1
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Jin JQ, Hong J, Elhage KG, Braun M, Spencer RK, Chung M, Yeroushalmi S, Hadeler E, Mosca M, Bartholomew E, Hakimi M, Davis MS, Thibodeaux Q, Wu D, Kahlon A, Dhaliwal P, Mathes EF, Dhaliwal N, Bhutani T, Liao W. Development of SkinTracker, an integrated dermatology mobile app and web portal enabling remote clinical research studies. Front Digit Health 2023; 5:1228503. [PMID: 37744686 PMCID: PMC10516539 DOI: 10.3389/fdgth.2023.1228503] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction In-person dermatology clinical research studies often face recruitment and participation challenges due to travel-, time-, and cost-associated barriers. Studies incorporating virtual/asynchronous formats can potentially enhance research subject participation and satisfaction, but few mobile health tools are available to enable remote study conduct. We developed SkinTracker, a patient-facing mobile app and researcher-facing web platform, that enables longitudinal collection of skin photos, patient reported outcomes, and biometric health and environmental data. Methods Eight design thinking sessions including dermatologists, clinical research staff, software engineers, and graphic designers were held to create the components of SkinTracker. Following iterative prototyping, SkinTracker was piloted across six adult and four pediatric subjects with atopic dermatitis (AD) of varying severity levels to test and provide feedback on SkinTracker for six months. Results The SkinTracker app enables collection of informed consent for study participation, baseline medical history, standardized skin photographs, patient-reported outcomes (e.g., Patient Oriented Eczema Measure (POEM), Pruritus Numerical Rating Scale (NRS), Dermatology Life Quality Index (DLQI)), medication use, adverse events, voice diary to document qualitative experiences, chat function for communication with research team, environmental and biometric data such as exercise and sleep metrics through integration with an Apple Watch. The researcher web portal allows for management and visualization of subject enrollment, skin photographs for examination and severity scoring, survey completion, and other patient modules. The pilot study requested that subjects complete surveys and photographs on a weekly to monthly basis via the SkinTracker app. Afterwards, participants rated their experience in a 7-item user experience survey covering app function, design, and desire for participation in future studies using SkinTracker. Almost all subjects agreed or strongly agreed that SkinTracker enabled more convenient participation in skin research studies compared to an in-person format. Discussion To our knowledge, SkinTracker is one of the first integrated app- and web-based platforms allowing collection and management of data commonly obtained in clinical research studies. SkinTracker enables detailed, frequent capture of data that may better reflect the fluctuating course of conditions such as AD, and can be modularly customized for different skin conditions to improve dermatologic research participation and patient access.
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Affiliation(s)
- Joy Q. Jin
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Julie Hong
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Kareem G. Elhage
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Mitchell Braun
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Riley K. Spencer
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Mimi Chung
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Samuel Yeroushalmi
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Edward Hadeler
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Megan Mosca
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Erin Bartholomew
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Marwa Hakimi
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Mitchell S. Davis
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Quinn Thibodeaux
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - David Wu
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | | | | | - Erin F. Mathes
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | | | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Wilson Liao
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
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Mahama A, Kojder P, Thibodeaux Q, Ruth J. Reactive infectious mucocutaneous eruption following COVID-19 in an adolescent boy: Case report and review of the literature. Pediatr Dermatol 2023; 40:162-165. [PMID: 36042536 PMCID: PMC9538754 DOI: 10.1111/pde.15122] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/08/2022] [Indexed: 01/25/2023]
Abstract
Reactive infectious mucocutaneous eruption (RIME) is a mucosal-predominant eruption that usually affects two or more mucosal sites. We present a case of RIME secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and provide a brief review of the literature with a focus on the natural history and response to treatment. This entity may require inpatient management and systemic corticosteroids for symptom control in the pediatric population.
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Affiliation(s)
- Ayisha Mahama
- University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Priscilla Kojder
- Division of Dermatology and Dermatologic Surgery, Department of Internal Medicine, University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Quinn Thibodeaux
- Division of Dermatology and Dermatologic Surgery, Department of Internal Medicine, University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Jennifer Ruth
- Division of Pediatric Dermatology, Department of Pediatrics, University of Texas at Austin Dell Medical School, Austin, Texas, USA
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3
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Bur D, Thibodeaux Q, Keeling B. Verrucous Melanoma Presenting as a Cutaneous Horn. Am J Dermatopathol 2022; 44:e106-e107. [PMID: 35642969 DOI: 10.1097/dad.0000000000002222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Verrucous malignant melanoma (MM) is a rare variant of melanoma that often presents diagnostic challenges. This case highlights the unique presentation of verrucous MM underlying a cutaneous horn. It is vital for dermatologists to be aware of this potentially benign-appearing variant to be able to diagnose and treat MM early on.
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Affiliation(s)
- Delfina Bur
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX; and
| | - Quinn Thibodeaux
- Department of Dermatology, The University of Texas at Austin Dell Medical School, Austin, TX
| | - Brett Keeling
- Department of Dermatology, The University of Texas at Austin Dell Medical School, Austin, TX
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Myers B, Reddy V, Chan S, Thibodeaux Q, Brownstone N, Koo J. Optimizing doxepin therapy in dermatology: introducing blood level monitoring and genotype testing. J DERMATOL TREAT 2022; 33:87-93. [PMID: 32347140 DOI: 10.1080/09546634.2020.1762841] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Doxepin, a tricyclic antidepressant, is the most efficacious antipruritic available to dermatologists; however its use is often suboptimal because of significant interindividual variability in doxepin plasma levels and clinical response between patients taking the same dose. As result, the Food and Drug Administration approves a maximum dose of 300 mg of doxepin per day and a 10 mg per cc liquid doxepin concentrate. These allow patients to significantly increase or decrease their dose, due to either a lack of clinical efficacy or side effects at typical dermatologic doses (often 10-25 mg per day). This review initially discusses the unique advantages of doxepin in dermatology. Then, it explores internal and external reasons why doxepin plasma levels and clinical response vary so significantly between patients, including genetic polymorphisms, drug interactions, comorbidities, sex, and ethnicity. Blood level monitoring is introduced, a tool dermatologists can use to optimize doxepin dosing in patients responding subtherapeutically to typical dermatologic doses. Without blood level monitoring, patients initially unresponsive to treatment could be labeled treatment failures when in fact they may be cases of inadequate dosing. Blood level monitoring allows for safe dose adjustments in these individuals to maximize patients' chances of achieving therapeutic success with this agent.
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Affiliation(s)
- Bridget Myers
- Dermatology, University of California, San Francisco, CA, USA
| | - Vidhatha Reddy
- Dermatology, University of California, San Francisco, CA, USA
| | - Stephanie Chan
- Dermatology, University of California, San Francisco, CA, USA
| | | | | | - John Koo
- Dermatology, University of California, San Francisco, CA, USA
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5
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Liu J, Chang HW, Grewal R, Cummins DD, Bui A, Beck KM, Sekhon S, Yan D, Huang ZM, Schmidt TH, Yang EJ, Sanchez IM, Nakamura M, Bhattarai S, Thibodeaux Q, Ahn R, Pauli M, Bhutani T, Rosenblum MD, Liao W. Transcriptomic Profiling of Plaque Psoriasis and Cutaneous T-Cell Subsets during Treatment with Secukinumab. JID Innov 2021; 2:100094. [PMID: 35757784 PMCID: PMC9214344 DOI: 10.1016/j.xjidi.2021.100094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 07/03/2021] [Accepted: 07/29/2021] [Indexed: 01/01/2023] Open
Abstract
The IL-17A inhibitor secukinumab is efficacious for the treatment of psoriasis. To better understand its mechanism of action, we investigated its impact on psoriatic lesions from 15 patients with moderate-to-severe plaque psoriasis undergoing secukinumab treatment. We characterized the longitudinal transcriptomic changes of whole lesional skin tissue as well as cutaneous CD4+ and CD8+ T effector cells and CD4+ T regulatory cells across 12 weeks of treatment. Secukinumab was clinically effective and reduced disease-associated overexpression of IL17A , IL17F, IL23A, IL23R, and IFNG in whole tissue as soon as 2 weeks after initiation of treatment. IL17A overexpression in T-cell subsets, primarily CD8+ T cells, was also reduced. Although secukinumab treatment resolved 89‒97% of psoriasis-associated expression differences in bulk tissue and T-cell subsets by week 12 of treatment, we observed expression differences involved in IFN signaling and metallothionein synthesis that remained unresolved at this time point as well as potential treatment-associated expression differences involved in IL-15 signaling. These changes were accompanied by shifts in broader immune cell composition on the basis of deconvolution of RNA-sequencing data. In conclusion, our study reveals several phenotypic and cellular changes within the lesion that underlie clinical improvement from secukinumab.
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Affiliation(s)
- Jared Liu
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Hsin-Wen Chang
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Robby Grewal
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Daniel D. Cummins
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Audrey Bui
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Kristen M. Beck
- Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Sahil Sekhon
- Department of Dermatology, Howard University, Washington, District of Columbia, USA
| | - Di Yan
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA
| | - Zhi-Ming Huang
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Timothy H. Schmidt
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Eric J. Yang
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Isabelle M. Sanchez
- Department of Dermatology, College of Medicine, University of Illinois, Chicago, Illinois, USA
| | - Mio Nakamura
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Shrishti Bhattarai
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Quinn Thibodeaux
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Richard Ahn
- Institute for Quantitative & Computational Biosciences, University of California Los Angeles, Los Angeles, California, USA
| | - Mariela Pauli
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Tina Bhutani
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Michael D. Rosenblum
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA,Correspondence: Wilson Liao, Department of Dermatology, University of California San Francisco, 2340 Sutter Street, Box 0808, San Francisco, California 94143, USA.
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Brownstone ND, Reddy V, Thibodeaux Q, Myers B, Chan S, Liao W, Bhutani T. Dupilumab-Induced Facial Flushing After Alcohol Consumption. Cutis 2021; 108:106-107. [PMID: 34735321 DOI: 10.12788/cutis.0316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Dupilumab is a biologic agent approved by the US Food and Drug Administration for the treatment of atopic dermatitis (AD). Here, we report 2 patients with AD who were treated with dupilumab and subsequently developed facial flushing after consuming alcohol. A possible mechanism of action for this side effect is discussed along with a potential role of dupilumab.
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Affiliation(s)
- Nicholas D Brownstone
- From the Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco
| | - Vidhatha Reddy
- From the Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco
| | - Quinn Thibodeaux
- From the Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco
| | - Bridget Myers
- From the Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco
| | - Stephanie Chan
- From the Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco
| | - Wilson Liao
- From the Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco
| | - Tina Bhutani
- From the Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco
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7
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Myers B, Reddy V, Brownstone N, Chan S, Thibodeaux Q, Koo J. The use of Goeckerman therapy in managing erythrodermic psoriasis resistant to multiple medications. Dermatol Online J 2021; 27:13030/qt4f8182b1. [PMID: 33818983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 06/12/2023] Open
Abstract
Erythrodermic psoriasis is a relatively rare, more dangerous inflammatory variant of psoriasis associated with high morbidity and mortality. It can be exceptionally challenging to manage, defeating even the most experienced dermatologist's arsenal of treatment strategies. Goeckerman therapy, a regimen of ultraviolet B phototherapy and crude coal tar, has demonstrable efficacy in severe and recalcitrant plaque-type psoriasis. However, its utility in erythrodermic psoriasis has not been explored within the dermatology literature. Herein, we present a patient with a long-standing history of erythrodermic psoriasis refractory to eleven treatment modalities including four biologic agents, who had his erythroderma 'turned around' following Goeckerman therapy. 'Turned around' is used to describe dramatically reducing a patient's cutaneous inflammation so that previously recalcitrant disease can now respond to maintenance therapy. The importance of a one to three week 'cool down' period of topical corticosteroid therapy prior to phototherapy or crude coal tar use is highlighted in this case as well. Although Goeckerman therapy is no longer regularly used, it remains one of the most efficacious treatments available for intractable psoriasis, attracting patients from all over the country desperate for symptom relief. This case suggests it may be useful in 'turning around' extremely difficult-to-treat erythrodermic psoriasis as well.
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Affiliation(s)
| | | | | | | | | | - John Koo
- Department of Dermatology, University of California San Francisco, San Francisco, CA.
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Thibodeaux Q, Beck K, Lockshin BN, Bhatia N, Levin E, Koo J, Bhutani T. Treatment of Plaque Psoriasis With an Excimer Laser Utilizing an Optimal Therapeutic UVB Dose Protocol. J Drugs Dermatol 2021; 19:49-354. [PMID: 32272510 DOI: 10.36849/jdd.2020.4891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: Traditionally, treatment with the excimer laser requires determining the minimal erythema dose on healthy skin or using plaque-based induration; however, these protocols often lead to underdosing of psoriatic plaques and reduced treatment efficacy. Objective: To prospectively evaluate the effect of the excimer laser on plaque psoriasis using an optimal therapeutic dose (OTD) protocol. Methods: Subjects with stable plaque psoriasis were tested with the Multi-Microdose (MMD) tip on the XTRAC excimer laser to determine a minimum blistering dose (MBD). Treatment was then initiated at 20% less than the MBD. A single psoriatic lesion was treated once weekly for up to 11 sessions. The change from baseline of the target lesion's modified psoriasis area severity index (mPASI), quality of life and safety were evaluated. Results: Thirteen subjects with a mean age of 48.9±14.9 years and Fitzpatrick skin types I-IV participated in the study. Target plaque mPASI significantly decreased at all time points relative to baseline with significant improvement by the second treatment. Patients reached mPASI-75 within 5±2 sessions. By the end of the study 92% of patients achieved mPASI-75. On average, patients maintained an mPASI score ≥50% for 60 days. Treatment was well tolerated with no erosions or hyperpigmentation. Erythema was the most common adverse event. Conclusion: The OTDTM protocol with the MMD® tip allows determining the optimal dose locally on the psoriatic plaque itself. Consequently, ineffectual dosing levels and treatments are minimized. The OTD protocol reduces treatment frequency from 2-3 times per week to once weekly. J Drugs Dermatol. 2020;19(4):349-354. doi:10.36849/JDD.2020.4891.
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Sanchez DP, Brownstone N, Thibodeaux Q, Reddy V, Myers B, Chan S, Bhutani T. Prescribing Isotretinoin for Transgender Patients: A Call to Action and Recommendations. J Drugs Dermatol 2021; 20:106-108. [PMID: 33400408 DOI: 10.36849/jdd.5400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Case Scenerio: A 26-year-old patient presents to the dermatology clinic with severe nodulocystic scarring acne. The patient identifies as a transgender male and notes that he has been receiving hormone replacement therapy for the past 4 years with weekly intramuscular testosterone injections.
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Myers B, Thibodeaux Q, Reddy V, Chan S, Brownstone N, Liao W, Bhutani T. Biologic Treatment of 4 HIV-Positive Patients: A Case Series and Literature Review. J Psoriasis Psoriatic Arthritis 2021; 6:19-26. [PMID: 35784673 PMCID: PMC9249044 DOI: 10.1177/2475530320954279] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
UNLABELLED The management of psoriatic disease in human immunodeficiency virus (HIV)-positive patients is challenging. Psoriasis in HIV-positive patients is often severe, progressive, and resistant to first- and second-line therapies, including topical treatments, phototherapy, highly active antiretroviral therapy (HAART), and oral retinoids. Other systemic agents used to treat psoriasis, such as methotrexate and cyclosporine, are immunosuppressants and thus many dermatologists may not feel comfortable prescribing them to HIV-positive patients who are already immunocompromised. Biologic agents, which target specific aspects of overactive immune pathways in psoriasis, have revolutionized the management of moderate-to-severe psoriasis. However, data is limited regarding their safety and efficacy in HIV-positive patients. OBJECTIVE Report four cases of HIV-positive patients managed on biologic therapy and summarize the cases of psoriasis in HIV-positive patients managed on biologic therapy that have been published in dermatologic literature to date. METHODS We searched PubMed and Embase databases using the terms HIV and psoriasis or HIV and psoriatic arthritis combined with one of the eleven biologics currently approved for treating psoriasis. RESULTS We identified 48 cases of anti-psoriasis biologic therapy (including adalimumab, infliximab, etanercept, ustekinumab, and guselkumab) in HIV-positive patients and added four. While data is limited, the evidence available suggests biologic agents are safe and efficacious in moderate-to-severe psoriasis and may even have a favorable effect on CD4 and HIV viral counts when used with concomitant HAART. CONCLUSION Further research would be helpful to establish practical guidelines for the use of anti-psoriasis biologic therapy in the HIV population, including that of newer agents.
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Affiliation(s)
- Bridget Myers
- University of California, San Francisco, Department of Dermatology, San Francisco, CA
| | - Quinn Thibodeaux
- University of California, San Francisco, Department of Dermatology, San Francisco, CA
| | - Vidhatha Reddy
- University of California, San Francisco, Department of Dermatology, San Francisco, CA
| | - Stephanie Chan
- University of California, San Francisco, Department of Dermatology, San Francisco, CA
| | - Nicholas Brownstone
- University of California, San Francisco, Department of Dermatology, San Francisco, CA
| | - Wilson Liao
- University of California, San Francisco, Department of Dermatology, San Francisco, CA
| | - Tina Bhutani
- University of California, San Francisco, Department of Dermatology, San Francisco, CA
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Myers B, Reddy V, Brownstone N, Chan S, Thibodeaux Q, Koo J. The use of Goeckerman therapy in managing erythrodermic psoriasis resistant to multiple medications. Dermatol Online J 2021. [DOI: 10.5070/d3272052387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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12
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Affiliation(s)
- Stephanie Chan
- Department of Dermatology, University of California, San Francisco, California
| | - Vidhatha Reddy
- Department of Dermatology, University of California, San Francisco, California
| | - Bridget Myers
- Department of Dermatology, University of California, San Francisco, California
| | - Nicholas Brownstone
- Department of Dermatology, University of California, San Francisco, California
| | - Quinn Thibodeaux
- Department of Dermatology, University of California, San Francisco, California
| | - John Koo
- Department of Dermatology, University of California, San Francisco, California
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13
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Rivera-Oyola R, Stanger R, Litchman GH, Thibodeaux Q, Koo J, Fried R, Goldenberg G, Han G, Hsu S, Kircik L, Knuckles M, Murina A, Weinberg J, Wu JJ, Lebwohl M. The Use of Brodalumab in Three Patients with Psoriasis and Psychiatric Comorbidities. J Clin Aesthet Dermatol 2020; 13:44-48. [PMID: 33488920 PMCID: PMC7819587] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Brodalumab, a first-in-class interleukin-17 (IL-17) receptor blocker, carries a black box warning for suicidal ideation and behavior, yet it is also one of the most powerful biologic agents in our armamentarium. We wish to highlight three patients with moderate-to-severe psoriasis and comorbid depression who were successfully treated with brodalumab. The patients were chosen by an expert panel comprising dermatologists, psychiatrists, and psychologists. Psoriasis disease severity was measured using the Psoriasis Area and Severity Index (PASI) score. All three patients experienced PASI 100 after treatment with brodalumab (N=3). Importantly, depressive symptoms improved or resolved in two out of three patients. One patient, who had a history of psychiatric hospitalizations, required in-patient psychiatric treatment during treatment. The use of brodalumab in patients with psoriasis can provide rapid-onset improvement in both skin and depressive symptoms.
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Affiliation(s)
- Ryan Rivera-Oyola
- Mr. Rivera-Oyola and Drs. Stanger, Goldenberg, Han, Kircik, Weinberg, and Lebwohl are with the Icahn School of Medicine at Mt. Sinai Hospital in the Department of Dermatology in New York, New York
- Dr. Litchman is with the National Society for Cutaneous Medicine in New York, New York
- Drs. Thibodeaux and Koo are with the University of California San Francisco in their Department of Dermatology in San Francisco, California
- Dr. Fried is with Yardley Dermatology Associates and Yardley Clinical Research Associates in Yardley, Pennsylvania
- Dr. Hsu is with Temple University's Lewis Katz School of Medicine in their Department of Dermatology in Philadelphia, Pennsylvania
- Dr. Knuckles is with M. L. F. Knuckles Dermatology in Corbin and Richmond, Kentucky and AdventHealth Hospital in Manchester, Kentucky
- Dr. Murina is with Tulane University's School of Medicine in their Department of Dermatology in New Orleans, Louisiana
- Dr. Wu is with the Dermatology Research and Education Foundation in Irvine, California
- Dr. Goldenberg is also with Goldenberg Dermatology in New York, New York
- Dr. Kircik is also with Indiana University Medical Center in Indianapolis, Indiana
| | - Roselyn Stanger
- Mr. Rivera-Oyola and Drs. Stanger, Goldenberg, Han, Kircik, Weinberg, and Lebwohl are with the Icahn School of Medicine at Mt. Sinai Hospital in the Department of Dermatology in New York, New York
- Dr. Litchman is with the National Society for Cutaneous Medicine in New York, New York
- Drs. Thibodeaux and Koo are with the University of California San Francisco in their Department of Dermatology in San Francisco, California
- Dr. Fried is with Yardley Dermatology Associates and Yardley Clinical Research Associates in Yardley, Pennsylvania
- Dr. Hsu is with Temple University's Lewis Katz School of Medicine in their Department of Dermatology in Philadelphia, Pennsylvania
- Dr. Knuckles is with M. L. F. Knuckles Dermatology in Corbin and Richmond, Kentucky and AdventHealth Hospital in Manchester, Kentucky
- Dr. Murina is with Tulane University's School of Medicine in their Department of Dermatology in New Orleans, Louisiana
- Dr. Wu is with the Dermatology Research and Education Foundation in Irvine, California
- Dr. Goldenberg is also with Goldenberg Dermatology in New York, New York
- Dr. Kircik is also with Indiana University Medical Center in Indianapolis, Indiana
| | - Graham H Litchman
- Mr. Rivera-Oyola and Drs. Stanger, Goldenberg, Han, Kircik, Weinberg, and Lebwohl are with the Icahn School of Medicine at Mt. Sinai Hospital in the Department of Dermatology in New York, New York
- Dr. Litchman is with the National Society for Cutaneous Medicine in New York, New York
- Drs. Thibodeaux and Koo are with the University of California San Francisco in their Department of Dermatology in San Francisco, California
- Dr. Fried is with Yardley Dermatology Associates and Yardley Clinical Research Associates in Yardley, Pennsylvania
- Dr. Hsu is with Temple University's Lewis Katz School of Medicine in their Department of Dermatology in Philadelphia, Pennsylvania
- Dr. Knuckles is with M. L. F. Knuckles Dermatology in Corbin and Richmond, Kentucky and AdventHealth Hospital in Manchester, Kentucky
- Dr. Murina is with Tulane University's School of Medicine in their Department of Dermatology in New Orleans, Louisiana
- Dr. Wu is with the Dermatology Research and Education Foundation in Irvine, California
- Dr. Goldenberg is also with Goldenberg Dermatology in New York, New York
- Dr. Kircik is also with Indiana University Medical Center in Indianapolis, Indiana
| | - Quinn Thibodeaux
- Mr. Rivera-Oyola and Drs. Stanger, Goldenberg, Han, Kircik, Weinberg, and Lebwohl are with the Icahn School of Medicine at Mt. Sinai Hospital in the Department of Dermatology in New York, New York
- Dr. Litchman is with the National Society for Cutaneous Medicine in New York, New York
- Drs. Thibodeaux and Koo are with the University of California San Francisco in their Department of Dermatology in San Francisco, California
- Dr. Fried is with Yardley Dermatology Associates and Yardley Clinical Research Associates in Yardley, Pennsylvania
- Dr. Hsu is with Temple University's Lewis Katz School of Medicine in their Department of Dermatology in Philadelphia, Pennsylvania
- Dr. Knuckles is with M. L. F. Knuckles Dermatology in Corbin and Richmond, Kentucky and AdventHealth Hospital in Manchester, Kentucky
- Dr. Murina is with Tulane University's School of Medicine in their Department of Dermatology in New Orleans, Louisiana
- Dr. Wu is with the Dermatology Research and Education Foundation in Irvine, California
- Dr. Goldenberg is also with Goldenberg Dermatology in New York, New York
- Dr. Kircik is also with Indiana University Medical Center in Indianapolis, Indiana
| | - John Koo
- Mr. Rivera-Oyola and Drs. Stanger, Goldenberg, Han, Kircik, Weinberg, and Lebwohl are with the Icahn School of Medicine at Mt. Sinai Hospital in the Department of Dermatology in New York, New York
- Dr. Litchman is with the National Society for Cutaneous Medicine in New York, New York
- Drs. Thibodeaux and Koo are with the University of California San Francisco in their Department of Dermatology in San Francisco, California
- Dr. Fried is with Yardley Dermatology Associates and Yardley Clinical Research Associates in Yardley, Pennsylvania
- Dr. Hsu is with Temple University's Lewis Katz School of Medicine in their Department of Dermatology in Philadelphia, Pennsylvania
- Dr. Knuckles is with M. L. F. Knuckles Dermatology in Corbin and Richmond, Kentucky and AdventHealth Hospital in Manchester, Kentucky
- Dr. Murina is with Tulane University's School of Medicine in their Department of Dermatology in New Orleans, Louisiana
- Dr. Wu is with the Dermatology Research and Education Foundation in Irvine, California
- Dr. Goldenberg is also with Goldenberg Dermatology in New York, New York
- Dr. Kircik is also with Indiana University Medical Center in Indianapolis, Indiana
| | - Richard Fried
- Mr. Rivera-Oyola and Drs. Stanger, Goldenberg, Han, Kircik, Weinberg, and Lebwohl are with the Icahn School of Medicine at Mt. Sinai Hospital in the Department of Dermatology in New York, New York
- Dr. Litchman is with the National Society for Cutaneous Medicine in New York, New York
- Drs. Thibodeaux and Koo are with the University of California San Francisco in their Department of Dermatology in San Francisco, California
- Dr. Fried is with Yardley Dermatology Associates and Yardley Clinical Research Associates in Yardley, Pennsylvania
- Dr. Hsu is with Temple University's Lewis Katz School of Medicine in their Department of Dermatology in Philadelphia, Pennsylvania
- Dr. Knuckles is with M. L. F. Knuckles Dermatology in Corbin and Richmond, Kentucky and AdventHealth Hospital in Manchester, Kentucky
- Dr. Murina is with Tulane University's School of Medicine in their Department of Dermatology in New Orleans, Louisiana
- Dr. Wu is with the Dermatology Research and Education Foundation in Irvine, California
- Dr. Goldenberg is also with Goldenberg Dermatology in New York, New York
- Dr. Kircik is also with Indiana University Medical Center in Indianapolis, Indiana
| | - Gary Goldenberg
- Mr. Rivera-Oyola and Drs. Stanger, Goldenberg, Han, Kircik, Weinberg, and Lebwohl are with the Icahn School of Medicine at Mt. Sinai Hospital in the Department of Dermatology in New York, New York
- Dr. Litchman is with the National Society for Cutaneous Medicine in New York, New York
- Drs. Thibodeaux and Koo are with the University of California San Francisco in their Department of Dermatology in San Francisco, California
- Dr. Fried is with Yardley Dermatology Associates and Yardley Clinical Research Associates in Yardley, Pennsylvania
- Dr. Hsu is with Temple University's Lewis Katz School of Medicine in their Department of Dermatology in Philadelphia, Pennsylvania
- Dr. Knuckles is with M. L. F. Knuckles Dermatology in Corbin and Richmond, Kentucky and AdventHealth Hospital in Manchester, Kentucky
- Dr. Murina is with Tulane University's School of Medicine in their Department of Dermatology in New Orleans, Louisiana
- Dr. Wu is with the Dermatology Research and Education Foundation in Irvine, California
- Dr. Goldenberg is also with Goldenberg Dermatology in New York, New York
- Dr. Kircik is also with Indiana University Medical Center in Indianapolis, Indiana
| | - George Han
- Mr. Rivera-Oyola and Drs. Stanger, Goldenberg, Han, Kircik, Weinberg, and Lebwohl are with the Icahn School of Medicine at Mt. Sinai Hospital in the Department of Dermatology in New York, New York
- Dr. Litchman is with the National Society for Cutaneous Medicine in New York, New York
- Drs. Thibodeaux and Koo are with the University of California San Francisco in their Department of Dermatology in San Francisco, California
- Dr. Fried is with Yardley Dermatology Associates and Yardley Clinical Research Associates in Yardley, Pennsylvania
- Dr. Hsu is with Temple University's Lewis Katz School of Medicine in their Department of Dermatology in Philadelphia, Pennsylvania
- Dr. Knuckles is with M. L. F. Knuckles Dermatology in Corbin and Richmond, Kentucky and AdventHealth Hospital in Manchester, Kentucky
- Dr. Murina is with Tulane University's School of Medicine in their Department of Dermatology in New Orleans, Louisiana
- Dr. Wu is with the Dermatology Research and Education Foundation in Irvine, California
- Dr. Goldenberg is also with Goldenberg Dermatology in New York, New York
- Dr. Kircik is also with Indiana University Medical Center in Indianapolis, Indiana
| | - Sylvia Hsu
- Mr. Rivera-Oyola and Drs. Stanger, Goldenberg, Han, Kircik, Weinberg, and Lebwohl are with the Icahn School of Medicine at Mt. Sinai Hospital in the Department of Dermatology in New York, New York
- Dr. Litchman is with the National Society for Cutaneous Medicine in New York, New York
- Drs. Thibodeaux and Koo are with the University of California San Francisco in their Department of Dermatology in San Francisco, California
- Dr. Fried is with Yardley Dermatology Associates and Yardley Clinical Research Associates in Yardley, Pennsylvania
- Dr. Hsu is with Temple University's Lewis Katz School of Medicine in their Department of Dermatology in Philadelphia, Pennsylvania
- Dr. Knuckles is with M. L. F. Knuckles Dermatology in Corbin and Richmond, Kentucky and AdventHealth Hospital in Manchester, Kentucky
- Dr. Murina is with Tulane University's School of Medicine in their Department of Dermatology in New Orleans, Louisiana
- Dr. Wu is with the Dermatology Research and Education Foundation in Irvine, California
- Dr. Goldenberg is also with Goldenberg Dermatology in New York, New York
- Dr. Kircik is also with Indiana University Medical Center in Indianapolis, Indiana
| | - Leon Kircik
- Mr. Rivera-Oyola and Drs. Stanger, Goldenberg, Han, Kircik, Weinberg, and Lebwohl are with the Icahn School of Medicine at Mt. Sinai Hospital in the Department of Dermatology in New York, New York
- Dr. Litchman is with the National Society for Cutaneous Medicine in New York, New York
- Drs. Thibodeaux and Koo are with the University of California San Francisco in their Department of Dermatology in San Francisco, California
- Dr. Fried is with Yardley Dermatology Associates and Yardley Clinical Research Associates in Yardley, Pennsylvania
- Dr. Hsu is with Temple University's Lewis Katz School of Medicine in their Department of Dermatology in Philadelphia, Pennsylvania
- Dr. Knuckles is with M. L. F. Knuckles Dermatology in Corbin and Richmond, Kentucky and AdventHealth Hospital in Manchester, Kentucky
- Dr. Murina is with Tulane University's School of Medicine in their Department of Dermatology in New Orleans, Louisiana
- Dr. Wu is with the Dermatology Research and Education Foundation in Irvine, California
- Dr. Goldenberg is also with Goldenberg Dermatology in New York, New York
- Dr. Kircik is also with Indiana University Medical Center in Indianapolis, Indiana
| | - Melissa Knuckles
- Mr. Rivera-Oyola and Drs. Stanger, Goldenberg, Han, Kircik, Weinberg, and Lebwohl are with the Icahn School of Medicine at Mt. Sinai Hospital in the Department of Dermatology in New York, New York
- Dr. Litchman is with the National Society for Cutaneous Medicine in New York, New York
- Drs. Thibodeaux and Koo are with the University of California San Francisco in their Department of Dermatology in San Francisco, California
- Dr. Fried is with Yardley Dermatology Associates and Yardley Clinical Research Associates in Yardley, Pennsylvania
- Dr. Hsu is with Temple University's Lewis Katz School of Medicine in their Department of Dermatology in Philadelphia, Pennsylvania
- Dr. Knuckles is with M. L. F. Knuckles Dermatology in Corbin and Richmond, Kentucky and AdventHealth Hospital in Manchester, Kentucky
- Dr. Murina is with Tulane University's School of Medicine in their Department of Dermatology in New Orleans, Louisiana
- Dr. Wu is with the Dermatology Research and Education Foundation in Irvine, California
- Dr. Goldenberg is also with Goldenberg Dermatology in New York, New York
- Dr. Kircik is also with Indiana University Medical Center in Indianapolis, Indiana
| | - Andrea Murina
- Mr. Rivera-Oyola and Drs. Stanger, Goldenberg, Han, Kircik, Weinberg, and Lebwohl are with the Icahn School of Medicine at Mt. Sinai Hospital in the Department of Dermatology in New York, New York
- Dr. Litchman is with the National Society for Cutaneous Medicine in New York, New York
- Drs. Thibodeaux and Koo are with the University of California San Francisco in their Department of Dermatology in San Francisco, California
- Dr. Fried is with Yardley Dermatology Associates and Yardley Clinical Research Associates in Yardley, Pennsylvania
- Dr. Hsu is with Temple University's Lewis Katz School of Medicine in their Department of Dermatology in Philadelphia, Pennsylvania
- Dr. Knuckles is with M. L. F. Knuckles Dermatology in Corbin and Richmond, Kentucky and AdventHealth Hospital in Manchester, Kentucky
- Dr. Murina is with Tulane University's School of Medicine in their Department of Dermatology in New Orleans, Louisiana
- Dr. Wu is with the Dermatology Research and Education Foundation in Irvine, California
- Dr. Goldenberg is also with Goldenberg Dermatology in New York, New York
- Dr. Kircik is also with Indiana University Medical Center in Indianapolis, Indiana
| | - Jeffrey Weinberg
- Mr. Rivera-Oyola and Drs. Stanger, Goldenberg, Han, Kircik, Weinberg, and Lebwohl are with the Icahn School of Medicine at Mt. Sinai Hospital in the Department of Dermatology in New York, New York
- Dr. Litchman is with the National Society for Cutaneous Medicine in New York, New York
- Drs. Thibodeaux and Koo are with the University of California San Francisco in their Department of Dermatology in San Francisco, California
- Dr. Fried is with Yardley Dermatology Associates and Yardley Clinical Research Associates in Yardley, Pennsylvania
- Dr. Hsu is with Temple University's Lewis Katz School of Medicine in their Department of Dermatology in Philadelphia, Pennsylvania
- Dr. Knuckles is with M. L. F. Knuckles Dermatology in Corbin and Richmond, Kentucky and AdventHealth Hospital in Manchester, Kentucky
- Dr. Murina is with Tulane University's School of Medicine in their Department of Dermatology in New Orleans, Louisiana
- Dr. Wu is with the Dermatology Research and Education Foundation in Irvine, California
- Dr. Goldenberg is also with Goldenberg Dermatology in New York, New York
- Dr. Kircik is also with Indiana University Medical Center in Indianapolis, Indiana
| | - Jashin J Wu
- Mr. Rivera-Oyola and Drs. Stanger, Goldenberg, Han, Kircik, Weinberg, and Lebwohl are with the Icahn School of Medicine at Mt. Sinai Hospital in the Department of Dermatology in New York, New York
- Dr. Litchman is with the National Society for Cutaneous Medicine in New York, New York
- Drs. Thibodeaux and Koo are with the University of California San Francisco in their Department of Dermatology in San Francisco, California
- Dr. Fried is with Yardley Dermatology Associates and Yardley Clinical Research Associates in Yardley, Pennsylvania
- Dr. Hsu is with Temple University's Lewis Katz School of Medicine in their Department of Dermatology in Philadelphia, Pennsylvania
- Dr. Knuckles is with M. L. F. Knuckles Dermatology in Corbin and Richmond, Kentucky and AdventHealth Hospital in Manchester, Kentucky
- Dr. Murina is with Tulane University's School of Medicine in their Department of Dermatology in New Orleans, Louisiana
- Dr. Wu is with the Dermatology Research and Education Foundation in Irvine, California
- Dr. Goldenberg is also with Goldenberg Dermatology in New York, New York
- Dr. Kircik is also with Indiana University Medical Center in Indianapolis, Indiana
| | - Mark Lebwohl
- Mr. Rivera-Oyola and Drs. Stanger, Goldenberg, Han, Kircik, Weinberg, and Lebwohl are with the Icahn School of Medicine at Mt. Sinai Hospital in the Department of Dermatology in New York, New York
- Dr. Litchman is with the National Society for Cutaneous Medicine in New York, New York
- Drs. Thibodeaux and Koo are with the University of California San Francisco in their Department of Dermatology in San Francisco, California
- Dr. Fried is with Yardley Dermatology Associates and Yardley Clinical Research Associates in Yardley, Pennsylvania
- Dr. Hsu is with Temple University's Lewis Katz School of Medicine in their Department of Dermatology in Philadelphia, Pennsylvania
- Dr. Knuckles is with M. L. F. Knuckles Dermatology in Corbin and Richmond, Kentucky and AdventHealth Hospital in Manchester, Kentucky
- Dr. Murina is with Tulane University's School of Medicine in their Department of Dermatology in New Orleans, Louisiana
- Dr. Wu is with the Dermatology Research and Education Foundation in Irvine, California
- Dr. Goldenberg is also with Goldenberg Dermatology in New York, New York
- Dr. Kircik is also with Indiana University Medical Center in Indianapolis, Indiana
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Reddy V, Myers B, Chan S, Brownstone N, Thibodeaux Q, Koo J. Management strategies for borderline and narcissistic personality disorders in dermatology practice: a review. J DERMATOL TREAT 2020; 33:1265-1268. [PMID: 33019816 DOI: 10.1080/09546634.2020.1832190] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Dermatologists are often ill-equipped to promptly identify and manage patients with personality disorders. Patients with borderline personality disorder (BPD) and narcissistic personality disorder (NPD) frequently present to dermatology clinics, particularly those that provide esthetic services. Although dermatologists should ideally utilize specific management strategies when working with these patients, there is a lack of awareness and availability of resources on how to do so. Here, we review the psychiatry, plastic and reconstructive surgery, and dermatology literature to provide recommendations on tangible management strategies for dermatologists to avoid common mistakes that are made while managing patients with BPD and NPD. Additionally, we also discuss common dermatologic manifestations of BPD and NPD to improve providers' ability to identify patients with these conditions in their practices.
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Affiliation(s)
- Vidhatha Reddy
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Bridget Myers
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Stephanie Chan
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Nicholas Brownstone
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Quinn Thibodeaux
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - John Koo
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
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15
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Myers B, Reddy V, Chan S, Thibodeaux Q, Brownstone N, Bhutani T. Sleep, Immunological Memory, and Inflammatory Skin Disease. Dermatology 2020; 237:1035-1038. [DOI: 10.1159/000510082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/09/2020] [Indexed: 11/19/2022] Open
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16
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Chan S, Reddy V, Myers B, Thibodeaux Q, Brownstone N, Liao W. Machine Learning in Dermatology: Current Applications, Opportunities, and Limitations. Dermatol Ther (Heidelb) 2020; 10:365-386. [PMID: 32253623 PMCID: PMC7211783 DOI: 10.1007/s13555-020-00372-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Indexed: 12/14/2022] Open
Abstract
Machine learning (ML) has the potential to improve the dermatologist's practice from diagnosis to personalized treatment. Recent advancements in access to large datasets (e.g., electronic medical records, image databases, omics), faster computing, and cheaper data storage have encouraged the development of ML algorithms with human-like intelligence in dermatology. This article is an overview of the basics of ML, current applications of ML, and potential limitations and considerations for further development of ML. We have identified five current areas of applications for ML in dermatology: (1) disease classification using clinical images; (2) disease classification using dermatopathology images; (3) assessment of skin diseases using mobile applications and personal monitoring devices; (4) facilitating large-scale epidemiology research; and (5) precision medicine. The purpose of this review is to provide a guide for dermatologists to help demystify the fundamentals of ML and its wide range of applications in order to better evaluate its potential opportunities and challenges.
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Affiliation(s)
- Stephanie Chan
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Vidhatha Reddy
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Bridget Myers
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Quinn Thibodeaux
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Nicholas Brownstone
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA.
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Smith MP, Ly K, Thibodeaux Q, Beck K, Yang E, Sanchez I, Nititham J, Bhutani T, Liao W. Evaluation of a Genetic Risk Score for Diagnosis of Psoriatic Arthritis. ACTA ACUST UNITED AC 2020; 5:61-67. [PMID: 32462110 PMCID: PMC7252226 DOI: 10.1177/2475530320910814] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Diagnosis of psoriatic arthritis (PsA) can be challenging, resulting in delays that contribute to irreversible joint damage, reduced quality of life, and increased mortality. Objective Use genetic markers to develop and evaluate a PsA genetic risk score (GRS) for its ability to discriminate between psoriasis (PsO) only and PsO with PsA among a psoriatic cohort with full genome-wide genotype data. Methods Genome-wide single-nucleotide polymorphism genotyping was performed on 724 psoriatic patients. A set of 11 candidate risk genes previously shown to be preferentially associated with PsO or PsA were selected. To evaluate the cumulative effects of these risk loci, a PsA GRS was developed using an unweighted risk allele count (cGRS) and a weighted (wGRS) approach. Additional analyses included only human leukocyte antigen (HLA) risk alleles. Results The discriminative power attributable to each GRS was evaluated by calculating the areas under the receiver operator characteristic curve (AUROC). The AUROC for the wGRS is 56.2% versus 54.1% for the cGRS, and the AUROC for the HLA-only wGRS model was 56.9% versus 55.7% for the HLA-only cGRS. Conclusion The AUROC of 56.9% for HLA-only wGRS indicates that this approach has the greatest power in discriminating PsA from PsO among these models. Given that an AUROC of 56.9% is quite modest, this study suggests that using a small number of well-validated genetic loci provides limited predictive power for PsA, and that future approaches may benefit from using a larger number of genetic loci.
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Affiliation(s)
| | - Karen Ly
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Quinn Thibodeaux
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Kristen Beck
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Eric Yang
- Department of Dermatology, University of California, San Francisco, CA, USA.,Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Isabelle Sanchez
- Department of Dermatology, University of California, San Francisco, CA, USA.,Department of Dermatology, University of Illinois at Chicago, IL, USA
| | - Joanne Nititham
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Wilson Liao
- Department of Dermatology, University of California, San Francisco, CA, USA
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18
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Affiliation(s)
- Vidhatha Reddy
- Correspondence to: Vidhatha Reddy, BA, 515 Spruce Street, San Francisco, CA 94118.
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Reddy V, Thomas S, Thibodeaux Q, Myers B, Bhutani T, Liao W. Psoriasis Vulgaris Successfully Treated with Goeckerman Treatment at Home: A Patient and Physician's Experience. Dermatol Ther (Heidelb) 2020; 10:329-338. [PMID: 32193841 PMCID: PMC7211769 DOI: 10.1007/s13555-020-00364-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Indexed: 11/26/2022] Open
Abstract
Goeckerman therapy is a highly effective treatment regimen for moderate-to-severe psoriasis. It involves regular exposure to ultraviolet B radiation and the application of crude coal tar. To our knowledge, only three centers in the USA currently offer a formal Goeckerman therapy treatment program; thus, access to this therapy is geographically limited. In this article, a motivated patient discusses his experience with generalized plaque psoriasis. This patient, while living in a Goeckerman-inaccessible area, deferred treatment with biologics and outpatient phototherapy to develop a modified Goeckerman regimen for at-home use. This home regimen, which did not involve the use of prescription-strength medications, resulted in full clearance of his psoriasis. We also discuss the patient’s case from the perspective of a dermatology treatment team that has reviewed his experience.
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Affiliation(s)
- Vidhatha Reddy
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | | | - Quinn Thibodeaux
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Bridget Myers
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Wilson Liao
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA.
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20
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Ly K, Chang AY, Kiprono SK, Jose M, Smith MP, Beck K, Sekhon S, Muraguri I, Mungai M, Coates SJ, Thibodeaux Q, Hulse S, Gualberto M, Jeon C, Nakamura M, Bhutani T, Maurer T, Liao W. Implementation of an Ultraviolet Phototherapy Service at a National Referral Hospital in Western Kenya: Reflections on Challenges and Lessons Learned. Dermatol Ther (Heidelb) 2020; 10:107-117. [PMID: 31734938 PMCID: PMC6994574 DOI: 10.1007/s13555-019-00342-1] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION In order to manage skin conditions at a national referral hospital level in Kenya, specialized dermatology services, such as dermatologic surgery, dermatopathology, phototherapy, and sub-specialty care, should be offered, as is typically available in referral hospitals around the world. A Kenyan patient with prurigo nodularis, whose severe itch remitted after phototherapy treatment at the University of California, San Francisco (UCSF), inspired the development of a phototherapy service at Academic Model Providing Access to Healthcare (AMPATH), a partnership in Western Kenya between Moi Teaching and Referral Hospital, Moi University College of Health Sciences, and a consortium of North American academic medical centers. METHODS Initial project funds were raised through a crowdfunding campaign and fundraising events. A new narrowband ultraviolet B phototherapy unit and replacement bulbs were donated and air shipped to Eldoret, Kenya. A team of dermatologists and phototherapy nurses from UCSF conducted a 2-day training session. US-based dermatologists affiliated with AMPATH provide ongoing support through regular communication and on-site visits. RESULTS Early in implementation, challenges faced included training clinical staff with limited experience in phototherapy and improving communication between nurses and clinicians. More recent challenges include frequent rotation of specialty clinic nurses in the dermatology clinic, adaptation of phototherapy guidelines to balance patient volume with service delivery capacity, and training assessment of disease activity in darkly pigmented skin. CONCLUSION Strategies that have been helpful in addressing implementation challenges include: increasing on-site and remote training opportunities for clinicians and nurses, developing a tiered payment schema, educating patients to combat misconceptions about phototherapy, dynamic phototherapy referral guidelines to accommodate service delivery capacity, and prioritizing the engagement of a multidisciplinary team.
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Affiliation(s)
- Karen Ly
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Aileen Y Chang
- Department of Dermatology, University of California, San Francisco, CA, USA.
- Academic Model Providing Access to Healthcare, Eldoret, Kenya.
| | - Samson K Kiprono
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Department of Medicine, Moi University School of Medicine, Eldoret, Kenya
| | - Margareth Jose
- Department of Dermatology, University of California, San Francisco, CA, USA
| | | | - Kristen Beck
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Sahil Sekhon
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Isabel Muraguri
- Department of Dermatology, University of California, San Francisco, CA, USA
| | | | - Sarah J Coates
- Department of Dermatology, University of California, San Francisco, CA, USA
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Quinn Thibodeaux
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Sarah Hulse
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Marissa Gualberto
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Caleb Jeon
- Department of Dermatology, University of California, San Francisco, CA, USA
- Division of Dermatology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Mio Nakamura
- Department of Dermatology, University of California, San Francisco, CA, USA
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Toby Maurer
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Department of Dermatology, Indiana University, Indianapolis, IN, USA
| | - Wilson Liao
- Department of Dermatology, University of California, San Francisco, CA, USA
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21
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Reddy V, Myers B, Brownstone N, Thibodeaux Q, Chan S, Liao W, Bhutani T. Update on Sleep and Pulmonary Comorbidities in Psoriasis. Curr Derm Rep 2020. [DOI: 10.1007/s13671-020-00293-3] [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: 10/25/2022]
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Smith MP, Ly K, Thibodeaux Q, Bhutani T. Chronic erythema nodosum with koebnerization to plaque psoriasis. Int J Womens Dermatol 2019; 5:387-388. [PMID: 31909164 PMCID: PMC6938916 DOI: 10.1016/j.ijwd.2019.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/14/2019] [Accepted: 08/26/2019] [Indexed: 11/24/2022] Open
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Koo J, Ho RS, Thibodeaux Q. Depression and suicidality in psoriasis and clinical studies of brodalumab: a narrative review. Cutis 2019; 104:361-365. [PMID: 31939925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Patients with psoriasis have high rates of depression and may be at increased risk for suicidal ideation and behavior (SIB). Attempted and completed suicides during clinical trials and other studies of psoriasis therapies, including brodalumab, highlight the importance of understanding psychiatric risk factors in patients with psoriasis. Recent meta-analyses, research studies, and published data from brodalumab clinical studies were reviewed. We also summarize research on effects of brodalumab on depression symptoms and occurrences of SIB in brodalumab clinical trials. Psoriasis elevates the risk for depression and possible suicide. Brodalumab has a boxed suicide warning; however, it states that there is no established causal association between treatment with brodalumab and increased risk for SIB. Clinicians are urged to evaluate patients with psoriasis for psychiatric risk factors regardless of their therapy and to consider the package insert and a comprehensive evaluation of relevant literature to make a well-balanced decision.
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Affiliation(s)
- John Koo
- University of California San Francisco Medical Center, USA
| | - Roger S Ho
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, USA
| | - Quinn Thibodeaux
- Department of Dermatology, University of California San Francisco Psoriasis and Skin Treatment Center, USA
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Abstract
Introduction: Psoriasis is a chronic, immune-mediated disease with significant associated comorbidities. Its pathogenesis is likely multifactorial, however, the interleukin-23/T helper 17 pathway has been identified as a critical axis in its pathogenesis. Interleukin-17A is the primary effector of this pathway and overexpression of IL-17A results in epidermal hyperplasia and an overly robust inflammatory response, resulting in the skin plaques and systemic inflammation seen in psoriasis. Targeted anti IL-17 therapies have demonstrated efficacy in the treatment of moderate-to-severe plaque psoriasis.Areas covered: A PubMed search was conducted for relevant literature. Secukinumab, ixekizumab, and brodalumab are anti IL-17 inhibitors currently approved for the treatment of moderate-to-severe plaque psoriasis. The efficacy and safety data from key phase III clinical trials are reviewed here.Expert opinion: By targeting a key mediator of the interleukin-23/T helper 17 pathway, IL-17 antagonists are an effective treatment for plaque psoriasis. It has demonstrated efficacy and a favorable safety profile in key phase III clinical trials. In addition to efficacy, IL-17 antagonists have also shown long-term maintenance of treatment response and a quick onset of action. The efficacy of IL-17 inhibitors in the treatment of moderate-to-severe psoriasis underscores the importance of the IL-23/Th17 pathway in the pathogenesis of psoriasis.
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Affiliation(s)
- Karen Ly
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Mary P Smith
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Quinn Thibodeaux
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Vidhatha Reddy
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Tina Bhutani
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
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Affiliation(s)
- Quinn Thibodeaux
- Correspondence to: Quinn Thibodeaux, MD, UCSF Psoriasis and Skin Treatment Center, 515 Spruce Street, San Francisco, CA 94118.
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Smith MP, Ly K, Thibodeaux Q, Weerasinghe T, Beck K, Shankle L, Armstrong AW, Boas M, Bridges A, Doris F, Gelfand JM, Lafoy B, Orbai AM, Takeshita J, Truman S, Wan MT, Wu JJ, Siegel MP, Bell SJ, Bhutani T, Liao W. Factors Influencing Sleep Difficulty and Sleep Quantity in the Citizen Pscientist Psoriatic Cohort. Dermatol Ther (Heidelb) 2019; 9:511-523. [PMID: 31177381 PMCID: PMC6704222 DOI: 10.1007/s13555-019-0306-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Sleep is essential for overall health and well-being, yet more than one-third of adults report inadequate sleep. The prevalence is higher among people with psoriasis, with up to 85.4% of the psoriatic population reporting sleep disruption. Poor sleep among psoriasis patients is particularly concerning because psoriasis is independently associated with many of the same comorbidities as sleep dysfunction, including cardiovascular disease, obesity, and depression. Given the high prevalence and serious consequences of disordered sleep in psoriasis, it is vital to understand the nature of sleep disturbance in this population. This study was designed to help meet this need by using survey data from Citizen Pscientist, an online patient portal developed by the National Psoriasis Foundation. METHODS Our analysis included 3118 participants who identified as having a diagnosis by a physician of psoriasis alone or psoriasis with psoriatic arthritis. Demographic information, psoriasis severity and duration, sleep apnea status, smoking and alcohol consumption, itch timing, and sleep characteristics were included. Two separate multivariate logistic regression models in STATA were used to determine whether the presence of psoriatic arthritis, age, gender, body mass index, comorbid sleep apnea, psoriasis severity, timing of worst itch, smoking status, or high-risk alcohol consumption were associated with sleep difficulty or low sleep quantity, defined by the American Academy of Sleep Medicine as less than 7 h of sleep per night on average. RESULTS Results from the multivariate logistic regressions found that sleep difficulty was associated with psoriatic arthritis (OR 2.15, 95% CI [1.79-2.58]), female gender (2.03 [1.67-2.46]), obese body mass index (BMI ≥ 30) (1.25 [1.00-1.56]), sleep apnea (1.41 [1.07-1.86]), psoriasis severity of moderate (1.59 [1.30-1.94]) or severe (2.40 [1.87-3.08]), and smoking (1.60 [1.26-2.02]). Low sleep quantity was associated with obese BMI (1.62 [1.29-2.03]), sleep apnea (1.30 [1.01-1.68]), psoriasis severity of moderate (1.41 [1.16-1.72]) or severe (1.40 [1.11-1.76]), and smoking (1.62 [1.31-2.00]). Sleep difficulty and low sleep quantity were not associated with age, alcohol consumption, or timing of worst itch. CONCLUSION These results are potentially meaningful in several aspects. We identify an important distinction between sleep difficulty and sleep quantity in psoriatic disease, whereby having psoriatic arthritis and being female are each associated with sleep difficulty despite no association with low sleep quantity. Furthermore, there is conflicting evidence from prior studies as to whether psoriasis severity is associated with sleep difficulty, but this well-powered, large study revealed a strong, graded relationship between psoriasis severity and both sleep difficulty and low sleep quantity. Overall, our results show that both sleep difficulty and low sleep quantity were associated with multiple factors in this analysis of a large psoriatic cohort. These findings suggest that dermatologists may gather clinically useful information by screening psoriatic patients for trouble sleeping and low sleep quantity to identify potential comorbidities and to more effectively guide disease management.
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Affiliation(s)
- Mary Patricia Smith
- Department of Dermatology, University of California, San Francisco, CA, USA.
| | - Karen Ly
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Quinn Thibodeaux
- Department of Dermatology, University of California, San Francisco, CA, USA
| | | | - Kristen Beck
- Department of Dermatology, University of California, San Francisco, CA, USA
| | | | - April W Armstrong
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, OR, USA
- Department of Dermatology, University of Southern California, Los Angeles, CA, USA
| | - Marc Boas
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, OR, USA
| | - Alisha Bridges
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, OR, USA
| | - Frank Doris
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, OR, USA
| | - Joel M Gelfand
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, OR, USA
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Brian Lafoy
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, OR, USA
| | - Ana-Maria Orbai
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, OR, USA
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Junko Takeshita
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, OR, USA
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah Truman
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, OR, USA
| | - Marilyn T Wan
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, OR, USA
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jashin J Wu
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, OR, USA
- Dermatology Research and Education Foundation, Irvine, CA, USA
| | | | | | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Wilson Liao
- Department of Dermatology, University of California, San Francisco, CA, USA
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, OR, USA
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Smith MP, Ly K, Thibodeaux Q, Weerasinghe T, Wu JJ, Yosipovitch G, Bhutani T, Liao W. Emerging Methods to Objectively Assess Pruritus in Atopic Dermatitis. Dermatol Ther (Heidelb) 2019; 9:407-420. [PMID: 31256388 PMCID: PMC6704205 DOI: 10.1007/s13555-019-0312-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Atopic dermatitis (AD) is an inflammatory skin disease with a chronic, relapsing course. Clinical features of AD vary by age, duration, and severity but can include papules, vesicles, erythema, exudate, xerosis, scaling, and lichenification. However, the most defining and universal symptom of AD is pruritus. Pruritus or itch, defined as an unpleasant urge to scratch, is problematic for many reasons, particularly its negative impact on quality of life. Despite the profoundly negative impact of pruritus on patients with AD, clinicians and researchers lack standardized and validated methods to objectively measure pruritus. The purpose of this review is to discuss emerging methods to assess pruritus in AD by describing objective patient-centered tools developed or enhanced over the last decade that can be utilized by clinicians and researchers alike. METHODS This review is based on a literature search in Medline, Embase, and Web of Science databases. The search was performed in February 2019. The keywords were used "pruritus," "itch," "atopic dermatitis," "eczema," "measurements," "tools," "instruments," "accelerometer," "wrist actigraphy," "smartwatch," "transducer," "vibration," "brain mapping," "magnetic resonance imaging," and "positron emission tomography." Only articles written in English were included, and no restrictions were set on study type. To focus on emerging methods, prioritization was given to results from the last decade (2009-2019). RESULTS The search yielded 49 results in PubMed, 134 results in Embase, and 85 results in Web of Science. Each result was independently reviewed in a standardized manner by two of the authors (M.S., K.L.), and disagreements between reviewers were resolved by consensus. Relevant findings were categorized into the following sections: video surveillance, acoustic surveillance, wrist actigraphy, smart devices, vibration transducers, and neurological imaging. Examples are provided along with descriptions of how each technology works, instances of use in research or clinical practice, and as applicable, reports of validation studies and correlation with other methods. CONCLUSION The variety of new and improved methods to evaluate pruritus in AD is welcomed by clinicians, researchers, and patients alike. Future directions include next-generation smart devices as well as exploring new territories, such as identifying biomarkers that correlate to itch and machine-learning programs to identify itch processing in the brain. As these efforts continue, it will be essential to remain patient-centered by developing techniques that minimize discomfort, respect privacy, and provide accurate data that can be used to better manage itch in AD.
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Affiliation(s)
- Mary Patricia Smith
- Department of Dermatology, University of California, San Francisco, CA, USA.
| | - Karen Ly
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Quinn Thibodeaux
- Department of Dermatology, University of California, San Francisco, CA, USA
| | | | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, CA, USA
| | - Gil Yosipovitch
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Wilson Liao
- Department of Dermatology, University of California, San Francisco, CA, USA
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Smith MP, Ly K, Thibodeaux Q, Bhutani T, Liao W, Beck KM. Acrodermatitis continua of Hallopeau: clinical perspectives. Psoriasis (Auckl) 2019; 9:65-72. [PMID: 31497529 PMCID: PMC6691962 DOI: 10.2147/ptt.s180608] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/09/2019] [Indexed: 01/30/2023]
Abstract
Acrodermatitis continua of Hallopeau (ACH) is a rare, sterile pustular eruption of one or more digits. The condition presents with tender pustules and underlying erythema on the tip of a digit, more frequently arising on a finger than a toe. As far as classification, ACH is considered a localized form of pustular psoriasis. The eruption typically occurs after local trauma or infection, but such a history is not always present and various other etiologies have been described including infectious, neural, inflammatory, and genetic causes. The natural progression of ACH is chronic and progressive, often resulting in irreversible complications such as onychodystrophy that can result in anonychia, as well as osteitis that can result in osteolysis of the distal phalanges. Because of the rarity of ACH, there have been no randomized controlled studies to evaluate therapies, resulting in an absence of standardized treatment guidelines. In clinical practice, a wide variety of treatments have been attempted, with outcomes ranging from recalcitrance to complete resolution. In recent years, the introduction of biologics has provided a new class of therapy that has revolutionized the treatment of ACH. Specifically, rapid and sustained responses have been reported with the use of anti-tumor necrosis factor agents like infliximab, adalimumab, and etanercept; IL-17 inhibitors like secukinumab; IL-12/23 inhibitors like ustekinumab; and IL-1 inhibitors like anakinra. Nevertheless, there remains a considerable need for more research into treatment for the benefit of individual patients with ACH as well as for the clinical knowledge gained by such efforts. The purpose of this review is to provide a comprehensive overview of the key features of ACH as well as a discussion of clinical management strategies for this unique and debilitating condition.
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Affiliation(s)
| | - Karen Ly
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Quinn Thibodeaux
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Wilson Liao
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Kristen M Beck
- Department of Dermatology, University of California, San Francisco, CA, USA
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Affiliation(s)
- Mary Patricia Smith
- Department of Dermatology, University of California, San Francisco, California
| | - Karen Ly
- Department of Dermatology, University of California, San Francisco, California
| | - Quinn Thibodeaux
- Department of Dermatology, University of California, San Francisco, California
| | - Kristen Beck
- Department of Dermatology, University of California, San Francisco, California
| | - Timothy Berger
- Department of Dermatology, University of California, San Francisco, California
| | - Rita Khodosh
- Department of Dermatology, University of California, San Francisco, California
| | - Wilson Liao
- Department of Dermatology, University of California, San Francisco, California
| | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco, California
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30
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Affiliation(s)
- Karen Ly
- Department of Dermatology, University of California, San Francisco, California
| | - Mary Patricia Smith
- Department of Dermatology, University of California, San Francisco, California
| | - Quinn Thibodeaux
- Department of Dermatology, University of California, San Francisco, California
| | - Kristen Beck
- Department of Dermatology, University of California, San Francisco, California
| | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco, California
| | - Wilson Liao
- Department of Dermatology, University of California, San Francisco, California
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31
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Smith MP, Ly K, Thibodeaux Q, Bhutani T, Nakamura M. Home phototherapy for patients with vitiligo: challenges and solutions. Clin Cosmet Investig Dermatol 2019; 12:451-459. [PMID: 31388308 PMCID: PMC6607222 DOI: 10.2147/ccid.s185798] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/07/2019] [Indexed: 12/31/2022]
Abstract
Vitiligo is a chronic autoimmune condition involving selective dysfunction and destruction of melanocytes in the skin, hair, or both. The typical presentation is well-demarcated depigmented skin patches. Given vitiligo is the most common cause of depigmentation worldwide and early disease responds best to treatment, prompt diagnosis and proactive management of vitiligo are critical. While a wide variety of treatments has demonstrated variable effectiveness in treating vitiligo, phototherapy remains standard of care because of its proven efficacy and favorable side effect profile. However, many patients with vitiligo are unable to access affordable, consistent, or convenient phototherapy. To address these issues, home-based phototherapy has emerged as a patient-centered alternative. The purpose of this review is to discuss management of vitiligo with a specific focus on access to home-based phototherapy (HBPT) for patients with this condition. Key challenges to HBPT include misperceptions around safety and efficacy, inadequate physician education and training, insurance and financial barriers, and appropriate patient selection. Solutions to these challenges are presented, such as approaches to improve physician education and increasing the evidence surrounding the effectiveness and safety of this treatment for vitiligo. In addition, various practical considerations are discussed to guide dermatologists on how to approach HBPT as a treatment option for patients with vitiligo.
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Affiliation(s)
- Mary Patricia Smith
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Karen Ly
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Quinn Thibodeaux
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Tina Bhutani
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Mio Nakamura
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
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Ly K, Beck KM, Smith MP, Thibodeaux Q, Bhutani T. Diagnosis and screening of patients with generalized pustular psoriasis. Psoriasis (Auckl) 2019; 9:37-42. [PMID: 31417859 PMCID: PMC6592018 DOI: 10.2147/ptt.s181808] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 06/01/2019] [Indexed: 12/21/2022]
Abstract
Generalized pustular psoriasis (GPP) is a rare and potentially life-threatening variant of psoriasis that is characterized by recurrent, acute onset, widely distributed pustular eruptions on inflamed, erythematous skin. It is important to recognize acute GPP as a subtype of psoriasis associated with high morbidity and mortality so therapy can be initiated without delay. Since GPP was first described in 1910 by Leopold von Zumbusch, it has been inconsistently defined, stratified, and diagnosed in the literature. Multiple definitions and diagnostic criteria have been proposed over the years. Recently, formal consensus guidelines on GPP have been published by international groups. This article reviews the current evidence and understanding in the diagnosis and screening of GPP.
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Affiliation(s)
- Karen Ly
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Kristen M Beck
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Mary P Smith
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Quinn Thibodeaux
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco, CA, USA
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Thibodeaux Q, Koo J. Phototherapy: is it still important? Cutis 2019; 103:311-312. [PMID: 31348453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Quinn Thibodeaux
- Department of Dermatology, University of California, San Francisco, USA
| | - John Koo
- Department of Dermatology, University of California, San Francisco, USA
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Abstract
Dupilumab is a fully human monoclonal IgG4 antibody directed against the alpha subunit of the IL-4 receptor and prevents the signaling of IL-4 and IL-13, two type 2 cytokines known to be important drivers of atopic diseases. In March of 2017, the United States Food and Drug Administration (FDA) approved dupilumab for the treatment of moderate-to-severe atopic dermatitis in adults that is uncontrolled with topical medications, becoming the first biologic agent approved to treat this chronic skin condition. In October of 2018, Dupilumab received approval by the FDA as an add-on maintenance therapy in patients with moderate-to-severe asthma aged 12 years or older with an eosinophilic phenotype or with oral corticosteroid-dependent asthma. This review summarizes the characteristics of dupilumab and the clinical research that has been published to date, including treatment efficacy and adverse events.
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Affiliation(s)
- Quinn Thibodeaux
- Department of Dermatology, University of California, San Francisco , San Francisco , USA
| | - Mary Patricia Smith
- Department of Dermatology, University of California, San Francisco , San Francisco , USA
| | - Karen Ly
- Department of Dermatology, University of California, San Francisco , San Francisco , USA
| | - Kristen Beck
- Department of Dermatology, University of California, San Francisco , San Francisco , USA
| | - Wilson Liao
- Department of Dermatology, University of California, San Francisco , San Francisco , USA
| | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco , San Francisco , USA
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