Patient-Reported Outcome Measures in Atopic Dermatitis and Chronic Urticaria Are Underused in Clinical Practice.

BACKGROUND: Patient-reported outcome measures (PROMs) are validated and standardized tools that complement physician evaluations and guide treatment decisions. They are crucial for monitoring atopic dermatitis (AD) and chronic urticaria (CU) in clinical practice, but there are unmet needs and knowledge gaps regarding their use in clinical practice. OBJECCTIVE: We investigated the global real-world use of AD and CU PROMs in allergology and dermatology clinics as well as their associated local and regional networks. METHODS: Across 72 specialized allergy and dermatology centers and their local and regional networks, 2,534 physicians in 73 countries completed a 53-item questionnaire on the use of PROMs for AD and CU. RESULTS: Of 2,534 physicians, 1,308 were aware of PROMs. Of these, 14% and 15% used PROMs for AD and CU, respectively. Half of physicians who use PROMs do so only rarely or sometimes. Use of AD and CU PROM is associated with being female, younger, and a dermatologist. The Patient-Oriented Scoring Atopic Dermatitis Index and Urticaria Activity Score were the most common PROMs for AD and CU, respectively. Monitoring disease control and activity are the main drivers of the use of PROMs. Time constraints were the primary obstacle to using PROMs, followed by the impression that patients dislike PROMs. Users of AD and CU PROM would like training in selecting the proper PROM. CONCLUSIONS: Although PROMs offer several benefits, their use in routine practice is suboptimal, and physicians perceive barriers to their use. It is essential to attain higher levels of PROM implementation in accordance with national and international standards.

Clinical Features and Outcomes of Acute versus Chronic Urticaria Triggered by COVID-19 Infection.

OBJECTIVE: Although acute urticaria (AU) and urticaria-like rash are commonly reported with COVID-19 infection, chronic spontaneous urticaria (CSU) triggered by COVID-19 is rare. The authors compared the features of COVID-19 infection-induced chronic CSU and AU to determine which patients' COVID-19 infection leads to CSU and possible indicators of chronicity. METHODS: The authors retrieved the charts of patients diagnosed with AU or CSU following COVID-19 at the Urticaria Centers of Reference and Excellence and compared patients in terms of demographic characteristics, length of time between infection and onset of urticaria, duration of urticaria, COVID-19 disease severity, laboratory test results, vaccination, and treatment status. RESULTS: A total of 92 patients were included in the study: 7 with CSU following COVID-19 and 85 with AU after COVID-19. The mean duration of urticaria for CSU and AU following COVID-19 was 13.0 ± 6.0 months and 7.1 ± 3.4 days, respectively. The average time between COVID-19 and the start of urticaria was longer in the CSU group (20.7 ± 3.9 days vs 4.5 ± 2.8 days, respectively; P = .000). No between-group differences were found for any other parameters. CONCLUSIONS: The onset of urticaria more than 2 weeks after COVID-19 infection may serve as an indicator for urticaria chronicity beyond 6 weeks and may help physicians predict the possible course of urticaria associated with COVID-19 infection. The relevance of basopenia and eosinopenia needs to be determined.

Assessment of Venous Blood Leukocyte Profiles and Immunoglobulin E Levels in Atopic Dermatitis Patients.

BACKGROUND: There are differing results in the literature regarding the relationship between atopic dermatitis (AD) and peripheral blood leukocyte profiles. OBJECTIVE: The aim of the study was to investigate the relationship between AD, blood immune cell profiles, and disease severity. METHODS: One hundred AD patients aged 1 month to 18 years without any history of infection or systemic disease were enrolled as the study group. Serum concentration levels of total immunoglobulin E, calculated blood leukocyte profiles, and AD index severity scoring were calculated for statistical comparison. RESULTS: The differences between the groups for neutrophil-lymphocyte ratio and eosinophil-lymphocyte ratio were statistically different. However, there was no statistically significant correlation between the investigated parameters and AD index severity scoring. CONCLUSIONS: Although significant differences were found in some of the parameters between the groups, unfortunately, the lack of correlation between the parameters investigated and the disease severity index restricts their use in clinical practice.

Validation of the Turkish version of the Urticaria Control Test: Correlation with other tools and comparison between spontaneous and inducible chronic urticaria.

BACKGROUND: The urticaria control test (UCT) is a questionnaire designed to determine if chronic urticaria (CU) is controlled or not and to aid therapeutic decision-making. It collects retrospective information about the symptoms and quality of life impairment over the last 4 weeks. The current study aimed to investigate the validity, reliability and sensitivity to change of the Turkish version of the UCT. We also evaluated its correlation with other tools and compared the UCT results of patients with chronic spontaneous urticaria (CSU) and patients with chronic inducible urticaria (CINDU). METHODS: Following forward/backward translation and cognitive debriefing, the Turkish version of the UCT was used in 81 CSU and 78 CINDU patients. Dermatology life quality index (DLQI), Chronic urticaria quality of life questionnaire (CU-Q2oL), urticaria activity score (UAS), patients' and physicians' global assessment visual analog scores and Likert scales were used at baseline and after four weeks to assess quality of life impairment, disease activity and disease control. Statistical analysis to determine the validity and reliability of the Turkish version of the UCT as well as comparison between CINDU and CSU patients were performed. RESULTS: Duration of disease was longer, disease control was poorer and severe complaints were more frequent in CINDU patients (duration of disease: 36.3 (24) ± 49.1 vs 31.5 (9) ± 67.9, p = .007, UCT baseline: 8.4 (8) ± 3.4 vs 10.4 (11) ± 3.9, p = .001 and patient's global assessment Likert scale severe complaints: 6 vs 15, p < .001, respectively). The UCT showed excellent internal consistency for CSU and a minimally acceptable consistency for CINDU (Cronbach's α 0.89 for CSU versus 0.68 for CINDU). It showed strong correlation with CU-Q2oL but a moderate correlation with DLQI (r = -0.649, P < .001 and r = -0.545, P < .001, respectively). It was able to discriminate between patients with different disease control and was sensitive to detect changes in the disease control in both groups. The minimally important difference of the UCT was found to be 3. CONCLUSIONS: The Turkish version of the UCT is a valid and reliable tool for the management of CU patients and can be used both in CSU and CINDU patients to determine if the treatment is sufficient and if disease activity and quality of life impairment are under control or not.

Various simultaneous nail changes due to valproic acid use.

There are only a few case reports about nail changes due to valproic acid in the literature despite its widespread use. We present a 50-year-old man who had onycholysis, roughness of the nail surface and brownish-yellow discoloration of both fingernails and toenails, which remarkably ameliorated upon cessation of valproic acid.

Single-center experience with potassium titanyl phosphate (KTP) laser for superficial cutaneous vascular lesions in face.

BACKGROUND AND OBJECTIVES: Superficial cutaneous vascular lesions (SCVLs) are quite common. Several types of lasers have been used to treat these lesions; however, there are no dedicated treatment guidelines and few studies in the literature addressed their treatment. AIMS: In this paper, we aimed to report our clinical experience with potassium titanyl phosphate (KTP) laser treatment on different types of facial SCVLs including telangiectasia, spider angioma, and erythema. METHODS: Data were retrospectively collected from 146 patients with SCVLs, who had been treated with the 532-nm wavelength laser at our outpatient dermatology clinic. Treatment responses were graded as four groups: clearance (> 75% improvement compared with the previous session), marked improvement (50-75%), partial improvement (25-50%), and no response (< 25%). RESULTS: The rate of clearance plus marked improvement (favorable outcome) was 66.1% for telangiectasia group, 93.5% for spider angioma group, and 26.7% for erythema group. Mean number of treatments was 2.9 ± 1.4 for telangiectasia group, 1.4 ± 0.8 for spider angioma group, and 2.9 ± 1.7 for facial erythema group. Only minimal adverse effects related to treatment procedure were detected in 5 out of 146 (3.4%) patients. CONCLUSIONS: Our results demonstrated that KTP laser might be a safe and effective laser modality for SCVLs, which may be associated with physiological problems due to cosmetic concerns.