Improvement of self-administration experience with a new injection device: Real-life experience with risankizumab in patients with psoriasis.

BACKGROUND: Trypanophobia or "needle phobia" represents a potential hindrance to the effective management of chronic diseases whenever an injectable therapy might be required, especially in case of frequent administrations. Psoriasis, a chronic dermatologic disease, can be effectively treated with biologic drugs administered subcutaneously. Thankfully, anti-IL-23 drugs require few administrations per year and are available in prefilled pens that hide the needle, thus representing a convenient option in patients with trypanophobia. METHODS: An observational multicentric study was conducted on patients with moderate-to-severe psoriasis who were treated with 75 mg × 2 risankizumab prefilled syringe therapy for more than 6 months and reported a loss of efficacy measured by the Psoriasis Area and Severity Index (PASI) from PASI 90 to PASI 75 attributed to a reduction of adherence due to trypanophobia. The patients were switched to 1 prefilled pen of risankizumab 150 mg and asked to fill out the Self-Injection Assessment Questionnaire (SIAQ) before and after the injection at week 0 and at the following administration after 12 weeks. Subjects scored each item of the SIAQ on a 5-point scale, scores were later transformed from 0 (worst experience) to 10 (best experience). RESULTS: Twenty-two patients were enrolled. The mean SIAQ predose domain scores were 5.5 for feelings about injection, 6.2 for self-confidence, and 6.4 for satisfaction with self-injection. After dose scores were higher (> 8.5) for each of the six domains at Week 0 and even higher after 12 weeks (> 9.0). CONCLUSIONS: User-friendly devices, such as prefilled pens, and a lower number of injections improved patient satisfaction in a group of patients with psoriasis on treatment with biologic drugs. We believe that treatment adherence could be positively influenced by such changes in the way of administration of a biologic treatment.

Assessing the Beneficial Impact of a Patient Support Program in Secukinumab-Treated Patients with Psoriasis in Italy.

PURPOSE: For patients with psoriasis, treatment adherence and persistence are fundamental if therapeutic goals are to be met. Patient Support Programs (PSPs) may be used as a support tool to assist patients and health care professionals optimize treatment and improve disease management. PATIENTS AND METHODS: In Italy, the PSP PSOLife CARE, which began on the 9th of February 2017 and is ongoing, aimed to support patients with psoriasis under therapy with secukinumab (Cosentyx®). A team of medical professionals including Dermatologists, Psychologists, Nutritionists, and field Nurses provided outpatient treatment as well as remote support via phone calls. Patients had a standard duration in the Program of 6 months. This report analyzes the data of patients who benefited from the Program from February 2017 to August 2020, for a total observation of 42 months. RESULTS: We provide here a descriptive report on the benefits of participation in the PSOLife CARE Program for patients with psoriasis and medical professionals involved in their care. Throughout their time in the PSOLife CARE Program, patient satisfaction remained consistently high with sustained improvements observed in all aspects of quality of life (ie emotional, social, physical, and economic). Despite exiting from the Program, most patients continued to adhere to secukinumab. Medical professionals also reported positive outcomes on their interactions with patients, with more than half of those surveyed rating the overall quality of the Program as "Outstanding". CONCLUSION: By supporting treatment adherence, the PSOLife CARE Program may have empowered patients to better manage their psoriasis, increasing their satisfaction with treatment and quality of life.

Measurement of a possible patch-testing outcome indicator.

BACKGROUND: Clinical performance measurements often employ outcome indicators to express the extent to which health services achieve a given clinical result. OBJECTIVE: The objective of our study was to develop an outcome indicator of patch testing. We identified and measured as a possible indicator the ratio of patients with allergic and/or photo-allergic contact dermatitis clinically cured/improved as a result of identification of relevant allergens. PATIENTS/METHODS: Patients with positive reactions considered relevant to their current dermatitis were interviewed by telephone 2 months after patch/photo-patch testing in order to assess their clinical outcome in relation to the recommended elimination of supposedly relevant allergens. RESULTS: Over a 4-year period positive reactions were seen in 1397 out of 2857 tested patients. Relevance was considered current in 578 subjects, and 506 of them were interviewed. Remission/significant improvement following allergen(s) contact avoidance was reported by 431 patients, the outcome indicator (431/506) thus scoring 85.2%. Among the 75 patients who reported no improvement, 41 had not avoided contact with the offending substance(s), 17 had other persistent concomitant skin conditions, and 17 were unchanged despite elimination of the alleged relevant allergens. CONCLUSIONS: The ratio of relevantly patch-test-positive patients resolved/improved after allergen avoidance is a useful patch-testing outcome indicator.

Squamomelanocytic tumor: a new case of a unique biphenotypic neoplasm of uncertain biological potential.

Squamomelanocytic tumor is an uncommon cutaneous neoplasm composed of an admixture of melanocytic and squamous cellular phenotypes. We describe a case of this tumor in a 94-year-old man who presented with a nodule on the back. Histologically, a well-demarcated expansive dermal nodule was composed of anastomosing epithelial strands with focal formation of squamous pearls and ductal structures commixed with elongated spindle cells with clear cytoplasm grouped in nests. The two cell types were diffusely admixed or clustered in groups within the nodule. Immunohistochemical studies showed that the spindle cells grouped in nests expressed S-100 and HMB-45 antigens, and the squamoid cells expressed cytokeratins and carcinoembrionic antigen (CEA) protein only in the inner layer of the ducts and the cystic space. Atypical features and high mitotic activity was observed in the melanocytic cells but slight atypia, mild dyskeratosis and mitotic figures were observed also in the squamoid component. This tumor represents a proliferation of two phenotypic cells that are distinctive for their intimate admixture and singular immunohistochemical profile. The authors discuss the histogenesis of this tumor, suggesting that it could represent an atypical solid-cystic hidradenoma colonized by a melanocytic malignant component. The biological behavior of this neoplasm remains currently uncertain.

Distinguishing androgenetic alopecia from chronic telogen effluvium when associated in the same patient: a simple noninvasive method.

BACKGROUND: Distinguishing chronic telogen effluvium (CTE) from androgenetic alopecia (AGA) may be difficult especially when associated in the same patient. OBSERVATIONS: One hundred consecutive patients with hair loss who were clinically diagnosed as having CTE, AGA, AGA + CTE, or remitting CTE. Patients washed their hair in the sink in a standardized way. All shed hairs were counted and divided "blindly" into 5 cm or longer, intermediate length (>3 to <5 cm), and 3 cm or shorter. The latter were considered telogen vellus hairs, and patients having at least 10% of them were classified as having AGA. We assumed that patients shedding 200 hairs or more had CTE. The kappa statistic revealed, however, that the best concordance between clinical and numerical diagnosis (kappa = 0.527) was obtained by setting the cutoff shedding value at 100 hairs or more. Of the 100 patients, 18 with 10% or more of hairs that were 3 cm or shorter and who shed fewer than 100 hairs were diagnosed as having AGA; 34 with fewer than 10% of hairs that were 3 cm or shorter and who shed at least 100 hairs were diagnosed as having CTE; 34 with 10% or more of hairs that were 3 cm or shorter and who shed at least 100 hairs were diagnosed as having AGA + CTE; and 14 with fewer than 10% of hairs that were 3 cm or shorter and who shed fewer than 100 hairs were diagnosed as having CTE in remission. CONCLUSION: This method is simple, noninvasive, and suitable for office evaluation.