Out-of-Pocket Costs in Alopecia Areata: A Cross-Sectional Study in German-speaking Countries.

Alopecia areata is a common skin disease which is associated with psychosocial and financial burden. No curative therapy exists and, hence, affected persons resort to self-financed cosmetic solutions. However, studies on the economic impact of alopecia areata on individuals are limited. To estimate annual individual out-of-pocket costs in persons with alopecia areata, a cross-sectional study using a standardized online questionnaire was performed in Germany, Austria and Switzerland. A total of 346 individuals (95.1% women, mean age: 38.5 ± 11.6 years) with alopecia areata participated between April and August 2020. Mean additional spending on everyday necessities was 1,248€ per person per year, which was significantly influenced by the duration of the illness, the treatment provider, and disease severity. Hair replacement products and cosmetics accounted for the highest monthly costs, followed by costs for physician visits, hospital treatments, and medication. Most participants (n = 255, 73.7%) were currently not undergoing treatment, due to lack of efficacy, side-effects, costs and acceptance of the disease. Sex differences in expenses were observed, with women having higher expenditures. Alopecia areata-related out-of-pocket costs place a considerable financial burden on affected individuals, are higher compared with those of other chronic diseases, and should be considered in economic assessments of the impact of this disease.

Analyzing web searches for axial spondyloarthritis in Germany: a novel approach to exploring interests and unmet needs.

Axial spondyloarthritis (axSpA) is an underdiagnosed condition with a high disease burden. Due to delayed diagnosis and limited access to specialist care, conventional health data might not sufficiently capture the perspective of affected individuals. The aim of this study was to assess public interest, unmet needs, and disease burden of axSpA in Germany through the analysis of thematic, geographic, and temporal patterns in national web search data. Google Ads Keyword Planner was used to identify axSpA-related keywords and their monthly search volume in Germany between January 2017 and December 2020. Identified keywords were qualitatively categorized into six categories. Overall, 265 axSpA-related keywords with a search volume of 3,881,490 queries were identified. Nearly 81% of the total search volume was assigned to the category terms and definition, while 19% referred to either outcomes, symptoms, diagnosis, management, or causes. In the category outcomes, prognostic outcomes like "life expectancy" generated more searches than physical manifestations like "pain". Less populated cities showed significantly more searches per 100,000 inhabitants than larger cities. Searches were seasonally stable with a Germany-wide peak in July 2017. This study provides an overview of public interest in axSpA based on web search data in Germany. The identified search patterns could be used to guide public health campaigns and optimize axSpA management in Germany.

Outlier detection in dermatology: Performance of different convolutional neural networks for binary classification of inflammatory skin diseases.

BACKGROUND: Artificial intelligence (AI) and convolutional neural networks (CNNs) represent rising trends in modern medicine. However, comprehensive data on the performance of AI practices in clinical dermatologic images are non-existent. Furthermore, the role of professional data selection for training remains unknown. OBJECTIVES: The aims of this study were to develop AI applications for outlier detection of dermatological pathologies, to evaluate CNN architectures' performance on dermatological images and to investigate the role of professional pre-processing of the training data, serving as one of the first anchor points regarding data selection criteria in dermatological AI-based binary classification tasks of non-melanoma pathologies. METHODS: Six state-of-the-art CNN architectures were evaluated for their accuracy, sensitivity and specificity for five dermatological diseases and using five data subsets, including data selected by two dermatologists, one with 5 and the other with 11 years of clinical experience. RESULTS: Overall, 150 CNNs were evaluated on up to 4051 clinical images. The best accuracy was reached for onychomycosis (accuracy = 1.000), followed by bullous pemphigoid (accuracy = 0.951) and lupus erythematosus (accuracy = 0.912). The CNNs InceptionV3, Xception and ResNet50 achieved the best accuracy in 9, 8 and 6 out of 25 data sets, respectively (36.0%, 32.0% and 24.0%). On average, the data set provided by the senior physician and the data set provided in accordance with both dermatologists performed the best (accuracy = 0.910). CONCLUSIONS: This AI approach for the detection of outliers in dermatological diagnoses represents one of the first studies to evaluate the performance of different CNNs for binary decisions in clinical non-dermatoscopic images of a variety of dermatological diseases other than melanoma. The selection of images by an experienced dermatologist during pre-processing had substantial benefits for the performance of the CNNs. These comparative results might guide future AI approaches to dermatology diagnostics, and the evaluated CNNs might be applicable for the future training of dermatology residents.

Automatic body part identification in real-world clinical dermatological images using machine learning.

BACKGROUND: Dermatological conditions are prevalent across all population sub-groups. The affected body part is of importance to their diagnosis, therapy, and research. The automatic identification of body parts in dermatological clinical pictures could therefore improve clinical care by providing additional information for clinical decision-making algorithms, discovering hard-to-treat areas, and research by identifying new patterns of disease. PATIENTS AND METHODS: In this study, we used 6,219 labelled dermatological images from our clinical database, which were used to train and validate a convolutional neural network. As a use case, qualitative heatmaps for the body part distribution in common dermatological conditions was generated using this system. RESULTS: The algorithm reached a mean balanced accuracy of 89% (range 74.8%-96.5%). Non-melanoma skin cancer photos were mostly of the face and torso, while hotspots of eczema and psoriasis image distribution included the torso, legs, and hands. CONCLUSIONS: The accuracy of this system is comparable to the best to-date published algorithms for image classification challenges, suggesting this algorithm could boost diagnosis, therapy, and research of dermatological conditions.

Happiness and depression in psoriasis: a cross-sectional study in Germany.

PURPOSE: Prior research on the psychological consequences of skin diseases has focused on assessing mental comorbidities. The aim of this study was to investigate subjective well-being in a large sample of individuals affected by psoriasis, a chronic inflammatory skin disease, and to explore the associations with depression and disease-related parameters such as disease severity. METHODS: A cross-sectional online survey was conducted from March to June 2019. The link to the questionnaire was shared on websites and Facebook pages of psoriasis patient organizations and campaigns. Participants filled in validated scales measuring subjective well-being-operationalized as positive affect (PA), negative affect (NA) and satisfaction with life (SWL); and depression. RESULTS: The data of 722 participants were analyzed. Exploratory factor analysis supported the differentiation of PA, NA, SWL, and depression as four different constructs. The respondents reported lower levels of PA than healthy individuals and judged themselves to be less happy and were less satisfied with their lives than the general population (except age group 65 + years). 40.3% of respondents were screened positive for depression. More severe psoriasis was associated with lower affective well-being and a higher risk for depression. CONCLUSION: The results of this study empirically supported the differentiation of subjective well-being and depression as different constructs in individuals with psoriasis, and underline the large mental burden of the disease which goes beyond a higher risk for depression. Measures of well-being should thus be incorporated in both research and clinical practice in patients with psoriasis in order to achieve a more comprehensive picture of the mental burden of this disease.

A Structured Intervention for Medical Students Significantly Improves Awareness of Stigmatisation in Visible Chronic Skin Diseases: A Randomised Controlled Trial.

People with visible skin diseases often experience stigmatisation. The aim of this study was to develop and evaluate a new intervention for medical students to counter the stigmatisation of people with skin diseases. The intervention was evaluated using a randomised controlled design. Effectiveness was assessed at 3 time points. Data from 127 participants were analysed. Regarding the outcome "social distance", a significant difference between the measurement points was observed for the intervention group (χ2(2) = 54.32, p < 0.001), which also showed a significant effect on agreement with negative stereotypes (F(1.67, 118.67) = 23.83, p < 0.001, partial η2 = 0.25). Regarding the outcome "agreement with disease-related misconceptions", a significant difference between the measurement time points was observed for the intervention group (χ2(2) = 46.33, p < 0.001); similar results were found for the outcome "stigmatising behaviour" (F(1.86, 131.89) = 6.16, p = 0.003, partial η2 = 0.08). The results should encourage medical faculties to invest in such courses in order to prevent stigmatisation of people with skin diseases.

[Atopic dermatitis-identifying needs in the German population by internet search queries]. / Atopische Dermatitis ­ Identifikation von Bedürfnissen der deutschen Bevölkerung mittels Internetsuchanfragen.

BACKGROUND: The internet is one of the most important sources for health-related information for the general population. Therefore, the analysis of internet search engines can help to capture the social interests and needs regarding diseases. OBJECTIVES: The aim of this study was to investigate the search queries related to atopic dermatitis (AD) regarding frequency, focus of interest and temporal occurrence in the German federal states in order to identify possible regional differences. MATERIAL AND METHODS: Using the Google Ads Keyword Planner, AD relevant keywords including the monthly search volume between January 2017 and December 2020 were identified, which were then assigned to different categories. RESULTS: Overall, 1419 keywords were found that had a search volume of 14,817,610 queries. The category 'general' had the highest search volume (n = 5,970,840), but most keywords were assigned to the category 'location' (n = 348). About 60% of the keywords assigned to 'location' were related to AD on the face. On a national level, Bremen and Hamburg had the highest search volume per 100,000 inhabitants. With more than 70%, an enormous increase in search volume could be observed, which was especially high in 2020. DISCUSSION: With this internet search analysis, it was possible to clarify which aspects of AD were of particular importance for the German population, which can help to adapt information campaigns to the target population. In addition, the study underlines the increasing relevance of the internet as a source of information regarding health-related topics.

Prescription Behaviour and Barriers to Prescription of Biologicals for Treatment of Chronic Inflammatory Skin Diseases in Dermatological Practice in Two German Federal States.

The globally increasing prevalence of chronic inflammatory skin diseases has substantial costs. Biologicals have become available as therapeutic options, but are encumbered with barriers to prescription. The aim of this study was to evaluate the barriers to prescription of biologicals in the treatment of chronic dermatological diseases. Dermatologists working in private practices in the German federal states of Bavaria and Lower Saxony participated in a cross-sectional study. Economic and legal aspects, including "high therapy costs", "low reimbursements", and "fear of regress claims", were identified as the most prevalent barriers. Significant differences between dermatologists from Bavaria and Lower Saxony were found only regarding the treatment of atopic dermatitis. This study demonstrates the prevalence of barriers to the prescription of biologicals in the treatment of chronic dermatological diseases. Overcoming these barriers could improve the usage of modern therapies and thereby expand patient-centred care for chronic skin diseases.

Retracing the COVID-19 Pandemic in Germany from a Public Perspective using Google Search Queries Related to "coronavirus".

AIM OF THE STUDY: During pandemics, the whole population is simultaneously confronted with the same health threat, resulting in enormous public interest. The current COVID-19 pandemic has left the world in a unique state of crisis. The aim of this analysis was to explore whether Google searches can be used to retrospectively retrace the COVID-19 pandemic in Germany and to detect local outbreaks by reflecting public interest in the virus. METHODS: Google Trends was used to explore the relative search volume (RSV) related to "coronavirus" from January 2020 to July 2020 in Germany. The RSV ranging between 0-100 was compared to new SARS-CoV-2 infections per day on a national level and to the cumulative infection numbers on a state level, as well as to important infectiological and political events. RESULTS: The most striking search peaks occurred after the first reported SARS-CoV-2 infection in Germany (January 27), during a major local outbreak in Heinsberg (February 25), after school closings (March 13) and the largest peak after nationwide contact restrictions (March 22) were announced. On a state level, peaks in RSV were observed after the first reported infection in each respective state. In addition, a higher RSV was recorded in states with higher numbers of infections (r=0,6, p=0,014) such as in Bavaria (RSV=96, 391 infections/100,000 inhabitants) and Baden-Württemberg (RSV=98, 340 infections/100,000 inhabitants). The lowest RSV (n=83) and lowest number of infections (50 infections/100,000 inhabitants) was observed in Mecklenburg-Western Pomerania. Since the end of May, SARS-CoV-2 related RSV remained at low level even when numbers of infections were temporarily rising due to local outbreaks such as the outbreak in Gütersloh, North Rhine-Westphalia. CONCLUSION: RSV related to "coronavirus" precisely reflected public interest during the beginning of the COVID-19 pandemic. As public interest has strongly declined, information distribution regarding the newest developments over the entire course of the pandemic will be a major public health challenge. ZIEL DER STUDIE: Während Pandemien ist die gesamte Gesellschaft zur gleichen Zeit mit derselben Erkrankung konfrontiert, was zu großem öffentlichen Interesse führt. Die aktuelle COVID-19 Pandemie hat die ganze Welt in einen einmaligen Ausnahmezustand versetzt. Ziel dieser Studie war es zu untersuchen ob das Pandemiegeschehen in Deutschland anhand von Google Suchanfragen retrospektiv rekonstruiert werden kann und ob lokale Ausbrüche mithilfe von Google Daten detektiert werden können. METHODIK: Das relative Google Suchvolumen (RSV) zum Thema "Coronavirus" wurde für den Zeitraum von Januar bis Juli 2020 mit Google Trends analysiert. Das RSV, das zwischen 0 und 100 betragen kann, wurde auf Bundesebene mit den täglich neu gemeldeten SARS-CoV-2 Infektionszahlen und auf Länderebene mit den kumulativen Infektionszahlen pro Bundesland sowie wichtigen infektiologischen und politischen Ereignissen verglichen. ERGEBNISSE: Höchstwerte im Google Suchvolumen nach der ersten gemeldeten SARS-CoV-2-Infektion in Deutschland (27. Januar), während des lokalen Ausbruchs in Heinsberg (25. Februar), nach den Schulschließungen (13. März) sowie, der absolute Höchstwert, nach Verkündung der bundesweiten Kontaktbeschränkungen (22. März) verzeichnet worden. Auf Bundesländerebene wurde immer dann ein Anstieg im Suchvolumen beobachtet, wenn die erste SARS-CoV-2 Infektion im jeweiligen Bundesland gemeldet wurde. Zudem wurde ein höheres RSV in Bundesländern mit mehr gemeldeten SARS-CoV-2-Infektionen registriert (r=0,6, p=0,014), wie z. B. in Bayern (RSV=96, 391 Infektionen/100 000 Einwohner) und Baden-Württemberg (RSV=98, 340 Infektionen/100 000 Einwohner). Das niedrigste RSV (n=83) und die niedrigste Anzahl an Infektionen (50 Infektionen/100 000 Einwohner) wurde in Mecklenburg-Vorpommern beobachtet. Seit Ende Mai ist das RSV bezüglich SARS-CoV-2 konstant gering, obwohl die Zahl an Neuinfektionen zwischenzeitlich aufgrund lokaler Ausbrüche gestiegen war wie z. B. der lokale Ausbruch in Gütersloh, Nordrhein-Westfalen. SCHLUßFOLGERUNG: Das RSV zum Thema "Coronavirus" bildeten das öffentliche Interesse während der ersten Monate der COVID-19 Pandemie präzise ab. Da das öffentliche Interesse jedoch stark nachgelassen hat, könnte es eine zentrale Herausforderung im weiteren Verlauf der Pandemie darstellen, die Bevölkerung weiterhin über neueste Entwicklungen und Maßnahmen informiert zu halten.

Trotz einer großen Auswahl wirksame Medikamente: Psoriatiker scheinen immer noch untertherapiert zu sein.

HINTERGRUND UND ZIELE: Durch die Entwicklung neuer anti-psoriatischer Medikamente und verbesserte Strukturen zu deren flächendeckender Einführung hat sich die medizinische Versorgung von Psoriasis-Patienten deutlich verbessert. In dieser Studie haben wir die tatsächliche Inanspruchnahme des Gesundheitswesens untersucht und Gründe für die Unzufriedenheit der Betroffenen ermittelt. PATIENTEN UND METHODIK: Diese nicht-interventionelle Querschnittsstudie wurde als anonyme Online-Befragung von 12/2018 bis 01/2019 in Deutschland durchgeführt. Teilnehmer mit einer selbstberichteten, von einem Arzt gestellten Psoriasis-Diagnose und Symptomen beantworteten Fragen zu ihrer Erkrankung, deren Einfluss auf das tägliche Leben und ihrer medizinischen Versorgung. ERGEBNISSE: 649 Teilnehmer mit einem mittleren Alter von 42,5 ± 13,7 Jahren und ausgewogener Geschlechterverteilung (männlich: 50,2 %) wurden ausgewertet. 54,1 % waren zum Zeitpunkt der Studie in ärztlicher Behandlung, 45,9 % nicht. Von den Teilnehmern mit medizinischer Versorgung waren 59,3 % nur mäßig oder weniger zufrieden mit ihrer Behandlung. Gründe für die Unzufriedenheit mit der Medikation waren unter anderem mangelnde Wirksamkeit und Nebenwirkungen. Von den nicht in ärztlicher Behandlung befindlichen Teilnehmern wurde "Zeitmangel des Arztes" als Hauptgrund für die Nichtinanspruchnahme ärztlicher Hilfe angegeben. SCHLUSSFOLGERUNGEN: Trotz der Verfügbarkeit effizienter Therapieoptionen in Deutschland sind viele Betroffene mit Psoriasis unzufrieden. Diese unterbehandelte Gruppe wurde als neue Zielgruppe identifiziert.

Despite large choice of effective therapies: Individuals with psoriasis still seem undertreated.

BACKGROUND AND OBJECTIVES: Due to the development of new anti-psoriatic drugs in combination with improved structures for implementation throughout Germany, the medical care of psoriasis patients has markedly improved. In this study we investigated the real-life utilization of the health care system and identified reasons for dissatisfaction in affected individuals. PATIENTS AND METHODS: This non-interventional cross-sectional study was conducted as an anonymous online survey from 12/2018 to 01/2019 in Germany. Participants with a self-reported physician-confirmed diagnosis of psoriasis and symptoms answered questions about their disease, its influence on daily life and their medical care. RESULTS: 649 participants with a mean age of 42.5 ± 13.7 years and equal gender distribution (male: 50.2 %) were evaluated. 54.1 % received medical treatment at the time of the study, 45.9 % did not. Among the participants with medical care, 59.3 % were only moderately or less satisfied with their treatment. Reasons for dissatisfaction with the medication included lack of efficacy and side effects. Participants without medical treatment specified a physician's lack of time as a main reason for not seeking medical help. CONCLUSIONS: Despite the availability of efficient therapeutic options in Germany, many individuals with psoriasis are not satisfied. This under-treated group was identified as a new target population.

Great green tea ingredient? A narrative literature review on epigallocatechin gallate and its biophysical properties for topical use in dermatology.

The purpose of this review is to examine epigallocatechin-3-gallate (EGCG) regarding its stability in different conditions (pH-value, concentration, temperature), its interactions with common cosmetic ingredients, and its application in the dermatological field. The literature research considered published journal articles (clinical trials and scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) and reference lists of respective articles. Higher concentrations of EGCG were reported to correlate with better stability and the same can be said for low temperatures and pH values. The interaction between EGCG and hyaluronic acid strengthens its antioxidant activities. Titanium dioxide coated with EGCG proved a suitable ingredient in sunscreens. The polyphenol possesses antioxidant properties, which proved effective in the prevention of UV-induced skin damage and to alleviate the symptoms of Imiquimod-induced psoriasis. The three endpoints of this review not only showed interesting results but also highlighted some limitations of EGCG. Studies show that the molecule is unstable, which may hinder its dermatological and cosmetic applications. The reported interactions with cosmetic ingredients were limited. As the health aspects of EGCG are well-reported, ECGC has become a focus of interest for health professionals trying to treat common dermatological diseases.

[Effects of an unconventional skin cancer prevention campaign : Impacts on the sun protection behavior of outdoor workers]. / Effekte einer unkonventionellen Hautkrebs-Präventionskampagne : Auswirkungen auf das Sonnenschutzverhalten von Außenberufstätigen.

BACKGROUND: The disease burden of actinic keratoses and keratinocyte carcinoma can be reduced by primary and secondary prevention. However, these measures are often poorly received, especially among the high-risk group of outdoor workers. OBJECTIVES: The aim of this follow-up study was to investigate whether an improvement in sun protection and awareness of skin changes could be observed among the study population, especially outdoor workers, one year after a prevention campaign focusing on this topic. MATERIALS AND METHODS: In 2017, all participants who initially participated in a study at the Bavarian Central Agricultural Festival 2016 and agreed to participate in the follow-up study were contacted by mail and received the same questionnaire and evaluation questions regarding possible behavioral changes. RESULTS: A total of 400 people took part in the follow-up study (response rate 52.8%). Of the 240 outdoor workers, 45.0% said they were more conscious of protecting themselves from the sun and 68.8% said they were more aware of skin changes. About 85.0% of outdoor workers indicated that they would consult a dermatologist earlier and 65.8% desired further prevention campaigns regarding skin cancer and sun protection. CONCLUSION: Overall, the majority of participants reported that they had improved sun protection behavior and awareness of skin changes after the intervention. Based on the participants' self-disclosure, especially outdoor workers tended to use sun protection measure more frequently. These findings underline the importance of target group-oriented awareness and prevention campaigns to reduce the burden of skin cancer.

Interest in Skin Cancer in Urban Populations: A Retrospective Analysis of Google Search Terms in Nine Large German Cities.

Skin cancer is a major public health issue, which could be reduced through prevention programmes. How-ever, prevention utilization is not very prevalent. It is therefore important to understand individuals' interest in skin cancer. Google AdWords Keyword Planner was used to identify the search volume of terms relating to skin cancer in 9 German cities between July 2014 and June 2018. From a total of 1,203 identified keywords, 1,047 search terms were related to skin cancer, which had a search volume of 3,460,980 queries for the study period. Most terms referred to "identifying skin cancer". For melanoma, the number of Google searches per 100,000 inhabitants correlated with the cancer registry data for melanoma incidence rates (men: r = 0.810, women: r = 0.569). Assessment of this data for the different cities further enabled identification of regional variations, which could help to identify areas with a high need for targeted prevention campaigns.

The impact of the first COVID-19 wave on office-based dermatological care in Germany: a focus on diagnosis, therapy and prescription of biologics

Background: The COVID-19 pandemic has led to widespread changes in medical care. However, it is still unclear to what extent the care of patients suffering from moderate-to-severe psoriasis, chronic spontaneous urticaria or atopic dermatitis has been affected. Objectives: This study was conducted to determine the impact of the SARS-CoV-2 pandemic on medical care in dermatological practices, focusing on physicians' concerns related to susceptibility to infections in combination with different treatment modalities. Materials & Methods: Dermatologists working in medical offices in the German federal states of Bavaria and Lower Saxony participated in a cross-sectional, non-interventional, questionnaire-based study investigating the influence of COVID-19 on dermatological care. The study was performed after the first wave of the coronavirus pandemic in July/August, 2020. Results: A total of 195 dermatologists participated in the study. Almost one in five practices were closed for at least one week during the pandemic. The care of patients with chronic inflammatory skin diseases was impaired, affecting diagnostic investigation. Physicians stated that the pandemic substantially influenced systemic therapy. Nearly half of physicians surveyed were concerned about increased susceptibility to infections under biological therapy. No significant differences were identified between the German federal states of Bavaria and Lower Saxony in the south and north of Germany, respectively. Conclusion: This study reveals a significant impact of the COVID-19 pandemic on the care of dermatological patients in medical offices in Germany. New management modalities and continuous education are needed to improve care in pandemic situations.

Adding happiness to complement the Dermatology Quality of Life Index in psoriasis and atopic dermatitis healthcare: a cross-sectional study

Background: The Dermatology Quality of Life Index (DLQI) is the most commonly used quality of life questionnaire in dermatology. Objectives: The aim of this study was to compare the DLQI to measures of wellbeing and general quality of life in patients with chronic inflammatory skin diseases. Materials & Methods: A cross-sectional study among patients with psoriasis and atopic dermatitis was conducted at a hospital in Munich, Germany (12/2017-04/2019). Participants filled in validated scales measuring happiness, quality of life, and DLQI. Results: In 102 patients with chronic inflammatory skin diseases, the DLQI was associated only with physical quality of life and negative emotions, and not psychological quality of life or positive affect. The DLQI alone accounted for 26% of variance in general quality of life. Combining DLQI and happiness accounted for a total of 73% of variance, with both variables contributing to the model. Conclusion: The DLQI alone only partially reflected well-being. Assessing happiness in addition to the widely used DLQI can contribute to a more comprehensive evaluation of well-being.

Dermatology and medical law: the effect of legal issues on the treatment of patients in dermatological practices in southern Germany

Background: Usage of modern therapies in the treatment of chronic dermatological diseases has proven to be effective but associated with high costs. High therapy costs might raise legal issues and even lead to recourse claims. Objectives: To evaluate dermatologists' interests and knowledge in medical law and the occurrence of recourse claims, and to assess the impact of medical law on clinical practice. Materials & Methods: Dermatologists of the "Psoriasis-Praxisnetz Süd-West e.V." participated in a web-based questionnaire study investigating the relationship between medical law and usage of modern therapies. The questionnaire was separated in two sub-polls carried out from 11/2016 to 12/2016 and 02/2017 to 03/2017, respectively. The first addressed general topics of medical law and the second specific legal topics, particularly recourse claims. Results: Overall, 76 dermatologists participated in the first and 66 in the second sub-poll. In the first sub-poll, 27.6% of participants attended a seminar on medical law within the last 12 months. Furthermore, 28.8% of the participants of the second sub-poll already experienced a previous recourse claim, and 26.3% of those stated feeling confident or rather confident on legal topics. This proportion was lower among those who had not experienced a recourse claim (17.0%). Overall, 73.7% of those who had a previous recourse claim changed their prescription behaviour as a direct consequence thereof. Conclusion: The study demonstrates a close relationship between medical law issues and the prescription behaviour of dermatologists working in private practices in southern Germany. Regular legal education would thus be beneficial for patient-centred care.

Psoriasis and addiction: assessing mental health based on a cross-sectional study in Germany.

Psoriasis is a chronic skin disease with a high mental burden. Well-known comorbidities include depression, anxiety, as well as alcohol and tobacco addiction, however, there is barely any evidence on other addictions. The aim of this study was to estimate the prevalence of the six most common addictions among psoriasis patients in Germany and to determine associated clinical factors. Dermatologists working in four dermatological clinics and 32 practices across Germany recruited patients between September 2018 and November 2019. This cross-sectional study contained questionnaires on six addictions, depression, anxiety, and the Dermatology Life Quality Index (DLQI). In addition, scores for the Psoriasis Area and Severity Index (PASI) were obtained by physicians. Overall, 502 patients (43.4% women; mean age: 49.7 ± 14.6 years) were included. Positive addictions were found in 30.3% for daily smoking, 8.6% for alcohol, 1.2% for gambling, 3.8% for internet use, 3.6% for food, and 6.0% for drugs. Younger age was associated with a higher probability of addiction except for alcohol dependency. The PASI was only significantly associated with smoking. Addictions seem to be common among psoriasis patients. Further research should include comprehensive data and control groups, furthermore, standardised screenings and early referrals could represent first steps to improve people-centred healthcare for patients with psoriasis.

Patients with Chronic Urticaria Remain Largely Undertreated: Results from the DERMLINE Online Survey.

INTRODUCTION: Chronic urticaria (CU) is an unpredictable disease, with high disease burden and a significant negative impact on quality of life, especially in patients of working age. Many patients are undertreated, and there is poor awareness of strategies to manage patients with CU in the real-world setting. The current study aimed to gain a better understanding of CU from the patients' perspective, including the body areas most affected by wheals and angioedema, the disease burden and current use of the healthcare system. METHODS: A nationwide online survey was performed in Germany involving individuals who reported a diagnosis of CU and experienced symptoms within 3 months prior to inclusion. RESULTS: This self-report survey included 1037 participants (89.2% female), with a mean ± standard deviation (SD) age of 33.4 ± 11.0 years and a mean ± SD disease duration of 10.0 ± 9.4 years. On average, participants suffered from urticaria symptoms for 3.0 ± 4.3 years before diagnosis. In 73% of participants, symptoms worsened due to external factors, with the majority specifying stress in their personal life or work-related stress as eliciting factors. Within the previous 3 months, 87.4 and 44.1% of participants experienced wheals and angioedema, respectively, at multiple body areas, and most (79.6%) participants had uncontrolled symptoms as measured with the Urticaria Control Test. Despite the high burden of disease, 60.3% of participants stated that they were not currently receiving treatment. The most commonly used therapies to treat CU were oral (72.8%) and non-prescription (43.3%) and prescription (47.3%) topical drugs, with 18.0% of the participants receiving injectable/infused drugs. CONCLUSION: The majority of the participants responding to the survey reported that CU is not sufficiently controlled, thereby severely influencing a highly productive time in their life. The body areas most affected by wheals and angioedema are specified, based on data provided by a large group of affected participants. A greater awareness of disease burden and available treatment options is needed.