Tips, Trends, and Truths: A Study of Psoriasis Treatment Content on TikTok.

INTRODUCTION: With more than two billion downloads since its launch, TikTok is the fastest-growing video-sharing platform in the world. Many people turn to TikTok for dermatologic medical information. However, there is limited data about psoriasis and psoriasis treatment content on this social media platform. OBJECTIVE: To compare the viewer engagement, content quality, and viewer experience of psoriasis treatment TikTok videos between physicians and non-physicians. METHODS: We searched the terms "psoriasis" and "psoriasis treatment" on TikTok. Video characteristics were collected. Content quality was evaluated using DISCERN. Viewer experience was assessed using the AVA. RESULTS: Viewer engagement did not significantly differ between physicians and non-physician content creators (0.033 plus/minus 0.005 vs 0.047 plus/minus 0.001, P=0.066). Compared to non-physicians, physicians created videos of higher quality (DISCERN: 1.76 plus/minus 0.058 vs 1.44 plus/minus 0.032, P<0.001) and of greater viewer experience (AVA: 2.55 plus/minus 0.183 vs 1.96 plus/minus 0.081, P=0.001). However, there is room for improvement in terms of creating videos of higher quality by both physicians and non-physicians. CONCLUSION: TikTok can be a powerful tool to promote health literacy and dispel misinformation. Dermatologists may consider focusing their efforts on creating comprehensive educational content and incorporating trending features to reach a wider audience. J Drugs Dermatol. 2024;23(2): doi:10.36849/JDD.7050e.

Consensus Statements on the Use of Corticosteroid-Containing Topical Medications in Psoriasis.

This article aims to provide consensus statements on the use of corticosteroid-containing topical medications for the management of psoriasis. This Psoriasis Expert Group (PEG) includes dermatologist voting members with expertise in psoriasis who convened and evaluated the use of topical medications and previously published guidelines. A modified Delphi process was conducted to reach consensus results. Two rounds of voting were conducted for each topic and panel consensus was determined.  Nine statements were developed regarding topical medication efficacy, patient quality of life, frequency of application, medication "feel", and safety and tolerability. Dermatologist experts voted on the statements separately. Patients were not polled. All items received agreement: 15 with high consensus and 1 with moderate consensus.  For the treatment of psoriasis, the PEG agreed that patients and physicians prefer topical medications that are effective, provide long-lasting results, have a quick onset of action, and "feel good on the skin" with few adverse effects. The developed consensus statements provide guidance on the topical treatment of psoriasis, including combination therapies, such as a vitamin D and topical corticosteroid analog. These recommendations will be continuously reviewed and updated as more evidence continues to emerge.  April W. Armstrong AW, Reddy R, Khan S, et al. Consensus statements on the use of corticosteroid-containing topical medications in psoriasis. J Drugs Dermatol. 2023;22(8):736-741. doi:10.36849/JDD.7453.

INDIVIDUAL ARTICLE: Fixed Combination Calcipotriene/Betamethasone (Cal/BDP) Cream: Evaluating the Role of Polyaphron Dispersion (PAD) Technology in Psoriasis Treatment.

Most patients with plaque psoriasis exhibit mild-to-moderate disease and topical therapies remain the mainstay treatment option for these patients. The use of topical steroids in combination with vitamin D analogs can produce synergistic effects and minimize adverse effects. However, due to the incompatible pH ranges of topical steroids and vitamin D analogs, combination formulations can be difficult to manufacture. Until recently, only anhydrous formulations of these 2 agents were developed as foam, gel/suspension, and ointment. However, anhydrous vehicles can often result in greasy or oily skin, thus limiting treatment adherence. Recently, Polyaphron Dispersion (PAD) technology presents a new, more cosmetically appealing vehicle that allows for both topical steroids and vitamin D analogs to coexist in an aqueous environment, such as a cream formulation. The calcipotriene/betamethasone dipropionate (CAL/BDP) cream enhances drug delivery by reducing the greasy and oily side effects of anhydrous formulations. Phase 3 clinical trials have demonstrated CAL/BDP cream’s superior efficacy in treating psoriasis over gel/suspension, and the clinical trials have also shown significantly improved patient satisfaction with the cream formulation.   .

No Racial Differences Found in Access to Biologics: A Population-Based Study of Psoriasis Patients in the United States.

BACKGROUND: Conflicting evidence exists regarding the role of race in access to biologics for patients with psoriasis. OBJECTIVE: To compare biologic use among adult and pediatric United States psoriasis patients of different racial backgrounds. METHODS: Population-based study of US psoriasis patients using the 2003 to 2018 Medical Expenditure Panel Survey (MEPS). RESULTS: Among 31,525,500 adults and children with psoriasis (weighted), 3,026,578 (9.6%) were on biologics. Among psoriasis patients, 27,464,864 (87.1%) self-identified as white, 2,033,802 (6.5%) self-identified as Black, 1,173,435 (3.7%) self-identified as Asian or Pacific Islander, and 853,399 (2.7%) self-identified as other races. Among those on biologics, 2,778,239 (91.8%) self-identified as white, 84,971 (2.8%) identified as Black, 89,452 (3.0%) self-identified as Asian or Pacific Islander, and 73,917 (2.4%) self-identified as other races. Multivariate logistic regression revealed no significant differences in biologic access between whites and non-whites after adjusting for sociodemographic factors including insurance status (OR for Blacks: 0.347 [0.118, 1.021], P=0.055; OR for Asians: 0.616 [0.240, 1.579], P=0.311; OR for other races: 0.850 [0.216, 3.336], P=0.814. CONCLUSION: The results of this study suggest that race alone is not independently associated with access to biologics among adult US psoriasis patients. Additional studies are necessary to evaluate factors independently associated with biologics access among adults and children with psoriasis in the US. J Drugs Dermatol. 2023;22(8):835-837. doi:10.36849/JDD.7134 Reddy R, Khan S, Yee D, et al. No racial differences found in access to biologics: a population-based study of psoriasis patients in the United States. .

Differences in accessing dermatology offices, primary care offices, and emergency departments between Hispanics and Non-Hispanic White Patients.

How Hispanic patients access dermatologic care for skin diseases is unknown. This study aims to determine if differences exist in accessing the emergency department (ED), primary care, and outpatient dermatologic offices for skin diseases between Hispanic and non-Hispanic White patients. This cross-sectional study used nationally representative data from the Medical Panel Expenditure Survey (MEPS) from 2016-2019. A total of 109,337,668 (weighted) patients with any skin disease diagnosed at an ED, primary care, or dermatology visit were identified. Hispanics comprised 13.0% and non-Hispanic Whites comprised 68.8% of this subpopulation. Overall, 94.1% of Hispanic patients attended a primary care visit for their skin complaint, 5.8% saw a dermatologist, and 0.1% attended an ED visit. Compared to non-Hispanic Whites, Hispanics were more likely to attend a primary care visit (aOR 1.865; 95%CI, 1.640-2.122) and less likely to attend an outpatient dermatology visit (aOR 0.536; 95%CI, 0.471-0.610), after adjusting for insurance status, education, income, sex, age, and comorbidities. Our study suggests that, compared to non-Hispanic Whites, Hispanic patients access primary care more frequently and outpatient dermatologic offices less frequently for their skin conditions. Language barriers, less familiarity with the healthcare system, and lack of adequate health insurance may play roles in this observation.

Evaluating Sentiment, Engagement, and Perception of Biologics Among Patients with Psoriasis and Psoriatic Arthritis on Reddit.

BACKGROUND: Limited analyses of social media content among psoriasis (PsO) and psoriatic arthritis (PsA) patients exist. These patients may turn to social media to gain insight into treatments such as biologics. OBJECTIVES: This study aims to analyze the content, sentiment, and engagement of social media posts regarding biologics for PsO and PsA. METHODS: Posts and comments discussing biologics were extracted from publicly accessible PsO and PsA Reddit groups. Posts were assigned higher (HOT) and lower order (LOT) themes, sentiments, and engagement scores. RESULTS: Of 1141 posts extracted, 705 posts were classified under the HOT general/efficacy. Twelve lower order themes (LOTs) were identified: general advice/experience (10.2%), symptoms improved (36.6%), switching biologics (10.5%), and time to results (13.4%). 61.3% of content was of positive sentiment, 24.0% was neutral, and 14.7% was of negative sentiment. The mean sentiment score, defined as the average of all posts' sentiment scores (where negative=-1, neutral=0, and positive=1), was overall positive at 0.47, 95% CI [.41-.52]. Mean sentiment scores between LOTs were significantly different (P<0.001). Information regarding biologics on Reddit is mostly positive; however, there remains a significant number of users expressing dissatisfaction with their efficacy or with biologics in general. Many users sought anecdotal advice. CONCLUSION: These findings can help guide educational efforts to anticipate concerns and appease hesitancy regarding biologics and their efficacy. J Drugs Dermatol. 2023;22(3):306-309. doi:10.36849/JDD.7124.

Biologics to breast milk: A cross-sectional study of popular eczema treatment content on TikTok.

We conducted a cross-sectional study to compare viewer engagement, content quality and viewer experience of eczema related medical content on TikTok between health care professionals and non-health care professionals. Compared to non-health care professionals, health care professionals created videos of higher quality and superior viewing experience. Viewer engagement did not differ significantly between videos made by health care professionals and non-health care professionals. Overall, content creators should focus on producing comprehensive, evidence-based videos.

"I'm Off My Meds": Public Perception of Interactions Between SARS-CoV-2 Vaccines and Anti-Psoriatic Treatments Online.

IMPORTANCE: Psoriasis patients may seek information about the SARS-CoV-2 vaccine and their diagnosis from social media platforms. Analyses of social media interactions may help guide dermatologists’ educational efforts during this pandemic. OBJECTIVES: This study analyzed the content and sentiment of online social media posts about the medication interaction between SARS-CoV-2 vaccines and anti-psoriatic therapies among psoriasis patients. DESIGN: Publicly accessible Facebook and Reddit groups regarding psoriasis and psoriatic arthritis were identified. Posts uploaded between March 1, 2021, and July 31, 2021, with information about the SARS-CoV-2 vaccine and psoriasis and psoriatic arthritis, were extracted. Themes, sentiment scores, and engagement scores were assigned to each post. RESULTS: 477 posts contained content pertaining to the vaccine and psoriatic medications. 19 (4%) of the posts contain negative sentiment, 232 (48.6%) contain neutral sentiment, and 226 (47.4%) contain positive sentiment. Several themes emerged from this study. A majority of posts (32.5%) contained concerns about holding or stopping medications prior to obtaining the vaccine. Other common concerns included fear of negative reaction (21.8%) and uncertainty about the ability to generate an efficient immune response to the vaccine while on anti-psoriatic medications (19.9%). CONCLUSIONS AND RELEVANCE: Concerns identified by our content analysis should be incorporated into education efforts to address the reasons for vaccine hesitancy among patients with psoriatic diseases. These patient concerns can also help guide our strategy for implementing evidence-based recommendations on COVID-19 vaccination. J Drugs Dermatol. 2022;21(8):901-905. doi:10.36849/JDD.6853.

2021 GRAPPA Meet the Experts Session: A Summary of Presentations.

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis hosted a Meet the Experts session at its 2021 virtual meeting. Dermatology and rheumatology experts held 5 sessions that broadly centered on psoriasis and psoriatic arthritis.

2021 GRAPPA Trainee Symposium: A Summary of Oral and Poster Presentations.

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) held a trainee symposium at its 2021 virtual meeting. Dermatology and rheumatology trainees presented their work on psoriasis and psoriatic arthritis (PsA). This report briefly reviews 5 oral presentations: prediction of cardiovascular events in psoriatic disease (PsD), correlation between spine abnormalities and clinical findings, biomechanical stress as a trigger for PsA, differences in DNA methylation among twins with PsD, and critical proteins associated with induction of PsD. In addition, we highlight 22 posters broadly discussing clinical and molecular implications of PsD.

SUPPLEMENT ARTICLE: A Novel Drug Delivery Method: Retrometabolic Drug Design.

Soft drugs, a class of retrometabolic drug design, contain a metabolically sensitive moiety that promotes rapid metabolism to inactive metabolites after exerting activity at its target site. The goal of soft drugs is to reduce systemic toxicity while enhancing local efficacy. Soft drugs have been approved for use in multiple medical specialties, such as the soft corticosteroid loteprednol etabonate for treatment of inflammatory ophthalmic disorders and soft beta-blocker derivatives for treatment of hypertensive emergencies in cardiology. Soft drugs have also found widespread use in the field of dermatology. In the setting of topical drug administration, soft drugs minimize the risk of systemic drug absorption and unwanted side effects. Soft janus kinase caspase 1 (JAK) inhibitors, soft transient receptor potential vanilloid (TRPV1), and soft estrogens among others have been explored as therapeutic options for a variety of inflammatory and autoimmune dermatologic conditions. The soft anticholinergic sofpironium bromide represents the latest expansion of soft drug use in dermatology for the treatment of primary axillary hyperhidrosis (PAH). A derivative of glycopyrronium, sofpironium bromide consists of a chemically modified structure that allows the drug to undergo rapid hydrolytic deactivation, and thus minimize the significant side effects associated with traditional anticholinergic drugs. Sofpironium bromide has demonstrated efficacy and safety for treatment of PAH in Phase II and Phase III clinical trials in Japan and the United States. Given the promising results from these studies, sofpironium bromide, in addition to other soft drugs under investigation, highlights the growing utility of retrometabolic drug design in dermatology. J Drugs Dermatol. 2022;21:4(Suppl 2):s5-10.

Public Perception of SARS-CoV-2 Vaccines Among Psoriasis Patients in Social Media: Content, Sentiment, and Engagement Analysis.

Background: Psoriasis patients may seek information about the SARS-CoV-2 vaccine and their disease from social media platforms. Analyses of social media interactions may help guide dermatologists' educational efforts during this pandemic. Objectives: This study analyzes social media interactions among patients with psoriasis and psoriatic arthritis regarding the SARS-CoV-2 vaccine to determine the misinformation circulating and the apprehension to receiving the vaccine. Methods: Publicly accessible Facebook and Reddit groups regarding psoriasis and psoriatic arthritis were identified. Posts uploaded between March 1, 2021 and July 31, 2021 which contained information about the SARS-CoV-2 vaccine were extracted. First-order themes, sub-themes, sentiment scores and engagement scores were assigned to each post. Results: 345 posts within the first-order theme of vaccination decision and 1379 posts within the first-order theme of vaccine reaction were analyzed. Within vaccination decision, common sub-themes for refusing the vaccine include fear of psoriasis flare up, vaccine is experimental, vaccine is unnecessary, vaccine is dangerous, and concern for reaction/vaccine efficacy while on psoriasis medications. 41.4% of posts contained positive sentiment; whereas, 38.3% contained negative sentiment. Within vaccine reaction, common sub-themes identified were no change to psoriasis, skin/joint flare up, skin flare up attributed specifically to stopping psoriasis medications, skin/joint improvement, and skin flare up but vaccine was worth it. 77.8% of posts contained positive sentiment; whereas, 6.2% contained negative sentiment. Conclusions: Our study identified common SARS-CoV-2 vaccine concerns within the psoriasis community which should be used to guide educational efforts.

Stress testing reveals gaps in clinic readiness of image-based diagnostic artificial intelligence models.

Artificial intelligence models match or exceed dermatologists in melanoma image classification. Less is known about their robustness against real-world variations, and clinicians may incorrectly assume that a model with an acceptable area under the receiver operating characteristic curve or related performance metric is ready for clinical use. Here, we systematically assessed the performance of dermatologist-level convolutional neural networks (CNNs) on real-world non-curated images by applying computational "stress tests". Our goal was to create a proxy environment in which to comprehensively test the generalizability of off-the-shelf CNNs developed without training or evaluation protocols specific to individual clinics. We found inconsistent predictions on images captured repeatedly in the same setting or subjected to simple transformations (e.g., rotation). Such transformations resulted in false positive or negative predictions for 6.5-22% of skin lesions across test datasets. Our findings indicate that models meeting conventionally reported metrics need further validation with computational stress tests to assess clinic readiness.

Tandem repeated irritation test (TRIT) studies and clinical relevance: Post 2006.

Background/Aims: Single or multiple applications of irritants can lead to occupational contact dermatitis, and most commonly irritant contact dermatitis (ICD). Tandem irritation, the sequential application of two irritants to a target skin area, has been studied using the Tandem Repeated Irritation Test (TRIT) to provide a more accurate representation of skin irritation. Objective: Here we present an update to Kartono's review on tandem irritation studies since 2006. Methods: We surveyed the literature available on PubMed, Embase, Google Scholar, and the UCSF Dermatology library databases since 2006. Results and discussion: The studies included discuss the tandem effects of common chemical irritants, organic solvents, occlusion as well as clinical relevance - and enlarge our ability to discern whether multiple chemical exposures are more or less likely to enhance irritation.

Sebo-pharmacokinetics: a proposed percutaneous sebum egression method.

BACKGROUND/AIMS: The sebaceous gland is widely believed a critical factor in the pathogenesis of acne vulgaris. Although extensive studies document the ability of oral and topical treatments to improve acne, little is known about the quantification and mechanism of drug delivery via the sebaceous gland. A percutaneous egression method presents a way to study how drugs reaching the bloodstream can enter the skin. METHODS: A literature search was performed across databases (PubMed, Embase, and Google Scholar) and the University of California, San Francisco (UCSF) textbook library with relevant search terms. RESULTS: This search failed to reveal data on sebo-pharmacokinetics (PK); however, many articles center on pharmacodynamics (PD) - i.e. functional improvement instigated by oral or topical treatments. Experiments on humans and hamsters - representative sebaceous gland models - demonstrate indirect PD measures of sebaceous gland function. DISCUSSION: Here, we summarize the current available data on drug delivery via the sebaceous gland and suggest a practical method to directly document sebo-PK in man and animal.