Using the Localized Scleroderma Cutaneous Assessment Tool (LoSCAT) to classify morphoea by severity and identify clinically significant change.

BACKGROUND: Validated scoring measures in morphoea can facilitate clinical trials. OBJECTIVES: To ascertain the clinical significance of scores on the Localized Scleroderma Cutaneous Assessment Tool (LoSCAT) and identify the change in scores correlated with clinically meaningful change. METHODS: A prospective study of 120 participants from the Morphea in Adults and Children (MAC) cohort was undertaken. Physician's subjective assessments of severity and of improvement were completed at each visit. Receiver operating characteristic analysis determined LoSCAT scores corresponding with mild, moderate and severe disease, and absolute and percentage changes in scores corresponding with improved or worsened disease activity or damage. RESULTS: Mild, moderate and severe activity corresponded with LoSCAT activity index (LoSAI) scores of 0-4, 5-12 and 13 and over, and with Physician's Global Assessment of activity (PGA-A) scores of 0-10, 11-30 and 31 and over. Mild, moderate and severe damage corresponded with LoSCAT damage index (LoSDI) scores of 0-10, 11-15 and 16 and over, and with PGA of damage (PGA-D) scores of 0-18, 19-30 and 31 and over. Improved activity was best indicated by LoSAI decrease of at least 2 points or 27·5%, or PGA-A decrease of at least 6 points. Improved damage was best indicated by LoSDI score decrease of at least 2 points. Worsening activity was best indicated by LoSAI increase of at least 2 points or 19·5%, or PGA-A increase of at least 4 points. Worsening damage was best indicated by LoSDI increase of at least 25·5%. CONCLUSIONS: The LoSCAT can be used to classify patients with morphoea by disease severity, and identify clinically significant improvement in activity. What's already known about this topic? The Localized Scleroderma Cutaneous Assessment Tool (LoSCAT) is a clinical tool that separately quantifies disease activity and damage in morphoea, and prior studies have demonstrated validity and reliability. What does this study add? The LoSCAT can be used to classify patients with morphoea by disease severity into mild, moderate and severe groups, and to identify clinically significant improvement in disease activity in patients with morphoea. The LoSCAT may be limited in its ability to detect clinically significant changes in disease damage.

Addictive-like behaviours to ultraviolet light among frequent indoor tanners.

BACKGROUND: Frequent, purposeful exposure to ultraviolet (UV) light may induce a compulsive desire to tan despite the negative consequences being known, suggesting a behavioural complex similar to addictive disorders. AIM: To assess the presence of addictive-like behaviours in subjects using indoor tanning salons. METHODS: Subjects (n = 100) were surveyed by two questionnaires: a modified CAGE questionnaire to assess behaviours consistent with problem tanning and a modified Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) ('substance dependence' criteria) to assess behaviours consistent with a dependence-like disorder. RESULTS: In total, 41% of subjects met criteria consistent with a 'tanning addictive disorder', and an additional 33% met criteria for problematic tanning behaviour based on the modified CAGE criteria or subthreshold criteria on the modified DSM-IV criteria. Female gender and early age of onset were associated with meeting tanning addiction criteria. CONCLUSION: A high percentage of subjects who tan frequently in indoor salons experience behaviours and consequences to their tanning consistent with other identified addictive disorders.

UVA1 phototherapy is effective in darker skin: a review of 101 patients of Fitzpatrick skin types I-V.

BACKGROUND: Studies suggest ultraviolet (UV) A1 phototherapy is efficacious and safe in treating a variety of skin disorders. However, most reports evaluating the benefits of UVA1 phototherapy have been from Europe, focusing on a predominantly Caucasian population. Darker skin types have been evaluated only sparingly; none the less, it is widely held that these patients respond poorly to UVA1 phototherapy due to increased pigmentation. OBJECTIVES: We aim to compare efficacy (clinical improvement scores) of UVA1 phototherapy among Fitzpatrick skin types. METHODS: A retrospective analysis of 101 patients receiving UVA1 treatment at the University of Texas Southwestern Medical Center in Dallas, TX was performed. Data on Fitzpatrick skin type and cumulative UVA1 doses were collected. Clinical improvement scores based on body surface area, erythema, induration, sclerosis, pigmentation, and symptoms of pain or pruritus were obtained. RESULTS: In the population studied, with morphoea and scleroderma being the most frequent diagnoses, improvement scores from UVA1 phototherapy and mean cumulative UVA1 doses were not significantly different among the Fitzpatrick skin types evaluated. Furthermore, little or no correlation was found between improvement score and skin type. CONCLUSIONS: Data indicate skin pigmentation as graded by Fitzpatrick skin type does not significantly influence the efficacy of UVA1 phototherapy. Thus, UVA1 should be considered as a therapeutic option in more darkly pigmented patients.