1
|
Jiménez Gómez N, González-Cantero Á, Ruiz-Villaverde R, Llamas-Velasco M, de la Cueva Dobao P, Rivera Díaz R, Martínez Lorenzo E, Alonso Pacheco ML, Baniandrés Rodríguez O, Mollet Sánchez J, Pitarch Bort G, Izu Belloso RM, Jaén Olasolo P. Family Planning Concerns Among Women With Psoriasis: A Descriptive, Cross-Sectional, Multicenter Study. Actas Dermosifiliogr 2024; 115:10-20. [PMID: 37442420 DOI: 10.1016/j.ad.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/21/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVE A significant proportion of women of childbearing age have psoriasis. The aim of this study was to examine family planning concerns in this population. MATERIAL AND METHODS Observational, descriptive, cross-sectional, multicenter study conducted between March 2020 and October 2021. We collected sociodemographic data and analyzed responses to a family planning questionnaire administered to women aged 18 to 45 years with plaque psoriasis who were candidates for systemic treatment. RESULTS We studied 153 patients (mean [SD] age, 35.4 [8.0] years; mean disease duration, 16.7 years) being treated at 11 Spanish hospitals. Overall, 38.4% of women were considered to have moderate to severe psoriasis by their physicians; perceived severity ratings were significantly higher among women. Psoriasis affected the women's desire to become pregnant or led to their delaying pregnancy in 1 in 3 respondents. They were concerned that their condition might worsen if they had to discontinue or switch treatment or that the treatment might harm the baby. Approximately half of the women had not received family planning counseling from their physicians, and this was more likely to be the case among never-pregnant women. Women on biologic therapy (58.7%) had better psoriasis control and a better quality of life than women on other treatments. Their sexual health was also less affected. CONCLUSIONS Women with psoriasis have numerous family planning concerns, which in some cases can lead them to delay pregnancy or affect their desire to become pregnant. Dermatologists need to receive better training regarding family planning in women with psoriasis so that they can provide their patients with more and better information.
Collapse
Affiliation(s)
- N Jiménez Gómez
- Hospital Universitario Ramón y Cajal, Madrid, España; Grupo de Dermatología Pedro Jaén, Madrid, España.
| | - Á González-Cantero
- Hospital Universitario Ramón y Cajal, Madrid, España; Grupo de Dermatología Pedro Jaén, Madrid, España; Facultad de Medicina, Universidad Francisco de Vitoria, Madrid, España
| | - R Ruiz-Villaverde
- Hospital Universitario San Cecilio Granada, Instituto Biosanitario de Granada (Ibs), Granada, España
| | | | | | - R Rivera Díaz
- Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, España
| | | | | | | | | | - G Pitarch Bort
- Hospital General Universitario de Castellón, Castellón, España
| | | | - P Jaén Olasolo
- Hospital Universitario Ramón y Cajal, Madrid, España; Grupo de Dermatología Pedro Jaén, Madrid, España
| |
Collapse
|
2
|
Jiménez Gómez N, González-Cantero Á, Ruiz-Villaverde R, Llamas-Velasco M, de la Cueva Dobao P, Rivera Díaz R, Martínez Lorenzo E, Alonso Pacheco ML, Baniandrés Rodríguez O, Mollet Sánchez J, Pitarch Bort G, Izu Belloso RM, Jaén Olasolo P. [Translated article] Family Planning Concerns Among Women With Psoriasis: A Descriptive, Cross-Sectional, Multicenter Study. Actas Dermo-Sifiliográficas 2024; 115:T10-T20. [PMID: 37923069 DOI: 10.1016/j.ad.2023.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/28/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVE A significant proportion of women of childbearing age have psoriasis. The aim of this study was to examine family planning concerns in this population. MATERIAL AND METHODS Observational, descriptive, cross-sectional, multicenter study conducted between March 2020 and October 2021. We collected sociodemographic data and analyzed responses to a family planning questionnaire administered to women aged 18 to 45 years with plaque psoriasis who were candidates for systemic treatment. RESULTS We studied 153 patients (mean [SD] age, 35.4 [8.0] years; mean disease duration, 16.7 years) being treated at 11 Spanish hospitals. Overall, 38.4% of women were considered to have moderate to severe psoriasis by their physicians; perceived severity ratings were significantly higher among women. Psoriasis affected the women's desire to become pregnant or led to their delaying pregnancy in 1 in 3 respondents. They were concerned that their condition might worsen if they had to discontinue or switch treatment or that the treatment might harm the baby. Approximately half of the women had not received family planning counseling from their physicians, and this was more likely to be the case among never-pregnant women. Women on biologic therapy (58.7%) had better psoriasis control and a better quality of life than women on other treatments. Their sexual health was also less affected. CONCLUSIONS Women with psoriasis have numerous family planning concerns, which in some cases can lead them to delay pregnancy or affect their desire to become pregnant. Dermatologists need to receive better training regarding family planning in women with psoriasis so that they can provide their patients with more and better information.
Collapse
Affiliation(s)
- N Jiménez Gómez
- Hospital Universitario Ramón y Cajal, Madrid, Spain; Grupo de Dermatología Pedro Jaén, Madrid, Spain.
| | - Á González-Cantero
- Hospital Universitario Ramón y Cajal, Madrid, Spain; Grupo de Dermatología Pedro Jaén, Madrid, Spain; Facultad de Medicina, Universidad Francisco de Vitoria, Madrid, Spain
| | - R Ruiz-Villaverde
- Hospital Universitario San Cecilio Granada, Instituto Biosanitario de Granada (Ibs), Granada, Spain
| | | | | | - R Rivera Díaz
- Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | | | | | | | | | - G Pitarch Bort
- Hospital General Universitario de Castellón, Castellón, Spain
| | | | - P Jaén Olasolo
- Hospital Universitario Ramón y Cajal, Madrid, Spain; Grupo de Dermatología Pedro Jaén, Madrid, Spain
| |
Collapse
|
3
|
Salgado-Boquete L, Arias-Santiago S, Belinchón-Romero I, de la Cuadra-Grande A, de la Cueva P, Gilaberte Y, Notario J, Rivera-Díaz R, Ruiz-Villaverde R, Carrascosa JM. Selection of Quality Indicators for the Certification of Psoriasis Units: The CUDERMA Project Delphi Consensus Study. Actas Dermosifiliogr 2023; 114:865-883. [PMID: 36796538 DOI: 10.1016/j.ad.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
Defining quality indicators is a key strategy for ensuring the quality and standardization of health care. The CUDERMA project, an initiative of the Spanish Academy of Dermatology and Venerology (AEDV), was undertaken to define quality indicators for the certification of specialized units in dermatology; the first 2 areas selected were psoriasis and dermato-oncology. The aim of this study was to reach a consensus on what should be assessed by the indicators used to certify psoriasis units. The structured process used to do this comprised a literature review to identify potential indicators, the selection of an initial set of indicators to be evaluated by a multidisciplinary group of experts and, finally, a Delphi consensus study. A panel of 39 dermatologists evaluated the selected indicators and classified them as either "essential" or "of excellence". Consensus was finally reached on 67 indicators, which will be standardized and used to develop the certification standard for psoriasis units.
Collapse
Affiliation(s)
- L Salgado-Boquete
- Servicio de Dermatología, Complejo Hospitalario de Pontevedra, Pontevedra, Galicia, España
| | - S Arias-Santiago
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, Andalucía, España; Facultad de Medicina, Universidad de Granada, Granada, Andalucía, España; Instituto Biosanitario de Granada (IBS), Granada, Andalucía, España.
| | - I Belinchón-Romero
- Servicio de Dermatología, Hospital General Universitario Dr. Balmis, Alicante, Comunidad Valenciana, España; Facultad de Medicina, Universidad Miguel Hernández, Alicante, Comunidad Valenciana, España; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Comunidad Valenciana, España
| | - A de la Cuadra-Grande
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, España
| | - P de la Cueva
- Servicio de Dermatología, Hospital Universitario Infanta Leonor, Madrid, España
| | - Y Gilaberte
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, Aragón, España
| | - J Notario
- Servicio de Dermatología, Hospital Universitario de Bellvitge, Barcelona, Catalunya, España
| | - R Rivera-Díaz
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, España
| | - R Ruiz-Villaverde
- Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Andalucía, España; Instituto Biosanitario de Granada (IBS), Granada, Andalucía, España
| | - J M Carrascosa
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol (HUGTiP), Barcelona, Catalunya, España; Facultad de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalunya, España; Institut d'Investigació en Ciènces de la Salut Germans Trias i Pujol (IGTP), Barcelona, Catalunya, España
| |
Collapse
|
4
|
Foley P, Gebauer K, Sullivan J, McMeniman E, Shumack S, Ng J, James A, Rawlin M, Sidhu S, Tilakaratne D, Turner M, Radulski B, Nash P, Baker C. Australian consensus: Treatment goals for moderate to severe psoriasis in the era of targeted therapies - Adult patients. Australas J Dermatol 2023; 64:476-487. [PMID: 37501636 DOI: 10.1111/ajd.14138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/15/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Over the last decade, the treatment landscape for moderate-severe psoriasis has rapidly evolved. The Australasian College of Dermatologists sought to review and update previously published treatment goals for moderate-severe psoriasis. METHODS A modified Delphi approach was used. Comprehensive literature review and guideline evaluation resulted in the development of statements and other questions to establish current clinical practices. Two rounds of anonymous voting were undertaken, with a collaborative meeting held in between to discuss areas of discordance. Overall, consensus was defined as achievement of ≥75% agreement in the range 7-9 on a 9-point scale (1 strongly disagree; 9 strongly agree). RESULTS Consensus was achieved on 26/29 statements in round 1 and a further 20 statements in round 2. There was strong agreement to expanding the classification/definition of psoriasis severity by including a choice of metrics, incorporating quality of life measures, and widening the scope of high-impact sites. Consensus was also reached on revised treatment response criteria, which were then incorporated into a new treatment algorithm. There was discordance with the current requirement to undertake a trial with established systemic agents before accessing targeted therapy. CONCLUSION The ability of new targeted treatment options to change the narrative in psoriasis patient care can only be properly realised if challenges to timely and equitable access are addressed. The proposed framework for the assessment, classification and management of moderate-severe psoriasis aligns with international recommendations. Its adoption into Australian clinical practice is hoped to improve treatment outcomes and patients' satisfaction with their care.
Collapse
Affiliation(s)
- Peter Foley
- Skin Health Institute, Carlton, Victoria, Australia
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Kurt Gebauer
- Fremantle Dermatology, Fremantle, Western Australia, Australia
- The University of Western Australia, Nedlands, Western Australia, Australia
| | - John Sullivan
- Kareena Private Hospital, Ramsay Surgical Centre, Miranda, New South Wales, Australia
- Kingsway Dermatology & Aesthetics, Miranda, New South Wales, Australia
| | - Erin McMeniman
- Dermatology Research Centre, Princess Alexandra Hospital Southside Clinical Unit, University of Queensland, Brisbane, Queensland, Australia
| | - Stephen Shumack
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jonathan Ng
- Hobart Medical Specialists, Hobart, Tasmania, Australia
| | - Amelia James
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Morton Rawlin
- General Practitioner, Lower Templestowe, Victoria, Australia
| | - Shireen Sidhu
- Department of Dermatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Dev Tilakaratne
- Department of Dermatology, Royal Darwin Hospital, Tiwi, Northwest Territories, Australia
- Darwin Dermatology, Tiwi, Northwest Territories, Australia
| | | | - Barbara Radulski
- CNC Dermatology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Peter Nash
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Department of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Rheumatology Research Unit, Sunshine Coast, Queensland, Australia
| | - Christopher Baker
- Skin Health Institute, Carlton, Victoria, Australia
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
5
|
Salgado-Boquete L, Arias-Santiago S, Belinchón-Romero I, de la Cuadra-Grande A, de la Cueva P, Gilaberte Y, Notario J, Rivera-Díaz R, Ruiz-Villaverde R, Carrascosa JM. [Translated article] Selection of Quality Indicators for the Certification of Psoriasis Units: The CUDERMA Project Delphi Consensus Study. Actas Dermosifiliogr 2023; 114:T865-T883. [PMID: 37678630 DOI: 10.1016/j.ad.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 09/09/2023] Open
Abstract
Defining quality indicators is a key strategy for ensuring the quality and standardization of health care. The CUDERMA project, an initiative of the Spanish Academy of Dermatology and Venerology (AEDV), was undertaken to define quality indicators for the certification of specialized units in dermatology; the first 2 areas selected were psoriasis and dermato-oncology. The aim of this study was to reach a consensus on what should be assessed by the indicators used to certify psoriasis units. The structured process used to do this comprised a literature review to identify potential indicators, the selection of an initial set of indicators to be evaluated by a multidisciplinary group of experts and, finally, a Delphi consensus study. A panel of 39 dermatologists evaluated the selected indicators and classified them as either "essential" or "of excellence". Consensus was finally reached on 67 indicators, which will be standardized and used to develop the certification standard for psoriasis units.
Collapse
Affiliation(s)
- L Salgado-Boquete
- Servicio de Dermatología, Complejo Hospitalario de Pontevedra, Pontevedra, Galicia, Spain
| | - S Arias-Santiago
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, Andalucía, Spain; Facultad de Medicina, Universidad de Granada, Granada, Andalucía, Spain; Instituto Biosanitario de Granada (IBS), Granada, Andalucía, Spain.
| | - I Belinchón-Romero
- Servicio de Dermatología, Hospital General Universitario Dr. Balmis, Alicante, Comunidad Valenciana, Spain; Facultad de Medicina, Universidad Miguel Hernández, Alicante, Comunidad Valenciana, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Comunidad Valenciana, Spain
| | - A de la Cuadra-Grande
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, Spain
| | - P de la Cueva
- Servicio de Dermatología, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Y Gilaberte
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, Aragón, Spain
| | - J Notario
- Servicio de Dermatología, Hospital Universitario de Bellvitge, Barcelona, Catalunya, Spain
| | - R Rivera-Díaz
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - R Ruiz-Villaverde
- Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Andalucía, Spain; Instituto Biosanitario de Granada (IBS), Granada, Andalucía, Spain
| | - J M Carrascosa
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol (HUGTiP), Barcelona, Catalunya, Spain; Facultad de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalunya, Spain; Institut d'Investigació en Ciènces de la Salut Germans Trias i Pujol (IGTP), Barcelona, Catalunya, Spain
| |
Collapse
|
6
|
Di Cesare A, Ricceri F, Rosi E, Fastame MT, Prignano F. Therapy of PsO in Special Subsets of Patients. Biomedicines 2022; 10:2879. [PMID: 36359399 PMCID: PMC9687729 DOI: 10.3390/biomedicines10112879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/17/2022] [Accepted: 10/27/2022] [Indexed: 01/02/2024] Open
Abstract
Psoriasis is a chronic, inflammatory skin disease that may occur at any age, with a bimodal peak of incidence around the age of 16-20 years of age (early onset) and 57-60 years (late-onset). It is estimated that roughly 70% of patients develop the disease before the age of 40, which coincides with the reproductive years. Moreover, psoriasis is a chronic disease, meaning that, with increased life-duration expectancy, the number of patients affected with psoriasis aged over 65 years is going to increase and represent a big therapeutic challenge. Actually, no specific drug recommendation is available, based only on the age of the patients, while therapeutic prescription should take into account that elderly patients have more comorbidities than younger patients, with polypharmacy and an increased risk of drug interactions. Women with psoriasis are more likely to report a worse influence of the disease on their quality of life, and they are more susceptible to the development of depression. Furthermore, pregnancy and lactation represent a major contraindication to several systemic agents, and only a few studies exist providing the safety of certain drugs during these periods of life of a woman, such as certolizumab pegol. In this paper, we discuss systemic therapeutic strategies, including conventional and biological therapies, in a special subset of patients affected with moderate-to-severe psoriasis focusing on elderly patients and on female patients in fertile age, pregnancy, and lactation.
Collapse
Affiliation(s)
| | | | | | | | - Francesca Prignano
- Department of Health Sciences, Section of Dermatology, University of Florence, 50125 Florence, Italy
| |
Collapse
|
7
|
Belinchón I, Armesto S, de la Cueva P, Ferrándiz L, Rivera Díaz R, Carrascosa J. Implementación de las recomendaciones sobre las actuaciones a seguir durante la edad fértil, el embarazo, el posparto, la lactancia y el cuidado perinatal en pacientes con psoriasis. Actas Dermo-Sifiliográficas 2022; 113:666-673. [DOI: 10.1016/j.ad.2022.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/21/2022] [Accepted: 02/27/2022] [Indexed: 11/29/2022] Open
|
8
|
Belinchón I, Armesto S, de la Cueva P, Ferrándiz L, Rivera Díaz R, Carrascosa J. [Translated article] Implementation of Recommendations for the Management of Psoriasis During Preconception, Pregnancy, Postpartum, Breastfeeding, and Perinatal Care. Actas Dermo-Sifiliográficas 2022. [DOI: 10.1016/j.ad.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
9
|
Bucur Ș, Savu AP, Stănescu AMA, Șerban ED, Nicolescu AC, Constantin T, Bobircă A, Constantin MM. Oversight and Management of Women with Psoriasis in Childbearing Age. Medicina (Kaunas) 2022; 58:780. [PMID: 35744043 DOI: 10.3390/medicina58060780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/31/2022] [Accepted: 06/04/2022] [Indexed: 11/16/2022]
Abstract
Psoriasis is a complex disease with many associated comorbidities, all of which have a negative impact on a patient's personal, social, and sexual life. There are some unique considerations in the effects of this disease among women. The average age of diagnosis in women with psoriasis is 28 years, and this onset corresponds to the fertile life of women. There is conflicting information about the effects of psoriasis on female fertility. Some studies suggest that this condition's associated comorbidities, personal behaviors, and reduced ovarian reserve, especially due to chronic inflammation, affect women's fertility. Another possible reason women with psoriasis are less likely to become pregnant is that their sexual intercourse frequency decreases after the condition's onset. The available information on the effects of pregnancy on women with psoriasis is limited. According to current evidence, most women will experience an improvement in their skin condition. Studies show that patients with moderate-to-severe psoriasis are more prone to experience pregnancy complications. The management of pregnant and lactating women with psoriasis is also difficult, as the safety profile of commonly used drugs in patients with psoriasis is not entirely known.
Collapse
|
10
|
Affiliation(s)
- Philip O Anderson
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California, USA
| |
Collapse
|