An effective patient-supporting intervention for topical treatment of psoriasis is also cost-effective.

BACKGROUND: A randomized controlled trial (RCT) of topical treatment combined with regular patient support provided by dermatological nurses in structured consultations of 20-min duration every fourth week improved psoriasis severity, quality of life and treatment adherence compared with topical treatment combined with standard patient support, which is seeing a dermatologist every third month. OBJECTIVES: To examine the economic impact of the patient support from a healthcare-sector perspective in the RCT. METHODS: Costs for primary care, secondary healthcare services and costs of prescription medication were compared for the intervention and nonintervention groups over 48 weeks. Health benefits were expressed in terms of quality-adjusted life-years (QALYs) measured by the EuroQoL five-dimension three-level questionnaire. Regression analyses were used to estimate incremental cost and QALYs. RESULTS: The incremental cost was estimated at £462, with an average increase of 0.08 QALYs per patients for participants receiving the intervention compared with those receiving standard care. The incremental cost-effectiveness ratio for patients was £5999/QALY. The intervention had an almost 100% probability of being cost-effective at a willingness-to-pay threshold of £30 000 per QALY. CONCLUSIONS: Addressing adherence issues is critical to improving outcomes for patients with psoriasis who use topical treatment. The personal support intervention was effective with an acceptable increase in costs.

Allergic reactivity for different dilutions of eugenol in repeated open application test and patch testing.

BACKGROUND: Eugenol is a known contact sensitiser included in fragrance mix I. OBJECTIVE: To assess the allergic reactivity to eugenol in different concentrations using patch test as well as repeated open application test (ROAT). METHODS: Overall 67 subjects from 6 European dermatology clinics participated in the study. The ROAT was performed for 21 days twice a day, applying 3 dilutions of eugenol (2.7%-0.5%) and a control. Before and after the ROAT, patch testing with 17 dilutions of eugenol (2.0%-0.00006%) and controls was performed. RESULTS: Out of the 34 subjects with contact allergy to eugenol, 21 (61.8%) showed a positive patch test before ROAT was performed, the lowest positive concentration was 0.031%. The ROAT was positive in 19 (55.9%) of the 34 subjects, the time until a positive reaction occurred was negatively associated with the concentration of the ROAT solution, as well as with the allergic reactivity of the subjects as defined by patch testing. In the patch test after ROAT, 20 of the 34 test subjects (58.8%) showed a positive reaction. In 13 (38.2%) of the 34 test subjects, the patch test result was not reproduceable, still 4 (31.0%) of these 13 subjects developed a positive ROAT. CONCLUSION: Eugenol can provoke a positive patch test reaction in a very low dose; besides, this hypersensitivity may persist even if a former positive patch test is not reproduceable.

Analysis of Hexavalent Chromium in Cement Samples From Countries Within and Outside the EU: A Study From the International Contact Dermatitis Research Group.

Background: Allergic contact dermatitis (ACD) caused by hexavalent chromium (Cr(VI)) is often severe and difficult to treat. The content of Cr(VI) in cement can be reduced by, for example, addition of iron(II) sulfate. Since 2005 the content of Cr(VI) in cement is regulated in the EU Directive 2003/53/EC and must not exceed 2 ppm. Since this regulation came into force, ACD caused by cement has markedly been reduced. Objective: To investigate Cr(VI) and total chromium content in samples of cement from countries within and outside the EU. Methods: The members of the International Contact Dermatitis Research Group (ICDRG) were invited to participate in the study with the aim to collect cement samples from geographically different areas. The content of Cr(VI) in the samples was estimated by the diphenyl carbazide spot test, atomic absorption spectroscopy was used to assess the total chromium content. Results: Forty-five cement samples were analyzed, containing amounts of Cr(VI) from <0.1 to >70 ppm. Twenty-one samples contained >2 ppm Cr(VI), 24 contained less. Four of 17 samples from within the EU contained >2 ppm Cr(VI), that is, higher amounts than stipulated in the EU directive, as compared with 17 samples from countries outside the EU. Conclusion: In countries outside the EU, significantly more cement samples contained >2 ppm Cr(VI).

Contact dermatitis in children caused by diabetes devices.

BACKGROUND: Insulin pumps and glucose monitoring devices improve diabetes mellitus control and enhance patients' quality of life. However, a growing number of adverse cutaneous reactions related to the use of these devices have been reported. OBJECTIVE: To investigate the culprits of localized contact dermatitis in paediatric patients with diabetes caused by insulin pumps and glucose monitoring devices. METHODS: Retrospective analysis of 15 paediatric patients patch tested as part of a clinical investigation for skin reactions associated with insulin pumps and glucose monitoring devices. RESULTS: Seven patients had positive patch test reactions to isobornyl acrylate (IBOA) and five had positive reactions to benzoyl peroxide (BP). Positive patch test reactions to materials from the glucose sensor and/or insulin pump were seen in 10 of the 15 patients. Three had positive reactions to adhesive remover wipe from Smith and Nephew Remove and four had reactions to EMLA plaster. CONCLUSION: A high share of patients showed positive reactions to IBOA and/or their medical devices (insulin pumps or glucose devices). A third of patients showed positive reactions to BP. The presence of additional unidentified allergens cannot be excluded, highlighting the importance of access to a full description of the chemical composition of the devices.

Long-term improvement of psoriasis patients' adherence to topical drugs: testing a patient-supporting intervention delivered by healthcare professionals.

BACKGROUND: Psoriasis affects 2-4% of the Western adult population and is a socio-economic burden for patients and society. Topical drugs are recommended as first-line treatment for mild-to-moderate psoriasis, but low adherence is a barrier to treatment success. Psoriasis patients require support, in order to improve their long-term use of topical drugs. The project aims to test whether a patient-supporting intervention delivered by dermatology nurses can reduce the severity of psoriasis, improve the use of topical drugs, and is cost-effective compared to standard procedure. METHODS: The intervention consists of improved support delivered to patients by three experienced dermatology nurses, who will support patients on a regular basis by consultations with a focus on providing reminder systems, accountability, reinforcement, and building trust in the treatment. Each patient will be supported by the same dermatology nurse throughout the entire study period. The effect will be compared with standard procedure. The intervention will be tested in a randomized controlled trial during a 48-week period. A group of patients with moderate-to-severe psoriasis (psoriasis affecting ≥ 4% of the total body surface area) and 18-85 years of age who are prescribed topical treatment will be randomized to a non-intervention (n ≈ 57) or intervention group (n ≈ 57). Participants in both arms will be prescribed topical preparations containing corticosteroid and/or calcipotriol. The primary outcome will be a change in the severity of psoriasis, measured as reduction in the Lattice-System Physician's Global Assessment. Secondary outcomes will include changes in health-related quality of life (measured by disease specific and generic questionnaires), primary adherence (i.e., proportion of filled prescriptions), and secondary adherence by objective measure (rate of topical drug consumption (obtained by weighing medication packages) compared to estimated recommended consumption). A health economic evaluation is planned to run alongside the trial. Participants' total health costs will be estimated on the basis of health costs reported to the national health registries and costs spent on the intervention, after which a cost-utility and cost-effectiveness analysis will be carried out. DISCUSSION: If the intervention can reduce the severity of psoriasis in a significant manner and is economically favorable compared to standard treatment, there is potential for implementing the intervention in dermatology clinics. TRIAL REGISTRATION: Clinicaltrials.gov NCT04220554 . Registered on January 7, 2020. Study results, either positive, negative, or inconclusive, will be published on www.clinicaltrials.gov . Trial registration no. with the Danish Regional Committee on Health Research Ethics, registration no. 72613.

Pros and cons of eHealth: A systematic review of the literature and observations in Denmark.

OBJECTIVES: The main objectives of this article are to systematically review the recent literature on patient safety in relation to the use of eHealth and to investigate how the Danish authorities supervise private eHealth clinics with regard to patient safety. METHODS: Original studies reporting the association between patient safety and the use of eHealth as a means of communication between patients and healthcare providers were included. Four literature databases were searched for English-language articles reporting results from cohort studies and clinical trials, published from 2015 until March 2021. Moreover, registered private eHealth clinics in Denmark were evaluated with reference to a recent national audit of patient safety issues in eHealth. RESULTS: The literature search retrieved four intervention studies. The studies did not identify any particular patient safety risks associated with the use of eHealth. Many different authorized healthcare providers (preferably, doctors) apply eHealth in various contexts. eHealth is being used as the only form of contact between the healthcare provider and the patient, as a supplement to patient visitations in an outpatient clinic, or as a tool for communicating between two or more healthcare providers. The regulation of eHealth involves patient safety issues but also has interfaces to marketing, IT systems, and infrastructure. Supervision of eHealth includes the organization of clinics, handling patient charts, prescription medicine, patient legal rights, and patient transition. However, there are many interfaces in the division of responsibilities among the various governmental players. CONCLUSION: eHealth is being used increasingly and in many settings, although recently published intervention studies investigating patient safety issues by the use of eHealth are limited. A structured and continuous governmental control and regulation of patient safety in relation to the use of eHealth is warranted.

Psoriasis patient preferences for topical drugs: a systematic review.

BACKGROUND: Topical drugs are recommended first-line treatment for mild-to-moderate psoriasis. However, patient preferences for the topical drugs differ, since a wide variety of topical drugs and topical drug formulations are available. OBJECTIVES: The aim of this study was to investigate psoriasis patient preferences for topical drugs. METHODS: A systematic literature search was performed for English-language articles in Embase, Medline, PsycINFO, Cinahl, Scopus, and the Cochrane Library. RESULTS: Four surveys, six randomized controlled trials, and two prospective studies of mainly good quality were included. Seven of the studies investigated patient preferences for topical drug formulations, while five studies investigated their preferences for different topical drugs. Overall, patients preferred drugs that are easy to apply, less messy, and have a pleasant scent. CONCLUSION: Psoriasis patient preferences for topical drugs differ. There is no one topical drug or topical drug formulation that suits everyone, which shows the importance of individualized prescriptions for topical drugs that are based on shared decision-making between the prescriber and patient.

Dermatology nurses view on factors related to Danish psoriasis patients' adherence to topical drugs: a focus group study.

BACKGROUND: Topical medications are first-line treatment for mild-to-moderate psoriasis, but adherence is low, which negatively affects patients' outcomes and quality of life. Nurses can play a central role in patient care, particularly in improving adherence. OBJECTIVES: To explore the experience of dermatology nurses with psoriasis patients' adherence to topical drugs. METHODS: We conducted a semi-structured focus group study with 6 dermatology nurses and 2 dermatology nursing students. Participants were recruited from a dermatology hospital outpatient clinic. Data were analyzed by a systematic text condensation method with a phenomenological-hermeneutic approach. RESULTS: Nurses experienced that factors such as social inequality, patient-centered nursing, and patients' quality of life can have an influence on adherence. CONCLUSION: Optimal adherence to topical treatments is a complex exercise and is influenced by many different factors. Involving nurses when prescribing topical treatments may be beneficial since they are one of the most trustworthy professions and have a holistic view on psoriasis severity, patient preferences, health care resources available and socioeconomic factors.

Improving psoriasis patients' adherence to topical drugs: a systematic review.

Background: Poor adherence to topical antipsoriatic drugs limits treatment effectiveness.Objective: The aim of this study was to investigate how health care providers may improve psoriasis patients' adherence to topical treatment.Materials and methods: A systematic literature search was performed for English-language articles in Embase, Medline, PsycINFO, Cinahl, Scopus, and the Cochrane Library.Results: Ten studies of varying quality were identified. Two randomized controlled trials (RCTs) testing the adherence-improving potential of interventions by health care providers to support patients showed improvement in adherence to topical treatment. In a prospective study with a pre/postdesign, an individualized, face-to-face consultation reported an improvement in patient-reported adherence to topical treatment over a 9-week period. Based on seven qualitative studies obtaining insights from either patients or health care providers, health care providers may need to address socio-economic factors, health care system factors, and treatment-, patient-, and disease-related factors in interventions that aim to improve the adherence of psoriasis patients to topical antipsoriatic drugs.Conclusion: There is a need to develop better adherence-improving interventions. A good patient-health care provider relationship is considered crucial to adherence and may be an important intervention target. Before interventions to improve adherence to topicals can be recommended for the clinic, the intervention should be tested in high-quality RCTs.

Can an app supporting psoriasis patients improve adherence to topical treatment? A single-blind randomized controlled trial.

BACKGROUND: Topical corticosteroid or corticosteroid/calcipotriol preparations are recommended first-line topical treatments of psoriasis, but a main cause for the lack of efficacy of topical treatments is considered low rates of adherence to topical drugs. Patient support by the use of applications (apps) for smartphones is suggested to improve medical adherence. METHODS/DESIGN: Design: An investigator-initiated, single-center, single-blind, parallel-group, phase-4 clinical superiority randomized controlled trial (RCT). PARTICIPANTS: 134 patients 18 to 75 years of age with mild-to-moderate psoriasis, who are capable of reading English language, own a smartphone, and are candidates for the study drug calcipotriol and betamethasone dipropionate (Cal/BD) cutaneous foam once daily prn (pro re nata). INTERVENTION: A 28-day adherence-supporting app providing compulsory daily treatment reminders that pop-up on the smartphone screen with a short alert sound. The app synchronizes through Bluetooth® to an electronic monitor (EM) attached to the medication canister. The EM contains a chip registering the amount of foam, day and time the patient use the foam dispenser. The information is displayed in a diary that shows the amount of Cal/BD cutaneous foam used and the number of applied treatment sessions. The app has an optional diary with the patient's rating of symptoms. Non-intervention: Use of Cal/BD cutaneous foam and EM without the app. All participants are prescribed Cal/BD cutaneous foam prn for the entire study period. Primary outcome obtained in week 4: rates of adherence measured by patient report, weight of medication canisters, and number of treatment sessions measured by the EM. Secondary outcomes obtained at baseline, weeks 4, 8, and 26: Lattice System Physician's Global Assessment (LS-PGA) and Dermatology Quality of Life Index (DLQI). DISCUSSION: This trial tests of whether an app can improve rates of adherence to a topical antipsoriatic drug. If the app improves rates of adherence and reduces the burden of psoriasis in a clinically significant way, the app could easily be implemented as a standard routine of care in the clinic. TRIAL REGISTRATION: NCT02858713 , registered on August 3, 2016. EudraCT number 2016-002143-42.

eHealth Technologies as an intervention to improve adherence to topical antipsoriatics: a systematic review.

BACKGROUND: Topical antipsoriatics are recommended first-line treatment of psoriasis, but rates of adherence are low. Patient support by use of electronic health (eHealth) services is suggested to improve medical adherence. OBJECTIVE: To review randomised controlled trials (RCTs) testing eHealth interventions designed to improve adherence to topical antipsoriatics and to review applications for smartphones (apps) incorporating the word psoriasis. MATERIAL AND METHODS: Literature review: Medline, Embase, Cochrane, PsycINFO and Web of Science were searched using search terms for eHealth, psoriasis and topical antipsoriatics. General analysis of apps: The operating systems (OS) for smartphones, iOS, Google Play, Microsoft Store, Symbian OS and Blackberry OS were searched for apps containing the word psoriasis. RESULTS: Literature review: Only one RCT was included, reporting on psoriasis patients' Internet reporting their status of psoriasis over a 12-month period. The rate of adherence was measured by Medication Event Monitoring System (MEMS®). An improvement in medical adherence and reduction of severity of psoriasis were reported. General analysis of apps: A total 184 apps contained the word psoriasis. CONCLUSION: There is a critical need for high-quality RCTs testing if the ubiquitous eHealth technologies, for example, some of the numerous apps, can improve psoriasis patients' rates of adherence to topical antipsoriatics.

Generalized Correlation Coefficient for Non-Parametric Analysis of Microarray Time-Course Data.

Modeling complex time-course patterns is a challenging issue in microarray study due to complex gene expression patterns in response to the time-course experiment. We introduce the generalized correlation coefficient and propose a combinatory approach for detecting, testing and clustering the heterogeneous time-course gene expression patterns. Application of the method identified nonlinear time-course patterns in high agreement with parametric analysis. We conclude that the non-parametric nature in the generalized correlation analysis could be an useful and efficient tool for analyzing microarray time-course data and for exploring the complex relationships in the omics data for studying their association with disease and health.

Worldwide utilization of topical remedies in treatment of psoriasis: a systematic review.

OBJECTIVE: To review published literature describing the global use of topical antipsoriatics. MATERIALS AND METHODS: Search for English-language articles in Embase, Pubmed, PsycINFO and Cochrane Library. RESULTS: Fifty-four selected publications were found, describing psoriasis patients' use of topical antipsoriatics, using six different methods to collect data. The eight most frequently used topical treatments from the regions North/South America, North/Central/South Europe, Asia, Middle East and Australia were: corticosteroids used by 16-79%, complementary and alternative medicines used by 10-62%, phototherapies used by 0.4-75%, calcipotriol used by 4.2-73%, corticosteroid/calcipotriol combinations used by 3.3-71%, tar used by 0.8-66%, anthralin used by 15% and emollients used as monotherapy by 1-23%. Rates of patient-reported adherence to topical remedies ranged from 51% to 90% and rates of patient-reported satisfaction with topical as it pertains to symptom control ranged from 12% to 52%. CONCLUSION: The identified use patterns are varying and reflect a lack of data from large parts of the world and noncomparable studies using heterogeneous study designs. However, this study emphasizes the importance of medical professionals involvement of the patient with respect to choosing prescribed topical treatment and the possibility of patients' use of alternative treatments. More drug utilization studies, both survey and register based, from different parts of the world are needed to provide more conclusive evidence about patients' use of topical antipsoriatics.

Medical adherence to topical corticosteroid preparations prescribed for psoriasis: A systematic review.

OBJECTIVE: Topical corticosteroids and corticosteroid combinations are the principal treatments in psoriasis. The aim of this study was to investigate published literature dealing with medical adherence to topical corticosteroid or corticosteroid combinations in patients with psoriasis. MATERIALS AND METHODS: Systematic electronic searches in English language literature were done until September 2015 without publication date restriction. RESULTS: We identified 11 studies consisting of five surveys, two prospective studies, one qualitative study, one mixed-method study, one register study, and one interventional study. Observation periods varied and rates of nonadherence ranged from 8% to 88.3%. The rates were reported by patients on eight nonvalidated scales and one validated scale, measured by medication weight in two studies, and in two studies rates of nonadherence were measured using prescription registers. Thirty-four multifactorial determinants of nonadherence were found. One designed intervention consisted of a disease management program, which improved adherence in the study period. Overall, the studies included were heterogeneous in design and had a high risk of bias. CONCLUSION: To improve health outcome in topical treatment of psoriasis, further studies should be conducted addressing determinants of nonadherence and test interventions to improve adherence. Validated measurements of medical nonadherence, prescription registers, or medication-weight are needed.

Proposed ICDRG Classification of the Clinical Presentation of Contact Allergy.

The International Contact Dermatitis Research Group proposes a classification for the clinical presentation of contact allergy. The classification is based primarily on the mode of clinical presentation. The categories are direct exposure/contact dermatitis, mimicking or exacerbation of preexisting eczema, multifactorial dermatitis including allergic contact dermatitis, by proxy, mimicking angioedema, airborne contact dermatitis, photo-induced contact dermatitis, systemic contact dermatitis, noneczematous contact dermatitis, contact urticaria, protein contact dermatitis, respiratory/mucosal symptoms, oral contact dermatitis, erythroderma/exfoliative dermatitis, minor forms of presentation, and extracutaneous manifestations.

Low patch test reactivity to nickel in unselected adolescents tested repeatedly with nickel in infancy.

BACKGROUND: It is questionable how repeated patch tests with nickel sulfate in infancy affect nickel patch test reactivity at a later age. METHODS: The Danish Allergy Research Center (DARC) cohort encompasses 562 infants invited to a clinical examination including patch tests with nickel sulfate six times during the first 36 months of life. At the follow-up investigation at 14 years of age (2013-2014), participants were offered re-patch tests with nickel sulfate. The Odense Adolescence Cohort Study TOACS cohort encompasses 1501 schoolchildren evaluated for the first time at 14 years of age (1995-1996) including clinical examination and nickel sulfate patch tests. The prevalence of nickel sensitization in the DARC cohort was compared to the prevalence in the TOACS cohort at 14 years of age. RESULTS: Nickel sulfate sensitization was found in 1.2% of the participants from the DARC cohort tested repeatedly with nickel sulfate in early childhood and retested at 14 years of age compared to 8.6% of the participants from the TOACS cohort patch-tested for the first time at 14 years of age using the same patch test system and test concentration. CONCLUSION: The significant difference in nickel patch test reactivity comparing the two cohorts may reflect an immunologic effect or the effect of nickel regulation.