36 research outputs found
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 38.0āĀ±ā15.1āyears (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, andāā„ā39 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 wereāā„
24 andāā„ā12 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 correlationsāā„ā0.7). 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
ā„10 andāā„ā6 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
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 45.90Ā±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 TDās 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 patientsā 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 concept for integrated care pathways for atopic dermatitis-A GA LEN ADCARE initiative
Introduction: The integrated care pathways for atopic dermatitis (ADāICPs) aim to bridge the gap between existing AD treatment evidenceābased 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 coāordination 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 GALEN ADCARE network and partners as well as all stakeholders, abbreviated as the ADāICPs 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 GALEN ADCARE centres. Results: The ADāICPs outline the diagnostic procedures, possible coāmorbidities, 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 ADāICPs 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
Biologic therapies in dermatology
Biologic therapies, the anti-cytokines in particular, have proved to be a significant addition to the dermatologistās armamentarium for the management of severe skin disease. This article summarizes the mechanism of action, dosage, approved indications, off-label uses and the future of biologic therapies in dermatology. </jats:p
Dermatology life quality index in Thai patients with systemic sclerosis: A cross-sectional study
Background: Systemic sclerosis (SSc) is a multisystem disorder that affects various organ systems. Although SSc patients have both physical and psychological illness, psychological distress is sometimes underestimated as most physicians usually pay more attention to physical problems. Aims: To evaluate dermatology-specific health-related quality of life (QoL) in Thai patients with SSc. Methods: SSc patients, who attended the Department of Dermatology, Siriraj Hospital, Bangkok, Thailand, between August 2009 and April 2010, were enrolled. The demographic data and skin manifestations of the patients were recorded. Skin thickness of each patient was analyzed by modified Rodnan skin score. QoL was evaluated by using the validated Thai version of dermatology life quality index (DLQI) questionnaire. Results: A total of 80 patients of SSc were enrolled in this study. Twelve patients had limited SSc, while 68 patients had diffuse SSc. The mean (SD) disease duration before period of evaluation was 9 (12.8) years. The mean total of DLQI score was 6.3 (range, 0-23). Patients with low DLQI score have longer disease duration than patients with high DLQI score (P<0.05). Pain/pruritus was the most significant problem to the patients. Salt and pepper appearance was the cutaneous finding that had association with high DLQI score. Conclusions: SSc had moderate impact on patientā²s dermatology-specific health-related QoL. Pain, pruritus, and obvious skin findings caused a significant impairment to SSc patients. Therefore, the treatment of pain and pruritus and prominent cutaneous findings should be taken into account to improve QoL of SSc patients
Responsiveness to Change and Interpretability of the Simplified Psoriasis Index
The Simplified Psoriasis Index (SPI) is a summary measure of psoriasis with separate components for current severity (weighted for functionally or psychosocially important sites), psychosocial impact, and past behavior. The current severity components of the professionally assessed SPI (proSPI-s) and self-assessed SPI (saSPI-s) have each been shown to be valid and reliable. Their responsiveness to change and equivalence to the current standard (Psoriasis Area and Severity Index, PASI) were investigated. Responsiveness and minimum clinically important differences (MCIDs) were derived from PASI changes from baseline at weeks 4 (n=100) and 10 (n=65) in patients commencing therapy for psoriasis. Receiver operating characteristic (ROC) analysis confirmed that both measures detected responsiveness well (area under the curve (AUC)=0.72ā0.96). On ROC and PASI-based anchor analysis, MCIDs equated to mean absolute and percentage changes of 5 and 60% (proSPI-s), and 7 and 70% (saSPIās). Satisfactory response as defined by ā©¾75% reduction in PASI equated to 85 and 95% reductions in proSPIās and saSPIās, respectively. PASI-equivalent cutoff scores for mild (PASI<10) and severe (PASI>20) psoriasis were <9 and >18 for proSPIās (n=300) and <10 and >20 for saSPIās (n=200; AUC=0.86ā0.96). These studies further support the validity of SPI for use in routine clinical practice