Unmet Needs in Darier's Disease from a Patient's Perspective: Lessons Learnt from the German Registry.

The MDHHgermany registry was initiated to characterize the "real-life" situation of affected individuals with Darier's disease (DD; Morbus Darier, MD) and Hailey-Hailey disease (HH), including their treatment and healthcare. To gain deeper insights into medical care of patients with DD, various aspects such as demographics, subjective symptoms, patient satisfaction with medical care, past and current therapies were explored. Patients with diagnosed DD were included. Subjective symptoms such as itch, pain and burning sensation were assessed. Individual therapy goals were recorded and patients assessed previous/current therapies along with satisfaction of medical care and treatment. A total of 55 patients were recruited; 47 patients were eligible for the analysis. Pruritus was rated the most bothersome symptom. Some 42.6% had not received systemic treatment so far or systemic therapies were rated ineffective (32.6%). Most commonly oral retinoids were prescribed, followed by corticosteroids. Patient satisfaction with medical care and treatment proved to be mediocre. This "real-life" data show an alarming unmet need regarding patients' satisfaction with medical care and treatment, evidenced by the reported lack of disease control. Further studies and interventions are needed to improve the spectrum of available therapies. MDHHgermany provides a foundational platform for future clinical trials, epidemiological studies, and pathophysiological analyses.

Supplement Individual Article: A Reappraisal of Fixed-Combination Halobetasol Propionate and Tazarotene for the Treatment of Psoriasis: Biological Underpinnings, Therapeutic Mechanisms, and Economic Considerations.

Psoriasis is a complex inflammatory disease, which can be triggered by the interplay among keratinocytes, various immune cells, and even dermal vascular endothelial cells. Understanding of the key players and cytokine/chemokine messengers involved in the initiation and maintenance of psoriasis has significantly evolved and led to numerous systemic biologic therapies targeting those specific components. These therapies, despite their successes, do not ubiquitously affect all pathogenic cellular pathways. They also carry their risks and may be contraindicated in certain patient populations. Therefore, other therapeutics are still necessary. Tazarotene, a decades-old topical retinoid, has been successfully used for treating cutaneous psoriasis. Its retinoid effect via binding to retinoic acid receptors (RAR)/retinoic X receptors (RXR) alters cellular gene expression of numerous pathogenic cells and leads to a long-standing maintenance effect despite discontinuation - a phenomenon known as remittance. Concurrent use of tazarotene with topical corticosteroids results in reduced incidence of treatment-related adverse events. A fixed-combination lotion containing halobetasol propionate (HP) and tazarotene (HP 0.01%/TAZ 0.045%, Duobrii, Ortho Dermatologics) was developed implementing polymeric emulsion technology that demonstrates efficacy in psoriasis while mitigating adverse events associated with each component alone as monotherapy. In this paper, we review the pathogenesis of psoriasis and illuminate the effect of tazarotene and HP on key cellular pathways. In addition, we review the clinical efficacy of fixed-combination HP 0.01%/TAZ 0.045% lotion in psoriasis as well as its long-term treatment maintenance, applicability in skin of color, and beneficial economic impact for patients and healthcare stakeholders. As HP 0.01%/TAZ 0.045% lotion is safe and exhibits excellent efficacy, it should be within the therapeutic toolbox for every psoriasis patient.J Drugs Dermatol. 2023;22:1(Suppl 1):s3-10.

A transgenic reporter mouse model for in vivo assessment of retinoic acid receptor transcriptional activation.

Background: Vitamin A is essential for a wide range of life processes throughout embryogenesis to adult life. With the aim of developing an in vivo model to monitor retinoic acid receptor (RAR) transactivation real-time in intact animals, we generated transgenic mice carrying a luciferase (luc) reporter gene under the control of retinoic acid response elements (RAREs) consisting of three copies of a direct repeat with five spacing nucleotides (DR5). Methods: Transgenic mice carrying a RARE dependent luciferase reporter flanked with insulator sequence were generated by pronuclear injection. RARE dependent luciferase activity was detected by in vivo imaging or in tissue extracts following manipulations with RAR/retinoid X receptor (RXR) agonists, RAR antagonists or in vitamin A deficient mice. Results: We found a strong induction of luciferase activity in a time and dose dependent manner by retinoic acid as well as RAR agonists, but not by the RXR agonist (using n=4-6 per group; 94 mice). In addition, luciferase activity was strongly reduced in vitamin A-deficient mice (n=6-9; 30 mice). These observations confirm that luciferase activity was controlled by RAR activation in the RARE-luc mouse. Luciferase activity was detectable in various organs, with high activity especially in brain and testis, indicating strong retinoid signalling in these tissues. Conclusion: The RARE-luc transgenic mice, which enabled real-time in vivo assessment of RAR activation, will be useful in understanding the normal physiology of vitamin A, the role of retinoid signalling in pathologies as well as to evaluate pharmacological ligands for RARs.

Eficacia y seguridad del tratamiento adalimumab en pacientes mayores de 12 años con hidradenitis supurativa severa con respuesta insuficiente al tratamiento sistémico convencional / Efficacy and safety of adalimumab treatment in patients older than 12 years with severe hidradenitis suppurativa with insufficient response to conventional systemic treatment

INTRODUCCIÓN: El presente dictamen expone la evaluación de la eficacia y seguridad del tratamiento con adalimumab en pacientes mayores de 12 años con diagnóstico de hidradenitis supurativa severa con respuesta insuficiente al tratamiento sistémico convencional (drenaje de abscesos y cobertura de antibióticos). La hidradenitis supurativa (HS) o acné inverso es una enfermedad folicular cutánea crónica, inflamatoria, recurrente y debilitante que suele presentar lesiones dolorosas e inflamadas en zonas del cuerpo que tienen glándulas apocrinas como axilas, zona inguinal y anogenital. La prevalencia de esta enfermedad se ha reportado entre 0.05 % y 4 % entre los años 2005 y 2014 en España, USA, Dinamarca y Francia. Los pacientes con HS moderada a severa reciben terapia inicial de antibióticos orales como tetraciclinas o combinación de clindamicina y rifampicina. El Petitorio Farmacológico de EsSalud incluye a clindamicina, rifampicina, isotretinoina, acitretina, meropenem, vancomicina, ciprofloxacino, las cuales forman parte del tratamiento sistémico convencional para el paciente con HS Hurley III. Sin embargo, existen pacientes que no alcanzan respuesta clínica de HS (HiSCR1 ) en el tiempo asignado para evaluar esta respuesta, para quienes los médicos especialistas de la institución sugieren el uso de adalimumab, un anticuerpo recombinante monoclonal IgG1. METODOLOGÍA: Se realizó la búsqueda sistemática de literatura con respecto a la eficacia y seguridad de adalimumab en pacientes con HS con respuesta insuficiente a tratamiento sistémico convencional. La búsqueda se realizó en las bases de datos bibliográfica: PubMed, The Cochrane Library y Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS). Adicionalmente, se buscó evidencia manualmente en páginas web de grupos que se dedican a la elaboración de guías de práctica clínica, tales como, el National Institute for Health and Care Excellence (NICE), la Agency for Healthcare Research and Quality (AHRQ), la Guidelines International Network (GIN), la New Zealand Guidelines Group (NZGG), la National Health and Medical Research Council (NHMRC), la Canadian Medical Association (CMA), la Hidradenitis Suppurativa Foundation (HSF), la Canadian Hidradenitis Suppurativa Foundation (CHSF), la European Hidradenitis Suppurativa Foundation, la British Association of Dermatologists (BAD); así como en entidades que realizan evaluación de tecnologías sanitarias como la Base Regional de Informes de Evaluación de Tecnologías en Salud de las Américas (BRISA), la Comissão Nacional de Incorporação de Tecnologias no Sistema Único de Saúde (CONITEC), el Scottish Medicines Consortium (SMC), la Canadian Journal of Health Technologies (CADTH), la Haute Autorité de Santé (HAS), el Institute for Clinical and Economic Review (ICER), el Centro Colaborador do Sus: Avaliação de Tecnologias e Excelência em Saúde (CATES), entre otras. Finalmente, se buscaron registros de ensayos clínicos en la página web www.clinicaltrials.gov, con el fin de identificar resultados aún no publicados y así disminuir el riesgo de sesgo de publicación. RESULTADOS: Se llevó a cabo una búsqueda de evidencia científica relacionada al uso de adalimumab como tratamiento de pacientes con HS severa con respuesta insuficiente al tratamiento sistémico convencional. En la presente sinopsis se describe la evidencia disponible según el tipo de publicación, siguiendo lo indicado en los criterios de elegibilidad (GPC, ETS, RS, MA y ECA fase III). CONCLUSIONES: El presente documento técnico recoge la mejor evidencia disponible hasta setiembre de 2021 con relación a la eficacia y seguridad del uso de adalimumab en paciente mayor a 12 años con diagnóstico de HS severa con respuesta insuficiente a tratamiento sistémico convencional. Se identificaron: una GPC de la BAD; cuatro ETS de SMC, CADTH, NICE y CONITEC y dos ECA de fase III (PIONEER I y PIONEER II). - Para el tratamiento de pacientes con HS que no responden al tratamiento sistémico, la GPC de la BAD recomienda la escisión quirúrgica y el uso de adalimumab; sin embargo, solo este último está dirigido a pacientes con HS severa. Las conclusiones de las cuatro ETS (SMC, CADTH, NICE,a CONITEC) fueron a favor del uso de adalimumab. Todas las ETS se basaron principalmente en los resultados de los ECA PIONEER I y PIONEER II. Aunque las ETS de NICE y CONITEC identificaron limitaciones afectan la validez de los resultados; también señalaron que dichas limitaciones afectaron particularmente el segundo periodo de seguimiento. Así, las ETS de la CADTH y NICE, condicionaron el uso de adalimumab a un descuento confidencial. Los resultados de los ECA PIONEER I y PIONEER II mostraron que, comparado con placebo, el uso de adalimumab (durante 12 semanas) estuvo asociado a una mayor tasa de respuesta (según el HiSCR), pero no mostró diferencia en la calidad de vida o el perfil de seguridad. La ausencia de información sobre la cantidad de datos imputados introduce riesgo de sesgo y afecta la validez de los resultados; particularmente después de las 12 semanas de tratamiento. Entre las semanas de tratamiento 12 y 36, las tasas de respuesta disminuyeron progresivamente hasta el 50 %, aproximadamente. Los especialistas de EsSalud enfatizan que las cicatrices producidas tras la escisión quirúrgica amplia (alternativa disponible en EsSalud) pueden afectar la funcionalidad de los pacientes; además, de haberse reportado en la evidencia científica que, luego de la cirugía, la recurrencia de la enfermedad ocurre entre el 27 % y el 69 % de los pacientes. Por lo expuesto, el Instituto de Evaluación de Tecnologías en Salud e Investigación aprueba el uso de adalimumab para el tratamiento de los pacientes adultos con diagnóstico de HS severo (Hurley III) con respuesta insuficiente al tratamiento sistémico convencional, como producto farmacéutico no incluido en el Petitorio Farmacológico de EsSalud. Dado que la evidencia está limitada a la población adulta, el IETSI no aprueba el uso de adalimumab para los pacientes menores de 18 años. La vigencia del presente dictamen es de un año, según lo establecido en el Anexo N° 1 y la continuación de dicha aprobación estará sujeta a la evaluación de los resultados obtenidos y de mayor evidencia que pueda surgir en el tiempo.

In vivo multiphoton imaging for non-invasive time course assessment of retinoids effects on human skin.

BACKGROUND: In vivo multiphoton imaging and automatic 3D image processing tools provide quantitative information on human skin constituents. These multiphoton-based tools allowed evidencing retinoids epidermal effects in the occlusive patch test protocol developed for antiaging products screening. This study aimed at investigating their relevance for non-invasive, time course assessment of retinoids cutaneous effects under real-life conditions for one year. MATERIALS AND METHODS: Thirty women, 55-65 y, applied either retinol (RO 0.3%) or retinoic acid (RA 0.025%) on one forearm dorsal side versus a control product on the other forearm once a day for 1 year. In vivo multiphoton imaging was performed every three months, and biopsies were taken after 1 year. Epidermal thickness and dermal-epidermal junction undulation were estimated in 3D with multiphoton and in 2D with histology, whereas global melanin density and its z-epidermal distribution were estimated using 3D multiphoton image processing tools. RESULTS: Main results after one year were as follows: a) epidermal thickening with RO (+30%); b) slight increase in dermal-epidermal junction undulation with RO; c) slight decrease in 3D melanin density with RA; d) limitation of the melanin ascent observed with seasonality and time within supra-basal layers with both retinoids, using multiphoton 3D-melanin z-epidermal profile. CONCLUSIONS: With a novel 3D descriptor of melanin z-epidermal distribution, in vivo multiphoton imaging allows demonstrating that daily usage of retinoids counteracts aging by acting not only on epidermal morphology, but also on melanin that is shown to accumulate in the supra-basal layers with time.

A novel dual reporter embryonic stem cell line for toxicological assessment of teratogen-induced perturbation of anterior-posterior patterning of the heart.

Reliable in vitro models to assess developmental toxicity of drugs and chemicals would lead to improvement in fetal safety and a reduced cost of drug development. The validated embryonic stem cell test (EST) uses cardiac differentiation of mouse embryonic stem cells (mESCs) to predict in vivo developmental toxicity, but does not take into account the stage-specific patterning of progenitor populations into anterior (ventricular) and posterior (atrial) compartments. In this study, we generated a novel dual reporter mESC line with fluorescent reporters under the control of anterior and posterior cardiac promoters. Reporter expression was observed in nascent compartments in transgenic mouse embryos, and mESCs were used to develop differentiation assays in which chemical modulators of Wnt (XAV939: 3, 10 µM), retinoic acid (all-trans retinoic acid: 0.1, 1, 10 µM; 9-cis retinoic acid: 0.1, 1, 10 µM; bexarotene 0.1, 1, 10 µM), and Tgf-ß (SB431542: 3, 10 µM) pathways were tested for stage- and dose-dependent effects on in vitro anterior-posterior patterning. Our results suggest that with further development, the inclusion of anterior-posterior reporter expression could be part of a battery of high-throughput tests used to identify and characterize teratogens.

Prescription patterns and costs of acne/rosacea medications in Medicare patients vary by prescriber specialty.

BACKGROUND: Prescription patterns for acne/rosacea medications have not been described in the Medicare population, and comparisons across specialties are lacking. OBJECTIVE: To describe the medications used for treating acne/rosacea in the Medicare population and evaluate differences in costs between specialties. METHODS: A cross-sectional study was performed of the 2008 and 2010 Centers for Medicare and Medicaid Services Prescription Drug Profiles, which contains 100% of Medicare part D claims. RESULTS: Topical antibiotics accounted for 63% of all prescriptions. Patients ≥65 years utilized more oral tetracycline-class antibiotics and less topical retinoids. Specialists prescribed brand name drugs for the most common topical retinoids and most common topical antibiotics more frequently than family medicine/internal medicine (FM/IM) physicians by 6%-7%. Topical retinoids prescribed by specialists were, on average, $18-$20 more in total cost and $2-$3 more in patient cost than the same types of prescriptions from FM/IM physicians per 30-day supply. Specialists (60%) and IM physicians (56%) prescribed over twice the rate of branded doxycycline than FM doctors did (27%). The total and patient costs for tetracycline-class antibiotics were higher from specialists ($18 and $4 more, respectively) and IM physicians ($3 and $1 more, respectively) than they were from FM physicians. LIMITATIONS: The data might contain rare prescriptions used for conditions other than acne/rosacea, and suppression algorithms might underestimate the number of specialist brand name prescriptions. CONCLUSION: Costs of prescriptions for acne/rosacea from specialists are higher than those from primary care physicians and could be reduced by choosing generic and less expensive options.

Cost-effectiveness analysis of using dermatologists versus pediatricians to treat mild to moderate acne.

OBJECTIVE: To assess the cost-effectiveness from the payer perspective of using dermatologists versus pediatricians to treat acne in adolescents ages 10-18. METHODS: A Markov model was constructed to explore outcomes over a 2-year period from the US private payer perspective. Patients ages 10-18 with acne entered the model under the "dermatologist"and "pediatrician" conditions. In each 3-month cycle,each modeled patient received topical retinoids,benzoyl peroxide (BP), antibiotics, or no treatment,and could progress to an acne-free state or remain in an acne state. RESULTS: The average patient spent42.3% of the time in acne-free states under the dermatologist condition and 28.0% of the time in acne-free states under the pediatrician condition.The cohort of 1000 patients experienced 1900 total quality-adjusted life years (QALYs) at a cost of $2.33 million in the dermatologist condition and 1883 total QALYs at a cost of $1.62 million in the pediatrician condition, yielding an ICER of $40,000/QALY. Most sensitivity analyses confirmed the base case results. CONCLUSION: Dermatologist treatment appears cost-effective related to producing additional QALYs at a cost of less than $100,000 per QALY gained. Health plans should consider creating incentives to direct enrollees to dermatologists for acne treatment.

Isotretinoin therapy for acne vulgaris and first episode psychosis in an adolescent patient / Primer episodio psicótico en adolescente con acné vulgar y tratamiento con isotretinoína

ABSTRACT Introduction: Isotretinoin is a member of the retinoid family of drugs, and has been used for the treatment of severe acne. Its use has been associated with various psychiatric and behavioural symptoms. Methodology: A case report and a non-systematic review of the literature are presented. Results: The case concerns a 13 year-old adolescent with insomnia, delusions, and auditory hallucinations, after two months of treatment with isotretinoin. The patient was admitted to hospital, where the use of psychoactive drugs and systemic disease that could explain the psychotic symptoms are ruled out. After two weeks of stopping the isotretinoin and starting with treatment with olanzapine 10 mg per day, there was complete remission of the psychotic symptoms. Discussion: On the onset of psychotic symptoms in an adolescent with no prior personal or family history of mental illness, the diagnosis of a secondary psychosis needs to be considered. Conclusion: Clinicians would benefit from knowing the psychiatric symptoms that could be associated with the use of this drug, as well as its suspension and specific treatment for emerging psychotic illness.

RESUMEN Introducción: La Isotreitonina, un medicamento de la familia de los retinoides ha sido utilizada para el tratamiento del acné severo. Su uso ha sido asociado con diversos síntomas psiquiátricos de tipo afectivo, psicótico y comportamental. Metodología: Reporte de caso y revisión no sistemática de la literatura relevante. Resultados: Hombre adolescente de 13 anos con insomnio, ideas delirantes, alucinaciones auditivas, luego de dos meses de tratamiento con isotretinoina. El paciente es hospital izado, se descartó el consumo de drogas psicoactivas y enfermedad sistémica que explicaran los síntomas psicóticos. Luego de dos semanas de suspender la isotretinoina y recibir tratamiento con olanzapina 10 mg al día remitieron los síntomas psicóticos. Discusión: El inicio de síntomas psicóticos en un adolescente sin antecedentes personales ni familiares de enfermedad mental exige considerar el diagnósitico de psicosis secundaria. Los clínicos se benefician de conocer los síntomas psiquiátricos que se pueden asociar con este medicamento, considerar la suspensión y el tratamiento específico para la psicopatología emergente.

Assessment of the efficacy and safety of a combination of 2 topical retinoids (RetinSphere) in maintaining post-treatment response of acne to oral isotretinoin.

INTRODUCTION: The high rate of relapse of acne lesions following oral isotretinoin treatment is a common problem which remains unsolved. To avoid or minimize relapses, topical retinoids have been used for many years as maintenance treatment. However, adverse effects frequently occur. AIMS: To determine the efficacy and safety of a new retinoid combination (Retinsphere technology) in maintaining post-treatment response to oral isotretinoin. PATIENTS AND METHODS: Prospective, randomized, double-blind and vehicle-controlled study of 30 patients with acne previously treated with isotretinoin. Treatment with the retinoid combination was applied to one side of the face and vehicle was applied to the other, once daily, for 3 months. Standardized photographs were taken using RBX technology at baseline, 1.5 months and 3 months. The primary efficacy endpoint was the appearance of relapse on the treated side compared to the vehicle-treated side. Other endpoints included lesion count, investigator-reported improvement, patient-reported improvement, impact on quality-of-life, and side effects. RESULTS: Although the majority of patients did not reach the total target dose of oral isotretinoin, the relapse rate was significantly lower on the retinoid-treated side compared to the vehicle-treated side. Likewise, improved lesion count and excellent tolerance were observed. CONCLUSIONS: This new retinoid combination (Retinsphere technology) were effective and safe as maintenance therapy after post-treatment response to oral isotretinoin in patients with acne.

Phototherapy and photochemotherapy for psoriasis.

Phototherapy is a first-line option for the treatment of moderate to severe psoriasis. Systematic reviews indicate near comparable efficacy of the different forms of phototherapy. Localized phototherapy can be an adjunctive treatment of recalcitrant plaques during systemic treatment of psoriasis. More than 200 psoralen-UV-A therapy treatment sessions is associated with an increased risk of keratinocytic cancers, whereas no increased risk has been demonstrated for narrow-band UV-B therapy. The mechanism of action of phototherapy in psoriasis is via inhibition of keratinocyte proliferation; induction of apoptosis in keratinocytes, dendritic, and T cells; and inhibition of Th1 and Th17 pathways, but activation of Th2.

Accumulation of dietary carotenoids, retinoids and tocopherol in the internal tissues of a bird: a hypothesis for the cost of producing colored ornaments.

Carotenoid-based ornaments may have evolved as a consequence of their costs of production, which would assure the reliability of the traits as signals of individual quality. Different costs due to carotenoid allocation to the signal have been proposed, considering the scarcity of these pigments at the environment (ecological cost) and their physiological properties that would trade against the maintenance of the organism. Carotenoids of many red ornaments (ketocarotenoids) are often the result of biotransformation of those pigments abundant in the diet (usually lutein and zeaxanthin). Some authors have suggested that such a conversion implies a cost relevant for signaling because it requires high levels of antioxidant vitamins in the tissues where biotransformation takes place. We explore this hypothesis in red-legged partridges (Alectoris rufa) by analyzing ketocarotenoids in the ornaments (bare parts) and carotenoids, vitamin A in different forms (free and esterified) and vitamin E in blood, liver and fat. Ketocarotenoids in ornaments (astaxanthin and papilioerythrinone) were not found in internal tissues, suggesting that they were directly transformed in the bare parts. However, ketocarotenoid levels where positively correlated with the levels of their precursors (zeaxanthin and lutein, respectively) in internal tissues. Interestingly, ketocarotenoid levels in bare parts negatively and positively correlated with vitamin A and E in the liver, respectively, the same links only being positive in blood. Moreover, retinyl and zeaxanthin levels in liver were negatively related. We hypothesize that storing substrate carotenoids in the main storage site (the liver) implies a cost in terms of regulating the level of vitamin A.

Assessment of the efficacy and tolerance of a new combination of retinoids and depigmenting agents in the treatment of melasma.

BACKGROUND: Melasma is a dermatosis with significant repercussions on patients' quality of life, and there is currently no standard treatment. Hydroquinone is deemed the treatment of choice, but its safety has been questioned in certain cases. AIMS: To determine the efficacy and safety of a new combination of retinoids in the improvement of melasma. PATIENTS/METHODS: Prospective, double-blind, vehicle-controlled, and randomized study in 30 patients with melasma. The product was applied on one side of the face and the vehicle on the other, twice daily during 3 months. Standardized photographs were taken using RBX technology on the three visits (basal, at one and a half months and at 3 months). The main variable to determine the efficacy was the improvement of the hemifacial Melasma Area Severity Index (MASI). Other variables were determined such as improvement perceived by the investigator, improvement perceived by the patient, impact on quality of life or side effects. RESULTS: The MASI improvement at 3 months of treatment was significant on the treated side vs. the vehicle side, reaching an improvement of 70%, which is comparable to the percentage of improvement described with hydroquinone. No notable side effects were detected, in spite of a significant percentage of patients included in the study citing a history that could be compatible with sensitive skin. CONCLUSIONS: This new combination of retinoids and depigmenting agents proved to be effective and safe in the treatment of melasma.

Summary of the Dutch S3-guidelines on the treatment of psoriasis 2011. Dutch Society of Dermatology and Venereology.

This document provides a summary of the Dutch S3-guidelines on the treatment of psoriasis. These guidelines were finalized in December 2011 and contain unique chapters on the treatment of psoriasis of the face and flexures, childhood psoriasis as well as the patient's perspective on treatment. They also cover the topical treatment of psoriasis, photo(chemo)therapy, conventional systemic therapy and biological therapy.

Factors associated with topical retinoid prescriptions for acne.

BACKGROUND: Topical retinoids are recommended as the main therapy for most acne patients. OBJECTIVE: To examine the factors associated with topical retinoid prescriptions for acne. METHODS: Retrospective analyses used data from the 2005-2010 National Ambulatory Medical Care Survey (NAMCS) and the 2004-2007 Marketscan Medicaid Database. Multivariate logistic regression models were used to assess the impact of patient and physician factors on the probability of getting a topical retinoid prescription. RESULTS: Results from analyzing the NAMCS data showed that topical retinoids were prescribed in 40.9% of acne-related physician visits. Older age, male gender, and having Medicaid insurance were associated with a lower likelihood of getting a topical retinoid prescription. Moreover, we found in the Medicaid dataset that seeing a pediatrician or family doctor was associated with lower odds of getting a topical retinoid prescription than seeing a dermatologist (OR = 0.24, 95% CI: 0.23, 0.25). LIMITATIONS: The available databases do not provide an assessment of the severity of the lesions either at baseline or over time. CONCLUSION: The frequency of receiving a topical retinoid prescription among acne patients was low and it was associated with age, gender, insurance type and physician specialty.

Cost-of-illness in psoriasis: comparing inpatient and outpatient therapy.

Treatment modalities of chronic plaque psoriasis have dramatically changed over the past ten years with a still continuing shift from inpatient to outpatient treatment. This development is mainly caused by outpatient availability of highly efficient and relatively well-tolerated systemic treatments, in particular BioLogicals. In addition, inpatient treatment is time- and cost-intense, conflicting with the actual burst of health expenses and with patient preferences. Nevertheless, inpatient treatment with dithranol and UV light still is a major mainstay of psoriasis treatment in Germany. The current study aims at comparing the total costs of inpatient treatment and outpatient follow-up to mere outpatient therapy with different modalities (topical treatment, phototherapy, classic systemic therapy or BioLogicals) over a period of 12 months. To this end, a retrospective cost-of-illness study was conducted on 120 patients treated at the University Medical Centre Mannheim between 2005 and 2006. Inpatient therapy caused significantly higher direct medical, indirect and total annual costs than outpatient treatment (13,042 € versus 2,984 €). Its strong influence on cost levels was confirmed by regression analysis, with total costs rising by 104.3% in case of inpatient treatment. Patients receiving BioLogicals produced the overall highest costs, whereas outpatient treatment with classic systemic antipsoriatic medications was less cost-intense than other alternatives.

Psoriasis treatments by payment type in the US outpatient office setting.

BACKGROUND: Many factors, including patients' methods of payment, may influence psoriasis treatment decisions. OBJECTIVE: To characterize psoriasis treatments by patients' types of payment in the US outpatient office setting. METHODS: Using the National Ambulatory Medical Care Survey (NAMCS), a large survey that samples outpatient office visits to US non-federally funded physicians, visits linked with sole diagnoses for psoriasis (ICD-9-CM: 696.1) were identified. There were 545 unweighted records. The types and number of treatments prescribed at these visits were categorized by expected major payment type to be used for the visit. RESULTS: Mainstay psoriasis therapies such as vitamin D analogs and clobetasol were prescribed regardless of payment type. Retinoids were also within the most frequently prescribed psoriasis medications for all payment types, however they were less frequently prescribed than vitamin D analogs. Payment type did not have a significant effect on the number of medications prescribed at psoriasis visits. LIMITATIONS: Data on treatment adherence and filling of prescriptions are not included in the NAMCS database. CONCLUSION: Prescribing patterns for psoriasis medications are similar across payment type. Additional factors appear to modulate therapy choice for patients with psoriasis.