Skin cancer prevention and screening programs are performed in many countries. Their benefit is discussed controversially. <b><i>Objective:</i></b> Our aim is to evaluate the Skin Cancer Screening Program 2013 in Switzerland by following up screenees upon interventions. <b><i>Methods:</i></b> Quality was assessed by personal follow-up via phone/e-mail of every patient that had been screened during this campaign and histological follow-up of all participants with suspicious skin lesions. <b><i>Results:</i></b> Of the 1,087 screenees requiring interventions, 263 agreed to participate in the follow-up. We were able to obtain 66 histology reports. During this campaign 33 malignant lesions (8 melanomas) were removed. <b><i>Conclusion:</i></b> The overall melanoma detection rate in our free Skin Cancer Screening Program is comparable to those in European public activities. The costs of free screening programs compare favorably with the prevented potential therapeutic costs of late-stage melanoma. The low response rate of screenees agreeing to be followed up limits conclusions of this study.</p

Supplementary Material for: Swiss S1 Guidelines on the Systemic Treatment of Psoriasis Vulgaris

Psoriasis vulgaris is a common, chronic inflammatory skin disease with a prevalence of 1.5-2% in Western industrialized countries. A relevant percentage of patients suffer from moderate-to-severe psoriasis and experience a significant reduction in quality of life. The choice of an adequate therapy could help to prevent disease and exacerbation of comorbidity, which could increase quality of life, avoid hospitalization and avoid reduction of working days. The present guidelines are focused on the initiation and management of systemic therapies in cases of moderate-to-severe plaque-type psoriasis in adults to optimize treatment response, adherence and quality of life. This first version of the Swiss S1 guidelines presents therapeutic recommendations which are based on a systematic literature search as well as an informal expert consensus of dermatologists in Switzerland

Supplementary Material for: Clinical Disease Patterns in a Regional Swiss Cohort of 34 Pyoderma Gangrenosum Patients

<i>Background/Aim:</i> Pyoderma gangrenosum (PG) is a rare, neutrophilic dermatosis often associated with an underlying disease, and clinical data or larger studies are rare. <i>Methods:</i> In this retrospective study, disease characteristics, clinical manifestations, and treatment response were evaluated in a Swiss cohort of PG patients. <i>Results:</i> In participating centers, 34 cases (21 females) of PG were analyzed based on clinical and histological presentation between 2002 and 2012. The mean age at diagnosis was 61.2 years; 50% of the patients experienced only 1 episode of PG. In 13 cases (out of 20), recurrences occurred during PG therapy; 64.1% showed only 1 lesion simultaneously. The predominant localization was the lower limb (67%). The lesions were disseminated in 26.6%. At the time of diagnosis or recurrence, the mean diameter was 37.6 mm and the mean ulcer size was 10.3 cm2. C-reactive protein (CRP) was elevated in 73.2%; leukocytosis was present in 58.9% and neutrophilia in 50.9%. At least 1 associated comorbidity was present in 85% (the most prominent being cardiovascular disease). The most often used systemic treatments were steroids (68.3%), cyclosporine A (31.7%), dapsone (31.7%), and infliximab (13.3%), and the most often used topicals were tacrolimus 0.1% (48.3%) and corticosteroids (35%). PG healed completely at discharge in 50.8%. The average time to diagnosis was 8 months, and the mean duration to healing was 7.1 months. <i>Conclusion:</i> PG is a difficult-to-diagnose skin disease. Here, markers for inflammation such as CRP, leukocytosis, and neutrophilia were elevated in 50-73% of the PG patients

Supplementary Material for: Superiority in Quality of Life Improvement of Biologics over Conventional Systemic Drugs in a Swiss Real-Life Psoriasis Registry

<p><b><i>Background:</i></b> Randomized controlled trials have shown the efficacy of systemic treatments in moderate-to-severe psoriasis. Clinical outcomes in psoriasis patients under real-world conditions are less well understood. <b><i>Objective:</i></b> This study compared Psoriasis Area and Severity Index (PASI) and Dermatological Life Quality Index (DLQI) improvement in all psoriasis patients registered in the Swiss Dermatology Network for Targeted Therapies. We asked whether outcomes differed between 4 treatment strategies, namely biologic monotherapy versus conventional systemic monotherapy, versus combined biologic and conventional systemic drugs, and versus therapy adaptation (switching from one type to another). <b><i>Methods:</i></b> PASI and DLQI within 1 year after onset of systemic treatment, measured at 3, 6, and 12 months, were compared among the 4 groups using generalized linear mixed-effects models. <b><i>Results:</i></b> Between March 2011 and December 2014, 334 patients were included; 151 received conventional systemic therapeutics, 145 biologics, 13 combined treatment, and 25 had a therapy adaptation. With regard to the absolute PASI, neither the biologic cohort nor the combined treatment cohort significantly differed from the conventional systemic therapeutics cohort. The odds of reaching PASI90 was significantly increased with combined therapy compared to conventional systemic therapeutics (<i>p</i> = 0.043) and decreased with a higher body mass index (<i>p</i> = 0.041). At visits 3 and 4, the PASI was generally lower than at visit 2 (visit 3 vs. visit 2, <i>p</i> = 0.0019; visit 4 vs. visit 2, <i>p</i> < 0.001). After 12 months, patients with biologic treatment had a significantly lower DLQI than those with conventional systemic therapeutics (<i>p</i> = 0.001). <b><i>Conclusion:</i></b> This study suggests that after 1 year of treatment, biologics are superior in improving the subjective disease burden compared to conventional systemic drugs.</p

Supplementary Material for: Efficacy and Survival of Systemic Psoriasis Treatments: An Analysis of the Swiss Registry SDNTT

<p><b><i>Background:</i></b> The Swiss psoriasis registry SDNTT (Swiss Dermatology Network for Targeted Therapies) records the long-term safety and effectiveness of systemic treatment regimens for psoriasis. <b><i>Patients and Methods:</i></b> Patients with moderate to severe psoriasis are included in the SDNTT when treatment with a conventional systemic agent or biologic is initiated that was not previously used by the respective patient. Patients are followed over a 5-year period. Clinical data are obtained every 3-6 months using standardized case report forms. Here, baseline data and follow-up data for 1 year of patients included from October 2011 until December 2014 were analyzed. <b><i>Results:</i></b> Within 39 months, 323 patients from 7 tertiary dermatology centers in Switzerland were recruited in the SDNTT; 165 patients received biologics and 158 conventional systemic therapies<i>.</i> Patients treated with biologics had a significantly higher severity (PASI 11.3 vs. 9.2, BSA 15.6 vs.11.9, psoriatic arthritis 36.4 vs. 10.8%; <i>p</i> ≤ 0.005, <i>p</i> ≤ 0.013, <i>p</i> ≤ 0.001) and a longer duration of illness (19.2 vs. 14.4 years, <i>p</i> ≤ 0.003) compared to patients starting a conventional systemic treatment. PASI reduction was satisfying in both treatment groups, with 60.6% of patients treated with biologics achieving PASI75 after 1 year compared to 54.2% of patients receiving conventional systemic drugs (nonsignificant). On average, the drug survival in patients receiving a biologic therapy was significantly longer than those receiving conventional systemic treatments (30.5 vs. 19.2 months, <i>p</i> ≤ 0.001). <b><i>Conclusions:</i></b> In the real-world setting of a prospective national therapy registry, the application of current therapeutic guidelines for patients with moderate to severe psoriasis resulted in a PASI reduction of approximately 70% within the first year of treatment, but current therapeutic targets of PASI75 and PASI90 were reached in only 58 and 36% of patients, respectively, at 1 year, highlighting a gap in efficacy between selective clinical trials and the real-world setting.</p