1
|
Greif C, Gibson RS, Kimball AB, Holcomb ZE, Porter ML. Evaluating minority representation across health care settings in hidradenitis suppurativa and psoriasis. Int J Womens Dermatol 2024; 10:e129. [PMID: 38240009 PMCID: PMC10796135 DOI: 10.1097/jw9.0000000000000129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 11/11/2023] [Indexed: 01/22/2024] Open
Abstract
Background Females and minorities have been underrepresented in clinical research despite legislative efforts, including in hidradenitis suppurativa (HS) and psoriasis (PsO) clinical trials. Objective To identify differences in demographic breakdowns of HS and PsO patients between health care settings to uncover any causative health disparities. Methods This study reports racial, ethnic, and sex of HS and PsO patient populations across the emergency department (ED), inpatient, clinical trial, and registry settings. In addition, 95% confidence intervals are used as proxies of statistical significance to compare demographics between settings. Results Female, Hispanic, and Black patients were underrepresented in HS clinical trials compared to their population prevalence (female: 63.7% vs 73.5%; Hispanic: 3.8% vs 12.0%; Black: 9.1% vs 20.3%). Female and Black patients were underrepresented in PsO trials compared to their population prevalence (female: 33.0% vs 54.8%; Black: 2.2% vs 5.7%). Black patients were overrepresented in the inpatient and ED settings in HS (inpatient vs ED vs population prevalence: 49.9% vs 49.9% vs 20.3%) and in the inpatient setting in PsO (inpatient vs population prevalence: 19.8% vs 5.7%). Limitations The main limitation is the reliability and generalizability of the published studies used to compare demographics across settings. Conclusion Underrepresentation of females and minorities in HS and PsO clinical trials is consistent with published literature. Overrepresentation of Black patients in acute care settings is likely multifactorial.
Collapse
Affiliation(s)
- Charlotte Greif
- Preliminary Internal Medicine Program, Internal Medicine Department, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Ruby S. Gibson
- Tulane Dermatology Program, Dermatology Department, Tulane University School of Medicine, New Orleans, Louisiana
| | - Alexa B. Kimball
- Dermatology Department, Harvard Medical School, Clinical Laboratory for Epidemiology and Applied Research in Skin, Boston, Massachusetts
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Zachary E. Holcomb
- Department of Medicine, Carilion Clinic, Section of Dermatology, Roanoke, Virginia
- Dermatology Department, Virginia Tech-Carilion School of Medicine, Roanoke, Virginia
| | - Martina L. Porter
- Dermatology Department, Harvard Medical School, Clinical Laboratory for Epidemiology and Applied Research in Skin, Boston, Massachusetts
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| |
Collapse
|
2
|
Harvey VM, Alexis A, Okeke CAV, McKinley-Grant L, Taylor SC, Desai SR, Jaleel T, Heath CR, Kang S, Vashi N, Lester J, Vasquez R, Rodrigues M, Elbuluk N, Hamzavi I, Kwatra SG, Sundaram H, Cobb C, Brown SG, Kohli I, Callender VD. Integrating skin color assessments into clinical practice and research: A review of current approaches. J Am Acad Dermatol 2024:S0190-9622(24)00215-9. [PMID: 38342247 DOI: 10.1016/j.jaad.2024.01.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/13/2024]
Abstract
Skin color classification can have importance in skin health, pigmentary disorders, and oncologic condition assessments. It is also critical for evaluating disease course and response to a variety of therapeutic interventions and aids in accurate classification of participants in clinical research studies. A panel of dermatologists conducted a literature review to assess the strengths and limitations of existing classification scales, as well as to compare their preferences and utilities. We identified 17 skin classification systems utilized in dermatologic settings. These systems include a range of parameters such as UV light reactivity, race, ethnicity, and degree of pigmentation. The Fitzpatrick skin type classification is most widely used and validated. However it has numerous limitations including its conflation with race, ethnicity, and skin color. There is a lack of validation data available for the remaining scales. There are significant deficiencies in current skin classification instruments. Consensus-based initiatives to drive the development of validated and reliable tools are critically needed.
Collapse
Affiliation(s)
- Valerie M Harvey
- Director, Hampton Roads Center for Dermatology, Newport News, Virginia; President, Skin of Color Society, Newport News, Virginia.
| | - Andrew Alexis
- Clinical Dermatology, Weill Cornell Medical College, New York, New York
| | - Chidubem A V Okeke
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia
| | - Lynn McKinley-Grant
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia
| | - Susan C Taylor
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Seemal R Desai
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas; Innovative Dermatology, Dallas, Texas
| | - Tarannum Jaleel
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Candrice R Heath
- Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Sewon Kang
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Neelam Vashi
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Jenna Lester
- Department of Dermatology, School of Medicine, University of California, San Francisco, California
| | | | - Michelle Rodrigues
- Department of Dermatology, Royal Children's Hospital, Victoria, Australia
| | - Nada Elbuluk
- Department of Dermatology, Keck Medicine, University of Southern California, Los Angeles, California
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hema Sundaram
- Private Practice, Rockville, Maryland; Private Practice, Fairfax, Virginia; Musculoskeletal and Dermatological Sciences, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Caryn Cobb
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Stafford G Brown
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia
| | - Indermeet Kohli
- The Henry W Lim, MD, Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan; Department of Physics and Astronomy, Wayne State University, Detroit, Michigan
| | - Valerie D Callender
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia
| |
Collapse
|
3
|
Elhage KG, Davis MS, Hakimi M, Spencer RK, Jin JQ, Yeroushalmi S, Chung M, Bartholomew E, Bhutani T, Liao W. Ethnoracial representation in hidradenitis suppurativa clinical trials. Arch Dermatol Res 2023; 315:1793-1796. [PMID: 36509944 DOI: 10.1007/s00403-022-02510-4] [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: 09/06/2022] [Revised: 11/16/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is an inflammatory skin disorder characterized by recurring painful and suppurating lesions, with the disease disproportionately affecting black populations in the United States. Ethnoracial representation in clinical trials is vital to ensuring results are generalizable. The purpose of this study is to examine whether ethnic or racial disparities exist in HS clinical trials. METHODS The US National Library of Medicine clinical trials database (clinicaltrials.gov) was queried to identify HS clinical trials. Trials that did not present ethnic or racial data on either the website or publication were not considered. RESULTS A total of 57 HS trials were identified. Of these, 23 trials, containing 2530 patients, included racial or ethnic data (Table 1). White patients made up 76.1% (1435/1886) of the study population, followed by Blacks or African Americans (13.7% (238/1732)), Hispanics or Latinos (7.2% (20/279), Asians (2.6% (26/1016)), American Indians or Alaska Natives (1.3% (14/1051)), and Native Hawaiians or Other Pacific Islanders (0.4% (4/926)). DISCUSSION Our results establish a significant lack of minority ethnoracial representation in HS clinical trials. Since HS prevalence is highest among Blacks or African Americans, it is imperative that future clinical trials are conducted with a larger proportion of this population. Furthermore, clinical trials that did not report racial or ethnic information were conducted in countries with predominantly White populations, which likely skewed the results of this study and caused underreporting of these patients.
Collapse
Affiliation(s)
- Kareem G Elhage
- Department of Dermatology, University of California, San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA.
| | - Mitchell S Davis
- Department of Dermatology, University of California, San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Marwa Hakimi
- Department of Dermatology, University of California, San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Riley K Spencer
- Department of Dermatology, University of California, San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Joy Q Jin
- Department of Dermatology, University of California, San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Samuel Yeroushalmi
- Department of Dermatology, University of California, San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Mimi Chung
- Department of Dermatology, University of California, San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Erin Bartholomew
- Department of Dermatology, University of California, San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Wilson Liao
- Department of Dermatology, University of California, San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| |
Collapse
|
4
|
Ferguson JE, Seger EW, White J, McMichael A. Racial/ethnic differences in treatment efficacy and safety for moderate-to-severe plaque psoriasis: a systematic review. Arch Dermatol Res 2023; 315:41-50. [PMID: 35050396 DOI: 10.1007/s00403-022-02324-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 01/07/2023]
Abstract
Biologic medications have revolutionized treatment of psoriasis; however, there remains uncertainty in which medications should be used to maximize efficacy based on race/ethnicity. The purpose was to determine if efficacy of biological medications differs based on race/ethnicity. A systematic review identified all clinical trials focused on biologic treatment outcomes from inception of database until March 5th, 2021. Included studies provided data on racial/ethnic differences in biologic skin clearance efficacy using the Psoriasis Area and Severity Index (PASI) and "clear/almost clear" scores. There were 1220 studies identified, and 24 included in the review. The races/ethnicities included were Asian (n = 2740), White (n = 9745), Black (n = 138), and Latino (n = 728). Ixekizumab provided the highest "clear/almost clear" score (90.7%, 89.4%) and PASI 75 (98.8%, 96.6%) for Asian and Latino patients, respectively. Guselkumab had the highest "clear/almost clear" score for White (86.8%) patients, while Black patients had highest "clear/almost clear" (75.0%) and PASI 75 (91.7%) scores to brodalumab. Limitations included lack of studies reporting outcome data based on race/ethnicity and lack of patients of color within psoriasis clinical trials. For treatment of plaque psoriasis, there is evidence of differences in efficacy of biologics improving clinical disease severity between different races or ethnicities.
Collapse
Affiliation(s)
- Jessica E Ferguson
- Division of Dermatology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.
- School of Medicine, University of Kansas, Kansas City, KS, USA.
| | - Edward W Seger
- Division of Dermatology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Jacob White
- School of Medicine, University of Kansas, Kansas City, KS, USA
| | - Amy McMichael
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
5
|
McKenzie S, Brown-Korsah JB, Syder NC, Omar D, Taylor SC, Elbuluk N. Variations in genetics, biology, and phenotype of cutaneous disorders in skin of color. Part II: Differences in clinical presentation and disparities in cutaneous disorders in skin of color. J Am Acad Dermatol 2022; 87:1261-1270. [PMID: 35817332 DOI: 10.1016/j.jaad.2022.03.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/20/2022]
Abstract
Skin of color (SOC) patients are projected to comprise the majority of the population by 2044, yet knowledge gaps in the clinical presentation and treatment of both common and uncommon dermatologic conditions in skin of color persist. Improved awareness of disparities that disproportionately impact SOC patients is necessary to address health inequity in the field of dermatology. The first part of this CME discussed structural, genetic, and immunophenotypic differences in SOC in common inflammatory disorders as well as cutaneous malignancies. The second part of this CME highlights clinical differences in the phenotypic presentation of the inflammatory disorders of atopic dermatitis, psoriasis, and hidradenitis suppurativa as well as the cutaneous malignancies of melanoma, basal cell carcinoma, and cutaneous T-cell lymphoma. Health disparities associated with each of these conditions are also discussed.
Collapse
Affiliation(s)
- Shanice McKenzie
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jessica B Brown-Korsah
- Case Western Reserve University, School of Medicine, Cleveland, Ohio; Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nicole C Syder
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Deega Omar
- George Washington University, School of Medicine and Health Sciences, Washington, District of Columbia
| | - Susan C Taylor
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nada Elbuluk
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California.
| |
Collapse
|
6
|
Ding J, Joseph M, Chawla S, Yau N, Khosa Z, Khawaja F, Khosa F. Disparities in psoriasis clinical trials: A cross-sectional analysis. J Am Acad Dermatol 2022; 87:1386-1389. [PMID: 36113618 DOI: 10.1016/j.jaad.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Jeffrey Ding
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marissa Joseph
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sahil Chawla
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Noelle Yau
- Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Zamzam Khosa
- Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Fajr Khawaja
- Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Faisal Khosa
- Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada.
| |
Collapse
|
7
|
Unmet Need in People with Psoriasis and Skin of Color in Canada and the United States. Dermatol Ther (Heidelb) 2022; 12:2401-2413. [PMID: 36131193 PMCID: PMC9588130 DOI: 10.1007/s13555-022-00811-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/05/2022] [Indexed: 11/24/2022] Open
Abstract
The experience of dermatological conditions such as psoriasis is different for people with skin of color (SoC) than for white individuals. The objective of this literature review was to understand challenges and unmet needs associated with access to care, diagnosis, and treatment of psoriasis among people with SoC in Canada and the United States. The review focused on studies published in the last 5 years. After screening 919 unique records, 26 studies were included. Importantly, lack of culturally competent care was identified as a key unmet need for psoriasis among people with SoC. In addition, cost of care and cultural views of psoriasis may influence decisions to seek care among people with SoC. Baseline patient characteristics in psoriasis studies and the prevalence/incidence of psoriasis vary across racial/ethnic groups, which may reflect differences in the rate and/or timing of diagnosis. The presentation of psoriasis differs across racial/ethnic groups, which may contribute to challenges in proper and timely diagnosis. Compared with white patients with psoriasis, individuals with SoC may be less familiar with and have different rates of treatment with biologic therapies for psoriasis, are more likely to be hospitalized for psoriasis, and their access to physicians may differ. Further, people with SoC are underrepresented in clinical trials of psoriasis therapies. Overall, the results of this literature review suggest that people with psoriasis and SoC face unique challenges in their disease experience. It is essential that clinicians and other stakeholders recognize and address these disparities to ensure equitable care. Skin conditions such as psoriasis are experienced differently by people with skin of color (SoC) compared with white individuals. Although it is known that psoriasis can vary in how it appears between these groups, other factors that affect care for patients with SoC are not well understood. For this review, we focused on challenges associated with accessing healthcare, receiving a diagnosis, and receiving treatment for psoriasis among people with SoC. A search of the academic literature identified several such challenges for people with SoC in Canada and the United States. A major challenge for people with psoriasis and SoC is having access to care that is compatible with their cultural values and practices. The cost of healthcare and cultural views of psoriasis may influence whether individuals with SoC decide to seek care. People with SoC are more likely to be hospitalized for psoriasis, and their access to physicians may differ compared with white individuals. In addition, differences in how psoriasis appears across racial/ethnic groups may hinder diagnosis. Psoriasis treatments that patients with SoC receive may differ from those that white individuals receive, and people with SoC may be less likely to be properly represented in clinical trials evaluating psoriasis therapies. Taken together, the findings of our review indicate that people with psoriasis and SoC face unique challenges in how they receive medical care for their condition. It is essential that clinicians and other stakeholders in the healthcare system recognize these challenges and work to address them.
Collapse
|
8
|
Sevagamoorthy A, Sockler P, Akoh C, Takeshita J. Racial and Ethnic Diversity of US Participants in Clinical Trials for Acne, Atopic Dermatitis, and Psoriasis: A Comprehensive Review. J DERMATOL TREAT 2022; 33:3086-3097. [PMID: 35980324 DOI: 10.1080/09546634.2022.2114783] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
An increasing body of literature describes underreporting of race and ethnicity, and overrepresentation of White individuals in clinical trials. We aimed to evaluate the racial and ethnic diversity of US participants in clinical trials for acne, atopic dermatitis (AD), and psoriasis. We performed a comprehensive review of clinical trials for these common dermatologic diseases that were published between January 2014 and July 2019. Race and ethnicity reporting among all trials, and the racial and ethnic distribution of US participants were compared by skin disease, intervention type, and trial phase. In total, 103 articles representing 119 unique trials were evaluated. Race and ethnicity were reported in only 22.7% of trials. The proportion of White participants (77.5%) was higher than that of the US population (72.5%, p < 0.01); a finding largely driven by psoriasis trials (84.7% White). The proportions of non-White and Hispanic individuals in non-topical (21.0% and 16.3%, respectively) and phase III (20.5% and 18.7%, respectively) trials were lower than those in topical (23.5% and 23.3%, respectively; p < 0.01) and phase I/II trials (25.6% and 22.3%, respectively; p < 0.01). Race and ethnicity remain underreported in dermatologic clinical trials, and US trial participant diversity differs by skin disease, intervention type, and trial phase.
Collapse
Affiliation(s)
- Anjana Sevagamoorthy
- Deparment of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Patrick Sockler
- Deparment of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | - Junko Takeshita
- Deparment of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.,Department of Biostatistics, Epidemiology and Informatics; Center for Clinical Epidemiology and Biostatistics; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
9
|
A Pilot Study to Assess the Reliability of Digital Image-Based PASI Scores Across Patient Skin Tones and Provider Training Levels. Dermatol Ther (Heidelb) 2022; 12:1685-1695. [PMID: 35727498 PMCID: PMC9276898 DOI: 10.1007/s13555-022-00750-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/20/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction The ability to perform psoriasis skin assessments remotely through digital image-based psoriasis area and severity index (DIB-PASI) would be a valuable tool for psoriasis clinical trials. An ideal teledermatological assessment would be robust across patients of diverse skin tones as well as across assessors of varying experience levels. In this pilot study, we evaluated the reliability of face-to-face (FTF) versus DIB-PASI scores determined by trained clinical assessors with a spectrum of experience and with patients of different skin tones. Methods Fourteen subjects of varying skin tones with moderate-to-severe plaque psoriasis were treated with adalimumab. In-person PASI assessments and digital photography were performed in the clinic at weeks 0, 12, and 24. Photographs were reviewed by four independent assessors to derive a digital image-based PASI score. The concordance of face-to-face PASI (FTF-PASI) and DIB-PASI were analyzed across patient and assessor factors. Results Overall concordance between FTF-PASI and DIB-PASI was high (ICC 0.82, p < 0.0001), with good agreement across individual assessors. When analyzed by PASI score component or body region, digital assessors also demonstrated good agreement with the FTF assessor. Similarly, DIB-PASI showed high concordance with FTF-PASI for patients with light skin tones and patients with medium-to-dark skin tones, and across clinical training levels. Conclusion Overall, PASI scores derived from digital images showed good agreement with those determined in person. Importantly, these remote assessments were reliable for both light and medium-to-dark skin tones, and robust to training level of the assessor. The findings from this pilot study lay the foundation for expanding teledermatology-based clinical trials for patients with psoriasis and enabling accurate, remote monitoring of disease severity and therapy response. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-022-00750-w.
Collapse
|
10
|
Felice S, Bressler MY, Karim R, Markowitz O. Transforming the treatment of psoriasis to the 21st century: Detecting subclinical therapeutic response to secukinumab using optical coherence tomography as a prognostic indicator. Lasers Surg Med 2022; 54:825-834. [PMID: 35598099 DOI: 10.1002/lsm.23551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Optical coherence tomography (OCT) is a noninvasive imaging device that scans the skin up to 2 mm in depth. OCT can capture real-time epidermal thickness (ET) measurements and detect subclinical changes in inflammatory skin diseases like eczema and psoriasis. © 2022 Wiley Periodicals LLC. OBJECTIVE To determine if measuring ET with OCT can detect a subclinical therapeutic response in psoriasis treated with the biological therapy, secukinumab (an IL-17A antagonist). DESIGN Phase IV, single-center, open-label, and single-arm study. PARTICIPANTS Twenty-six consecutive patients with moderate to severe plaque psoriasis. MEASUREMENTS Clinical, dermoscopic, and OCT images were obtained at each visit. The clinician measured disease severity with the Investigator's Global Assessment (IGA) and Psoriasis Area And Severity Index (PASI). OCT was used to scan the ET at the center of lesional skin (ET-L), along the border, and normal skin (ET-N) on the same body plane; their difference was noted as ΔET. RESULTS Initially, ET-L was greater than ET-N (p < 0.0001), their differences decreased throughout the study, and there were no significant differences at Week 16 (p = 0.48). Twenty-four (92%) patients achieved a 50% reduction in PASI score (PASI50); they had lower ΔET at Weeks 0, 1, 3, 4, and 8 compared to those who did not clear (p < 0.04). Having a lower ΔET at Week 4 was associated with a shorter time to reach PASI50 (p = 0.02). CONCLUSION ET measurements using OCT can detect an early subclinical response to secukinumab compared to clinical scoring and identify nonresponders as early as 4 weeks.
Collapse
Affiliation(s)
- Skye Felice
- OptiSkin, New York, New York, USA.,Department of Dermatology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA.,New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York, USA
| | - Moshe Y Bressler
- OptiSkin, New York, New York, USA.,Department of Dermatology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | | | - Orit Markowitz
- OptiSkin, New York, New York, USA.,Department of Dermatology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| |
Collapse
|
11
|
Mosca M, Hong J, Hadeler E, Hakimi M, Brownstone N, Bhutani T, Liao W. A cross-sectional study of ethnoracial representation in pediatric plaque psoriasis clinical trials. J Am Acad Dermatol 2021; 86:442-444. [PMID: 34624415 DOI: 10.1016/j.jaad.2021.09.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/05/2021] [Accepted: 09/24/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Megan Mosca
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco, San Francisco, California.
| | - Julie Hong
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco, San Francisco, California
| | - Edward Hadeler
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco, San Francisco, California
| | - Marwa Hakimi
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco, San Francisco, California
| | - Nicholas Brownstone
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco, San Francisco, California
| | - Tina Bhutani
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco, San Francisco, California
| | - Wilson Liao
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco, San Francisco, California
| |
Collapse
|
12
|
Hadeler E, Hong J, Mosca M, Hakimi M, Brownstone N, Bhutani T, Liao W. Perspectives on the Future Development of Mobile Applications for Dermatology Clinical Research. Dermatol Ther (Heidelb) 2021; 11:1451-1456. [PMID: 34491532 PMCID: PMC8422374 DOI: 10.1007/s13555-021-00604-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Indexed: 12/17/2022] Open
Abstract
The COVID-19 pandemic significantly impacted clinical research in dermatology and practices around the country transitioned to teledermatology amid physical distancing requirements. Despite their growing use in teledermatology and clinical care, dermatology applications have not been studied extensively in the research space. The use of mobile applications has the potential to improve the experience of study subjects and physicians and increase the pool of individuals willing to participate in research beyond the pandemic. We discuss the various pros and cons of mobile apps, as well as the necessary components they require to successfully conduct research.
Collapse
Affiliation(s)
- Edward Hadeler
- Department of Dermatology, University of California, San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA.
| | - Julie Hong
- Department of Dermatology, University of California, San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Megan Mosca
- Department of Dermatology, University of California, San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Marwa Hakimi
- Department of Dermatology, University of California, San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Nicholas Brownstone
- Department of Dermatology, University of California, San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Wilson Liao
- Department of Dermatology, University of California, San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| |
Collapse
|
13
|
Shwe S, Nguyen C, Bhutani T. Racial disparities in clinical trials of biologic treatments for psoriatic arthritis. J Am Acad Dermatol 2021; 87:910-912. [PMID: 34464628 DOI: 10.1016/j.jaad.2021.08.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/01/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Samantha Shwe
- Department of Dermatology, University of California, Irvine, CA 92697.
| | - Cristina Nguyen
- Department of Dermatology, University of California, Irvine, CA 92697
| | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco, CA 94115
| |
Collapse
|