[Psoriasis in dupilumab-treated atopic dermatitis]. / Psoriasis bei Dupilumab-behandeltem atopischem Ekzem.

Dupilumab is a monoclonal antibody that binds to the common alpha chain of the IL­4 and IL-13 receptor and blocks the Th2 signaling pathway, which plays a key role in the development of atopic dermatitis. We report on the case of a 40-year-old man, who developed histologically confirmed psoriasis after 6 weeks of dupilumab therapy. The arbitrary, abrupt stopping of the unusual, not guideline-based oral steroid therapy, together with the blockade of the Th2 signaling pathway by dupilumab were apparently the relevant trigger factors for the newly developed psoriasis in our patient.

A systematic review of factors influencing treatment adherence in chronic inflammatory skin disease - strategies for optimizing treatment outcome.

Adherence describes how a patient follows a medical regime recommended by a healthcare provider. Poor treatment adherence represents a complex and challenging problem of international healthcare systems, as it has a substantial impact on clinical outcomes and patient safety and constitutes an important financial burden. Since it is one of the most common causes of treatment failure, it is extremely important for physicians to reliably distinguish between non-adherence and non-response. This systematic review aims to summarize the current literature on treatment adherence in dermatology, focusing on chronic inflammatory skin diseases such as psoriasis, atopic dermatitis and acne. A systematic literature search was performed using the PubMed Database, including articles from 2008 to 2018. Low treatment adherence is a multidimensional phenomenon defined by the interplay of numerous factors and should under no circumstances be considered as the patient's fault alone. Factors influencing treatment adherence in dermatology include patient characteristics and beliefs, treatment efficacy and duration, administration routes, disease chronicity and the disease itself. Moreover, the quality of the physician-patient relationship including physician-time available for the patient plays an important role. Understanding patients' adherence patterns and the main drivers of non-adherence creates opportunities to improve adherence in the future. Strategies to increase treatment adherence range from reminder programs to simplifying prescriptions or educational interventions. Absolute adherence to treatment may not be realistically achievable, but efforts need to be made to raise awareness in order to maximize adherence as far as possible.

Survey: statewide family support programs.

Results of a survey of 23 state conducted family support programs are presented. Sixteen programs are legislatively mandated and the majority have a similar purpose: reduction of out-of-home placements. However, great variability exists on eligibility criteria, methods of program administration, amount of support, and types of services provided. Program evaluation data are reviewed indicating that cost-benefits, decreased rates of out-of-home placement, and effects on family enhancement are primary concerns of these programs. Implications for future program development based upon normalization philosophy and stress/coping theories are presented.

Misattribution in a fearful situation following different modes of arousal.

52 female college students were exposed to procedures expected to produce some physical or emotional arousal (viewing a sexually-explicit film or riding an exercise bicycle) and were subsequently asked to approach a snake, of which they had previously reported being afraid. Their performance was compared to that of control subjects who had been exposed to non-arousing tasks (viewing a film about sunspots or reading an article about exercise). The prediction that prior arousal would produce misattribution and reduce snake avoidance was not supported.