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Kalita V, Abs D, Bursztejn AC. Barriers and suggestions for improving the implementation of guidelines in the systemic treatment of moderate to severe psoriasis: A literature review. Ann Dermatol Venereol 2024; 151:103280. [PMID: 38776863 DOI: 10.1016/j.annder.2024.103280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/21/2023] [Accepted: 04/02/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Despite the availability of a wide range of therapies for the systemic treatment of moderate to severe psoriasis, many psoriasis patients do not receive adequate treatment, suggesting that guidelines may not be correctly applied by physicians. OBJECTIVES The aim of this study was to analyze data on physicians' implementation of, and reasons for noncompliance with, guidelines for the systemic treatment of moderate to severe psoriasis. METHODS We conducted a systematic literature review according to the Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the PubMed and Embase databases for studies on guideline adherence in the systemic treatment of moderate to severe psoriasis. All eligible articles were retrieved in full text and the relevant references of retrieved articles were included. RESULTS A total of 20 studies were selected. Four studies investigated knowledge of the guidelines, six studies examined their application, and five studies focused on the various barriers to implementation. Finally, five studies discussed ways to improve implementation. Several studies on the quality of psoriasis care have revealed discrepancies between the reality and the optimal care described in national and international guidelines. CONCLUSION Various barriers to implementation of recommendations exist, such as economic barriers, lack of dermatologic orientation towards, lack of knowledge of recommendations by other specialists, lack of applicability, and country- and practice-specific features (e.g., different benefit/risk ratios, different reimbursement rates and conditions). This review can help the everyday practitioner to better understand these barriers, which will have a direct impact on improving the quality of life of psoriasis patients.
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Affiliation(s)
- V Kalita
- Dermatology Department, Nancy University Hospital, Bâtiment P Canton, 6 allée du Morvan, 54500 Vandœuvre-lès-Nancy, France.
| | - D Abs
- Dermatology Department, Nancy University Hospital, Bâtiment P Canton, 6 allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - A-C Bursztejn
- Dermatology Department, Nancy University Hospital, Bâtiment P Canton, 6 allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
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Khan R, Mirza MA, Aqil M, Alex TS, Raj N, Manzoor N, Naseef PP, Saheer Kuruniyan M, Iqbal Z. In Vitro and In Vivo Investigation of a Dual-Targeted Nanoemulsion Gel for the Amelioration of Psoriasis. Gels 2023; 9:gels9020112. [PMID: 36826282 PMCID: PMC9957534 DOI: 10.3390/gels9020112] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
Psoriasis, due to its unique pathological manifestations and the limited success of existing therapeutic modalities, demands dedicated domain research. Our group has developed nanotherapeutics consisting of bioactives such as Thymoquinone (TQ) and Fulvic acid (FA), which have been successfully incorporated into a Nanoemulsion gel (NEG), taking kalonji oil as oil phase. The composition is aimed at ameliorating psoriasis with better therapeutic outcomes. TQ is a natural bio-active that has been linked to anti-psoriatic actions. FA has anti-inflammatory actions due to its free radical and oxidant-scavenging activity. Our previous publication reports the formulation development of the NEG, where we overcame the pharmaco-technical limitations of combining the above two natural bioactives. In vitro evaluation of the optimized NEG was carried out, which showed an enhanced dissolution rate and skin permeation of TQ. This work furthers the pharmaceutical progression of dual-targeted synergistic NEG to treat psoriasis. A suitable animal model, BALB/c mice, has been used to conduct the in vivo studies, which revealed the effective anti-psoriatic action of TQ. Molecular docking studies corroborated the results and revealed a good binding affinity for both the targets of TNF-α (Tumor necrosis factor) and IL-6 (Interlukin-6). Tissue uptake by Confocal laser scanning microscopy (CLSM), a skin interaction study of the gel formulation, and an antioxidant free radical scavenging assay (1-1 Diphenyl-2-picrylhydrazyl DPPH) were also carried out. It was concluded that the NEG may be effective in treating psoriasis with minimal side effects.
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Affiliation(s)
- Rahmuddin Khan
- Department of Pharmaceutics, School of Pharmaceutical Education & Research (SPER), Jamia Hamdard, New Delhi 110062, India
| | - Mohd. Aamir Mirza
- Department of Pharmaceutics, School of Pharmaceutical Education & Research (SPER), Jamia Hamdard, New Delhi 110062, India
- Correspondence: (M.A.M.); (Z.I.); Tel.: +91-9213378765 (M.A.M.); +91-9811733016 (Z.I.)
| | - Mohd Aqil
- Department of Pharmaceutics, School of Pharmaceutical Education & Research (SPER), Jamia Hamdard, New Delhi 110062, India
| | - Thomson Santosh Alex
- Department of Pharmaceutics, School of Pharmaceutical Education & Research (SPER), Jamia Hamdard, New Delhi 110062, India
| | - Nafis Raj
- Department of Biosciences, Jamia Millia Islamia, New Delhi 110025, India
| | - Nikhat Manzoor
- Department of Biosciences, Jamia Millia Islamia, New Delhi 110025, India
| | | | - Mohamed Saheer Kuruniyan
- Department of Dental Technology, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | - Zeenat Iqbal
- Department of Pharmaceutics, School of Pharmaceutical Education & Research (SPER), Jamia Hamdard, New Delhi 110062, India
- Correspondence: (M.A.M.); (Z.I.); Tel.: +91-9213378765 (M.A.M.); +91-9811733016 (Z.I.)
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Nast A, Gaskins M, Eisert L, Werner RN, Borradori L, Marinovic B, Paul C, Dressler C. Prioritizing topics in guideline development: results of a two-phase online survey of dermatologist members of the EADV. J Eur Acad Dermatol Venereol 2018; 33:227-233. [PMID: 30317678 DOI: 10.1111/jdv.15282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 09/27/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Most clinical guidelines in dermatology are encyclopaedic, covering a disease and its aetiology, diagnosis, treatment and prevention in their entirety. The usability and uptake of guideline recommendations might be improved by guidelines that are more concise and address specific questions ranked by users according to their perceived importance. OBJECTIVE To survey the largest association of dermatologists in Europe, identify which questions in their everyday practice they felt would benefit from short, evidence-based guidance and rank these systematically. METHODS A two-phase online survey using a structured ranking approach and the members directory of the European Academy of Dermatology and Venereology (EADV). RESULTS The first survey yielded 265 suggestions, indicating a response rate of 3.7%. We grouped all responses according to themes and subsequently combined these into a list of 35 broader topics. These were presented to all members of the EADV in the second survey (response rate: 9.7%), which yielded a list of the top 10 topics participants felt were most in need of guidance. The first three were 'Systemic drug treatment in dermatology during pregnancy and for women wishing to have children in the near future', 'alopecia areata' and 'interpretation of laboratory results in connective tissue diseases'. CONCLUSION Our two-phase survey of EADV members and a structured ranking process were practical to implement and yielded a list of the top 10 topics in dermatology and venereology for guideline development. Guideline dissemination needs to be improved, and practical, more concise guidelines may facilitate efforts to do so.
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Affiliation(s)
- A Nast
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology und Allergy, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - M Gaskins
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology und Allergy, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - L Eisert
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology und Allergy, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - R N Werner
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology und Allergy, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - L Borradori
- Department of Dermatology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - B Marinovic
- Department of Dermatovenereology, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - C Paul
- Department of Dermatology, CHU Toulouse et Université Paul Sabatier, Toulouse, France
| | - C Dressler
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology und Allergy, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
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Mahé E, Bursztejn AC, Phan A, Corgibet F, Beauchet A. Management of childhood psoriasis in France. A national survey among general practitioners, pediatricians, and dermatologists. Dermatol Ther 2017; 31. [DOI: 10.1111/dth.12567] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 09/18/2017] [Accepted: 10/02/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Emmanuel Mahé
- Dermatology Department; Hôpital Victor Dupouy; Argenteuil France
| | | | - Alice Phan
- Nephrology-Rheumatology-Dermatology Department; Hôpital Femme Mère Enfant, Hospices Civiles de Lyon; Bron France
| | | | - Alain Beauchet
- Public Health Department; Centre Hospitalier Universitaire Ambroise Paré, Université Versailles-Saint-Quentin-en-Yvelines, Assistance Publique-Hôpitaux de Paris; Boulogne-Billancourt France
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Eissing L, Radtke M, Zander N, Augustin M. Barriers to guideline-compliant psoriasis care: analyses and concepts. J Eur Acad Dermatol Venereol 2015; 30:569-75. [DOI: 10.1111/jdv.13452] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/04/2015] [Indexed: 12/18/2022]
Affiliation(s)
- L. Eissing
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - M.A. Radtke
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - N. Zander
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - M. Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
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Lolli E, Saraceno R, Calabrese E, Ascolani M, Scarozza P, Chiricozzi A, Onali S, Petruzziello C, Chimenti S, Pallone F, Biancone L. Psoriasis Phenotype in Inflammatory Bowel Disease: A Case-Control Prospective Study. J Crohns Colitis 2015; 9:699-707. [PMID: 25908719 DOI: 10.1093/ecco-jcc/jjv068] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 04/14/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Whether inflammatory bowel disease [IBD] is associated with specific psoriasis phenotypes is undefined. In a case-control prospective study, we aimed to assess the severity and phenotype of psoriasis in IBD vs matched non-IBD controls with psoriasis [non-IBD]. METHODS From 2011 to 2013, dermatological assessment was performed in all IBD patients showing lesions requiring characterisation. In patients with psoriasis, assessment included: presence, characteristics, and severity. Each IBD patient with psoriasis was matched [gender, ethnicity, age ± 5 years] with one non-IBD patient with psoriasis. STATISTICAL ANALYSIS data were expressed as median [range], chi-square, Student's t test. RESULTS Dermatological assessment was performed in 251 IBD patients [115 females, age 47 [16-85]; IBD duration 9 years [1-46]]: 158 Crohn's disease [CD] [63%], 93 ulcerative colitis [UC] [37%]. Psoriasis was detected in 62 [25%] IBD patients: 36 [58%] CD, 26 UC [42%; p = 0.44]. Clinical characteristics were comparable between IBD patients with or without psoriasis: age 50 [23-72] vs 47 [16-85]; IBD duration 9.5 [1-46] vs 9 [1-41]; p = non-significant]. The non-IBD group included 62 patients with psoriasis: 35 male; age 47 [18-75]. Mild psoriasis was more frequent in IBD vs non-IBD [87% vs 53%; p < 0.0001], whereas moderate and severe psoriasis were more frequent in non-IBD vs IBD [37% vs 13%, p = 0.004; 10% vs 0%; p = 0.036]. Plaque-type psoriasis was the most common phenotype in both IBD and non-IBD [p < 0.0001 vs others phenotypes].The frequency of plaque-type, nail psoriasis and psoriatic arthritis was lower in IBD vs non-IBD [p = 0.008; p < 0.0001; p = 0.006]. Psoriasis occurred after anti-tumour necrosis factor [TNF]α treatment in six CD patients [7%]. CONCLUSIONS Severity and phenotypes of psoriasis may differ between patients with IBD and their matched non-IBD controls.
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Affiliation(s)
- Elisabetta Lolli
- GI Unit, Department of Systems Medicine, University Tor Vergata of Rome, Italy
| | - Rosita Saraceno
- Department of Dermatology, University of Rome Tor Vergata, Italy
| | - Emma Calabrese
- GI Unit, Department of Systems Medicine, University Tor Vergata of Rome, Italy
| | - Marta Ascolani
- GI Unit, Department of Systems Medicine, University Tor Vergata of Rome, Italy
| | - Patrizio Scarozza
- GI Unit, Department of Systems Medicine, University Tor Vergata of Rome, Italy
| | | | - Sara Onali
- GI Unit, Department of Systems Medicine, University Tor Vergata of Rome, Italy
| | | | - Sergio Chimenti
- Department of Dermatology, University of Rome Tor Vergata, Italy
| | - Francesco Pallone
- GI Unit, Department of Systems Medicine, University Tor Vergata of Rome, Italy
| | - Livia Biancone
- GI Unit, Department of Systems Medicine, University Tor Vergata of Rome, Italy
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Affiliation(s)
- J Schmitt
- Centre for Evidence-based Healthcare, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
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