Vitiligo Health Education: A Study of Accuracy and Engagement of Online Educational Materials.

INTRODUCTION: Many vitiligo patients seek healthcare information online. However, the accuracy and quality of this information is unknown. OBJECTIVE: To determine the accuracy, quality, viewer engagement, and viewer experience of vitiligo videos on social media. METHODS: We searched the term “vitiligo” on YouTube. Videos were stratified based on source categories. Video accuracy was assessed using DAS and ANDI. Video quality was assessed using GQS. Viewer experience was assessed using AVA. RESULTS: Sixty videos were evaluated for inclusion and exclusion criteria. We evaluated 49 videos with a total of 28.2 million views, 431,416 likes, and 61,976 comments. Of these videos, 27 (55%) were from healthcare sources, and 22 (45%) were from non-healthcare sources. When compared to videos from non-healthcare sources, videos from healthcare sources had significantly higher accuracy scores (ANDI = 3.69 ± 0.16 vs 2.77 ± 0.36; P=0.017 and DAS = 3.72 ± 0.13 vs 3.07 ± 0.28; P=0.029) but significantly fewer views (38,883 vs 1,231,947; P=0.005). Videos from alternative medicine sources had the lowest accuracy scores when compared to the remainder of the videos (ANDI = 0.5 ± 0.13 vs 3.66 ± 0.14; P<0.001 and DAS = 1.25 ± 0.11 vs 3.73 ± 0.11; P<0.001). CONCLUSION: Inaccurate videos on vitiligo are prevalent on social media. Misinformation can lead to potentially harmful interventions and delay in seeking evidence-based care. Videos from healthcare sources were more accurate but were viewed less than those from non-healthcare sources. Further efforts are needed to improve the visibility and viewer experience of accurate healthcare content on social media. J Drugs Dermatol. 2021;20(6):623-629. doi:10.36849/JDD.5835.

Pathophysiology, Clinical Presentation, and Treatment of Psoriasis: A Review.

IMPORTANCE: Approximately 125 million people worldwide have psoriasis. Patients with psoriasis experience substantial morbidity and increased rates of inflammatory arthritis, cardiometabolic diseases, and mental health disorders. OBSERVATIONS: Plaque psoriasis is the most common variant of psoriasis. The most rapid advancements addressing plaque psoriasis have been in its pathogenesis, genetics, comorbidities, and biologic treatments. Plaque psoriasis is associated with a number of comorbidities including psoriatic arthritis, cardiometabolic diseases, and depression. For patients with mild psoriasis, topical agents remain the mainstay of treatment, and they include topical corticosteroids, vitamin D analogues, calcineurin inhibitors, and keratolytics. The American Academy of Dermatology-National Psoriasis Foundation guidelines recommend biologics as an option for first-line treatment of moderate to severe plaque psoriasis because of their efficacy in treating it and acceptable safety profiles. Specifically, inhibitors to tumor necrosis factor α (TNF-α) include etanercept, adalimumab, certolizumab, and infliximab. Other biologics inhibit cytokines such as the p40 subunit of the cytokines IL-12 and IL-13 (ustekinumab), IL-17 (secukinumab, ixekizumab, bimekizumab, and brodalumab), and the p19 subunit of IL-23 (guselkumab, tildrakizumab, risankizumab, and mirikizumab). Biologics that inhibit TNF-α, p40IL-12/23, and IL-17 are also approved for the treatment of psoriatic arthritis. Oral treatments include traditional agents such as methotrexate, acitretin, cyclosporine, and the advanced small molecule apremilast, which is a phosphodiesterase 4 inhibitor. The most commonly prescribed light therapy used to treat plaque psoriasis is narrowband UV-B phototherapy. CONCLUSIONS AND RELEVANCE: Psoriasis is an inflammatory skin disease that is associated with multiple comorbidities and substantially diminishes patients' quality of life. Topical therapies remain the cornerstone for treating mild psoriasis. Therapeutic advancements for moderate to severe plaque psoriasis include biologics that inhibit TNF-α, p40IL-12/23, IL-17, and p19IL-23, as well as an oral phosphodiesterase 4 inhibitor.