Impact of microwave thermolysis energy levels on patient-reported outcomes for axillary hyperhidrosis and osmidrosis.

OBJECTIVE: Microwave thermolysis (MWT) is an emerging treatment for axillary hyperhidrosis reducing both sweat and odor. No prior studies have investigated and compared the different available energy settings of the MWT device. This study evaluated patient-reported outcome measures (PROMs) for axillary hyperhidrosis and osmidrosis following MWT treatment with two different energy levels. METHODS: Twenty adults with axillary hyperhidrosis and osmidrosis reported sweat on Hyperhidrosis Disease Severity scale (HDSS: 1-4) and odor on Odor scale (OS: 1-10), respectively, supplemented by overall Dermatology Life Quality Index (DLQI: 0-30). This was a prospective, randomized, patient-blinded and intraindividually controlled study with 3 months follow-up (FU). Randomization comprised MWT treatment of one axilla with a standard medium energy setting (energy level 3) and the contralateral axilla with a standard high energy setting (energy level 5). RESULTS: At baseline, patients reported substantial sweat and odor, negatively affecting their quality of life. At 3 months FU, PROMs showed improved quality of life with significantly reduced odor and sweat. Overall DLQI was reduced from a median of 10 to 4, with a median 6.5-point reduction (p = 0.0002). HDSS was reduced from a median of 4 to 2 on both sides, with a median reduction of 1 for medium energy level and 2 points for high energy level (p = 0.014). OS was reduced from a median of 8 to 3 for both energy levels, with a median reduction of 3.5 and 4.5 points for the medium and high energy level, respectively (p = 0.017). Local skin reactions were mild and transient, but slightly more pronounced following treatment with the high energy level. CONCLUSION: MWT effectively improved patients' quality of life, axillary sweat, and odor 3 months after on baseline treatment. Treatment with the high energy level presented a subtle but significant increase of efficacy based on PROMs for both sweat and odor. Patients were willing to accept a higher amount of temporary local skin reactions from a higher energy setting when experiencing greater odor and sweat reduction.

Long-term follow-up of hand eczema in hairdressers: a prospective cohort study of Danish hairdressers graduating from 1985 to 2007.

BACKGROUND: Occupational hand eczema is common among hairdressers and implementing effective preventive measures requires a good understanding of the disease's epidemiology. OBJECTIVE: To investigate the long-term development of hand eczema (HE) in hairdressers. METHODS: A prospective cohort study of all hairdressers graduating from Danish hairdressing vocational schools from 1985 to 2007 was conducted. A self-administered questionnaire was sent in 2009 with follow-up in 2020. Data from the Danish labour market supplementary pension scheme provided information on yearly affiliation with the hairdressing trade. RESULTS: The cumulative lifetime prevalence of HE increased from 42.3% at baseline to 45.2% at follow-up (odds ratio [OR], 1.1; 95% confidence interval [CI], 1.0-1.2). The incidence rate decreased from 42.8 cases/1000 person-years (95% CI, 40.8-44.8) at baseline to 3.4 cases/1000 person-years (95% CI, 2.5-4.6) within the follow-up period. HE onset occurred within 8 years of beginning an apprenticeship for >90% of cases and occurred within the apprenticeship period for 68% of cases. The risk factors associated with having had HE at baseline were a previous positive patch test (adjusted OR [aOR], 5.3; 95% CI, 4.2-6.6), a history of atopic dermatitis (aOR, 3.4; 95% CI, 2.9-4.0) and female sex (aOR, 1.8; 95% CI 1.4-2.3). The most important risk factors at follow-up were previous HE (aOR, 10.1; 95% CI, 7.3-13.8) and a positive patch test within the follow-up period (aOR, 4.5; 95% CI, 3.0-6.8). Among the hairdressers who had HE at baseline, 65.5% exhibited remission, whereas 34.6% had persistent and often severe HE at follow-up. Hairdressers with persistent HE were the subgroup of the study population most frequently affected by the risk factors identified for HE. CONCLUSIONS: Primary prevention of HE should focus on hairdressing apprentices and fully trained hairdressers who have recently graduated. Approximately one-third of trained hairdressers develop persistent and often severe HE, emphasizing the need for early intervention.

Clinical characteristics including cardiovascular and metabolic risk factors in adolescents with psoriasis.

BACKGROUND: Clinical studies on psoriasis in adolescents have mainly been performed in patients with severe psoriasis. Population-based studies of clinical characteristics and risk factors for later cardiovascular and metabolic disease in children and adolescents are lacking. OBJECTIVES: To examine the clinical characteristics of adolescents with psoriasis nested in a general population cohort. Furthermore, to investigate cardiovascular and metabolic risk factors in the adolescents with psoriasis compared to parentally predisposed and non-predisposed adolescents without psoriasis from the same birth cohort. METHODS: We identified adolescents with and without psoriasis using a nationwide general population birth cohort in Denmark. A clinical examination included skin inspection and scoring of psoriasis severity, completion of a questionnaire on psoriasis and comorbidities, physical measurements, and blood sampling. Participants also completed self-administered questionnaires on quality of life and mental health. RESULTS: We included 81 adolescents with psoriasis and 234 controls (110 with genetic predisposition for psoriasis and 124 without predisposition). Median age was 15.6 (13.5-18.5) years, and in those with active psoriasis, median Psoriasis Area and Severity Index score was 1.2 (0.1-11.4). The scalp was the most common site of psoriasis, both at debut and at time of examination. Diaper rash in infancy was more frequent in the psoriasis group. No significant differences regarding quality of life, anxiety and depression were found. More adolescents with psoriasis were obese (8.6% vs. 1.7%, P = 0.008), and physical measures of abdominal obesity were also significantly higher. HbA1c was significantly higher (31.55 vs. 30.81 mmol/mol, P = 0.048), while no differences were found for blood pressure, lipids or high-sensitivity C-reactive protein. In a subgroup analysis, this was evident in the non-predisposed psoriasis-free controls only. CONCLUSIONS: Overall, adolescents with psoriasis from this general population had mild disease. Still, early markers of cardiovascular and metabolic disease were elevated.

Localization of treatment-resistant areas in patients with psoriasis on biologics.

BACKGROUND: Traditionally, psoriasis in certain body sites such as the scalp, nails, palms, soles and intertriginous areas has been acknowledged as difficult to treat. OBJECTIVES: To investigate the body location of treatment-resistant psoriasis in patients treated with biologic agents in real-world clinical practice, and to study the association between localization and quality of life. METHODS: This was an observational, noninterventional, study. We investigated the skin and/or nail location of treatment-resistant psoriasis in patients with moderate-to-severe psoriasis treated for > 6 months with biologic agents. A partial or good response to treatment was defined as having a Psoriasis Area and Severity Index (PASI) score ≥ 1 and ≤ 5. Experienced PASI assessors used a uniform data collection form in which the body area was divided into 26 regions and 20 nails. RESULTS: We included 146 patients with chronic plaque-type psoriasis (109 men, 74·7%, mean ± SD age 49·8 ± 13·7 years), with a median PASI score of 2·4 (interquartile range 1·2-3·2). The median PASI reduction from treatment initiation was 86·1% (interquartile range 78·1-91·3). The most common site of recalcitrant psoriasis was the anterior lower leg [49·3%; 95% confidence interval (CI) 41·2-57·4]. Further common sites of recalcitrant psoriasis were the posterior lower leg (24·7%; 95% CI 17·7-31·6), elbow (35·6%; 95% CI 27·8-43·4) and the scalp (19·2%; 95% CI 12·8-25·6%). No association between Dermatology Life Quality Index and specific areas of recalcitrant psoriasis were observed. CONCLUSIONS: In real-world clinical practice, the most common sites of recalcitrant psoriasis in patients treated with biologic agents are the anterior lower leg, posterior lower leg and elbows. Recalcitrant psoriasis in no specific area caused a greater impact on quality of life than any other area.

Sleep disturbance in psoriasis: a case-controlled study.

BACKGROUND: Sleep is essential for daytime functioning and health. Given the physical symptoms of psoriasis, a higher prevalence of sleep disorders can be expected. So far, the studies examining sleep disturbance in psoriasis have been of less-than-optimal methodological quality and with mixed results. OBJECTIVES: To examine the prevalence of sleep disturbance in patients with plaque psoriasis compared with a control group, to evaluate associations with health-related quality of life (HRQoL) and examine possible disease-related predictors of disturbed sleep. METHODS: We used a cross-sectional, case-controlled design. Participants included 179 consecutively recruited patients with plaque psoriasis and 105 controls. Measures included psoriasis severity (Psoriasis Area and Severity Index); HRQoL (Dermatology Life Quality Index); insomnia severity [Insomnia Severity Index (ISI)]; sleep quality [Pittsburgh Sleep Quality Index (PSQI)]; stress (Perceived Stress Scale); itch (Itch Severity Scale); and depressive symptoms (Beck Depression Inventory). Analyses included group comparisons and regression analyses to identify predictors of sleep disturbance. RESULTS: A total of 25% of patients with psoriasis reported clinical insomnia (ISI > 15), compared with 10·5% of controls. In all, 53·6% of patients with psoriasis were poor sleepers (PSQI > 5), compared with 21·9% of controls. Itch was statistically significantly associated with all sleep-related outcomes. CONCLUSIONS: A higher proportion of patients with psoriasis experience poor sleep than controls from the general population. Itch was the main predictor of impaired sleep. Improved control of psoriasis with decreased itch may improve sleep disturbance in psoriasis.

A prospective 52-week randomized controlled trial of patient-initiated care consultations for patients with psoriasis.

BACKGROUND: Treatment and care of moderate-to-severe psoriasis require lifelong consultations with a dermatologist with close monitoring of systemic treatment. OBJECTIVES: To investigate the effect of patient-initiated care consultation (PICC) for patients with psoriasis in a dermatology outpatient clinic. METHODS: A prospective randomized controlled trial with patients on well-controlled systemic treatment randomized to either (i) the PICC group, where they participated in one annual consultation with a dermatologist but were able to initiate consultations when needed; or (ii) routine care, where they participated in a consultation every 12-16 weeks. The primary outcome was the Dermatology Life Quality Index (DLQI). Other outcomes were safety, patient adherence and satisfaction with healthcare assessed at baseline and after 52 weeks. The study was registered with clinical trials number NCT02382081. RESULTS: In total 150 patients were included, with 58·0% treated with biologics, 37·3% with methotrexate and 4·7% with acitretin. At week 52 no statistically significant mean difference between groups was detected in DLQI (0·28, 95% confidence interval -0·35 to 0·9) or Psoriasis Area and Severity Index (-0·24, 95% confidence interval -0·84 to 0·36). Patients in the PICC group requested 63% fewer consultations with a dermatologist: mean 2·5 ± 0·1 vs. 5·1 ± 0·6 (P = 0·001). Patient adherence and safety with treatment monitoring were equal between groups, but the PICC group was significantly better at attending consultations than the control group (P = 0·003). CONCLUSIONS: PICC offers additional clinical benefits over routine care, making patients less dependent on clinical visits. The intervention adds no harm to monitoring systemic treatment, and patients report high quality of life and satisfaction with healthcare.

Fragrance contact allergens in 5588 cosmetic products identified through a novel smartphone application.

BACKGROUND: More than 25% of the adult European population suffers from contact allergy, with fragrance substances recognized as one of the main causes. Since 2005, 26 fragrance contact allergens have been mandatory to label in cosmetic products within the EU if present at 10 ppm or above in leave-on and 100 ppm or above in wash-off cosmetics. OBJECTIVE: To examine exposure, based on ingredient labelling, to the 26 fragrances in a sample of 5588 fragranced cosmetic products. METHODS: The investigated products were identified through a novel, non-profit smartphone application (app), designed to provide information to consumers about chemical substances in cosmetic products. Products registered through the app between December 2015 and October 2016 were label checked according to International Nomenclature of Cosmetic Ingredients (INCI) for the presence of the 26 fragrance substances or the wording 'fragrance/parfum/aroma'. RESULTS: The largest product categories investigated were 'cream, lotion and oil' (n = 1192), 'shampoo and conditioner' (n = 968) and 'deodorants' (n = 632). Among cosmetic products labelled to contain at least one of the 26 fragrances, 85.5% and 73.9% contained at least two and at least three of the 26 fragrances, respectively. Linalool (49.5%) and limonene (48.5%) were labelled most often among all investigated products. Hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC/Lyral® ) was found in 13.5% of deodorants. Six of the 26 fragrance substances were labelled on less than one per cent of all products, including the natural extracts Evernia furfuracea (tree moss) and Evernia prunastri (oak moss). A total of 329 (5.9%) products had one or more of the 26 fragrance substances labelled but did not have 'parfum/fragrance/aroma' listed on the label. CONCLUSIONS: Consumers are widely exposed to, often multiple, well-established fragrance contact allergens through various cosmetic products intended for daily use. Several fragrance substances that are common causes of contact allergy were rarely labelled in this large sample of cosmetic products.

The association between atopic dermatitis and hand eczema: a systematic review and meta-analysis.

BACKGROUND: Atopic dermatitis (AD) and hand eczema (HE) are common chronic and relapsing inflammatory skin conditions that often co-occur. OBJECTIVES: While several studies have addressed their relationship, the exact association estimate is unknown. METHODS: We systematically reviewed published literature on the association between AD and HE in PubMed, Embase and Web of Science using the following search terms: (atopic dermatitis OR atopic eczema) AND (hand dermatitis OR hand eczema). Meta-analyses were then performed to examine the association between AD and the point, 1-year and lifetime prevalence of HE, respectively. RESULTS: We identified 35 relevant studies, of which 26 were included in the meta-analyses. AD was associated with an increased prevalence of HE with regard to point [odds ratio (OR) 2·35; 95% confidence interval (CI) 1·47-3·76], 1-year (OR 4·29; 95% CI 3·13-5·88) and lifetime prevalence (OR 4·06; 95% CI 2·72-6·06). Furthermore, positive associations between AD and occupational HE were identified when assessing the 1-year (OR 4·31; 95% CI 2·08-8·91) and lifetime prevalence (OR 2·81; 95% CI 2·08-3·79). Similar positive associations were found in the general population studies, i.e. OR 4·19 (95% CI 3·46-5·08) and OR 5·69 (95% CI 4·41-7·36). CONCLUSIONS: Important study limitations include the wide use of questionnaire studies, and lack of prospective studies as well as poor clinical phenotype descriptions. In conclusion, our systematic review and meta-analysis showed that patients with AD had a strongly increased prevalence of HE. Clinicians should continue to guide patients with AD away from occupations with a high risk of HE.