scholarly journals Refractory Pediatric Psoriasis and Atopic Dermatitis: The Importance of Therapeutical Adherence and Biological Management

Biomedicines ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 958
Author(s):  
Katherine A. Kelly ◽  
Adaora Ewulu ◽  
Veronica K. Emmerich ◽  
Courtney E. Heron ◽  
Steven R. Feldman
Keyword(s):  
Atopic Dermatitis ◽  
Medication Adherence ◽  
Biologic Therapy ◽  
Treatment Regimens ◽  
Resistant Disease ◽  
Pubmed Search ◽  
Key Phrases ◽  
Allergic Contact ◽  
Poor Medication Adherence ◽  
Rule Out

The rates of refractory pediatric psoriasis and atopic dermatitis (AD) have steadily risen over the last few decades, demanding newer and more effective therapies. This review aims to explore the reasons for resistant disease, as well as its management; this includes the indications for, efficacy of, and safety of current therapies for refractory pediatric dermatologic disease. A PubMed search for key phrases was performed. Poor medication adherence is the most common cause of resistant disease and may be managed with techniques such as simplified treatment regimens, more follow-ups and educational workshops, as well as framing and tailoring. Once problems with adherence are ruled out, escalating treatment to stronger biologic therapy may be indicated. Development of anti-drug antibodies (ADAs) can cause patients’ disease to be refractory in the presence of potent biologics, which may be addressed with regular medication use or concomitant methotrexate. If patients with AD fail to respond to biologic therapy, a biopsy to rule out mycosis fungoides, or patch testing to rule out allergic contact dermatitis, may be indicated. A limitation of this study is the absence of more techniques for the management of poor medication adherence. Managing medication adherence, escalating treatment when appropriate, and addressing possible anti-drug antibodies will help assure control and relief for patients with resistant disease.

scholarly journals An Overview on Contact Dermatitis: Simple Review

2021 ◽  
pp. 325-332
Author(s):  
Shahad Abdulaziz S. Alzahrani ◽  
Bandar Mohammed A. Abu Murad ◽  
Rawan Lafi S. Alatawi ◽  
Ghadah Eid M. Alatwi ◽  
Wejdan Lafi S. Alatawi ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Contact Dermatitis ◽  
Vital Role ◽  
Cumulative Exposure ◽  
Hypersensitivity Reactions ◽  
Lower Infection ◽  
Allergic Contact ◽  
Exclusion Method ◽  
Rule Out

Contact dermatitis (CD) is usually the result of cumulative exposure to sensitive irritants and accounts for 80% of all contact dermatitis cases. ICD can coexist with atopic dermatitis (AD) and allergic contact dermatitis (ACD). Patients with Alzheimer's disease and ACD may also have a lower infection threshold for ICD. Therefore, it must stand out from EA and CAD lesions. People with ICD have experienced uncontrolled tingling and burning sensations. Itching is typically manifested in patients with AD and ACD. Compared with AD and ACD, ICD lesions are usually well described. The prognosis of ICD is based on the exclusion method. Monitor patients to rule out type 1 and type 4 hypersensitivity reactions. A negative result indicates the prognosis of ICD. Management includes identifying and avoiding irritants through the normal use of emollients. Although ICD is older, it is not uncommon in some majors, and genetics and environment play a vital role in its development.

Eczematous Disorders, Atopic Dermatitis, and Ichthyoses

2018 ◽  
Author(s):  
Seth R Stevens
Keyword(s):  
Atopic Dermatitis ◽  
Differential Diagnosis ◽  
Contact Dermatitis ◽  
Seborrheic Dermatitis ◽  
Inflammatory Dermatosis ◽  
Poison Ivy ◽  
Eczematous Dermatitis ◽  
Total Body ◽  
Allergic Contact ◽  
Nummular Eczema

This review describes eczematous dermatitis, or eczema, a skin disease that is characterized by erythematous vesicular, weeping, and crusting patches; atopic dermatitis, a common chronic inflammatory dermatosis that generally begins in infancy; and the ichthyoses, a group of diseases of cornification that are characterized by excessive scaling. The purpose of this review is to examine the major variants, epidemiology, etiology, diagnosis, differential diagnosis, and treatment of these dermatologic diseases. Figures depict chronic eczematous dermatitis, allergic contact dermatitis to poison ivy, seborrheic dermatitis, nummular eczema, acute eczematous patches, lichenified patches that appear after chronic rubbing of eczematous patches, erythroderma (total body erythema), and marked scaling (acquired ichthyosis). Tables list the diagnostic criteria for atopic dermatitis and the differential diagnosis of atopic dermatitis. This review contains 9 highly rendered figures, 2 tables, and 88 references.

Abstract 148: Association of Dosing Frequency on Medication Adherence in Patients with Non-Valvular Atrial Fibrillation

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Tanya Burton ◽  
Lauren J Lee ◽  
Ying Fan ◽  
Winghan Jacqueline Kwong
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Medication Adherence ◽  
Health Plan ◽  
Index Date ◽  
Improve Medication Adherence ◽  
Treatment Regimens ◽  
Pharmacy Claims ◽  
Comorbidity Burden ◽  
Dosing Frequency

Objective: Previous studies suggest that the complexity of a dosing regimen may affect medication adherence. We examined the association between dosing frequency and adherence for 2 concomitant medications commonly prescribed to patients with non-valvular atrial fibrillation (NVAF), metoprolol (MET) and carvedilol (CAR). Methods: A retrospective claims study from a large US commercial and Medicare Advantage health plan analyzed data of adults ( > 18 years) with 1 inpatient or 2 outpatient claims for NVAF between 1/1/2008 - 12/31/2010. Patients with > 2 pharmacy claims for MET or CAR were analyzed separately. Within MET and CAR samples, once-daily (QD) and twice-daily (BID) cohorts were defined by the dosing frequency on pharmacy claims. The index date was set as the date of the first MET or CAR claim. Patients were continuously enrolled in the health plan for 1 year before (pre-index) and 1 year after (post-index) the index date. MET patients were required to have > 1 pre-index claim for acute myocardial infarction, angina, heart failure, or hypertension; CAR patients were required to have ≥1 claim for heart failure or hypertension. Patients using both QD and BID formulations of the index medication were excluded. Adherence to the index medication was assessed by the proportion of days covered (PDC) during the post-index period. PDC between QD and BID patients was compared using logistic regression to adjust for demographic and pre-index clinical characteristics. The proportion of QD and BID patients who discontinued the index medication (defined by a gap > 30 days) during the post-index period was also compared. Results: The analysis included 11,621 MET patients (QD: 6,084; BID: 5,537) and 4,393 CAR patients (QD: 203; BID: 4,190). Mean (SD) age was 70 (12) years for MET and CAR patients; 59% of MET and 69% of CAR patients were male. Compared to patients with BID dosing, patients with QD dosing were on average younger, more likely to be male, and had a lower comorbidity burden. Fewer patients discontinued MET or CAR with QD than BID dosing (MET: 38% vs. 51%, p<0.001; CAR: 39% vs. 48%, p=0.009). The proportion of patients with PDC > 80% was greater for patients with QD than BID dosing (MET: 62% vs. 50%, p< 0.001; CAR: 63% vs. 53%, p=0.004). MET patients with BID dosing were less likely to achieve PDC > 80% than patients with QD dosing (adjusted OR: 0.66; 95% CI: 0.609-0.712). CAR patients with BID dosing were less likely to achieve PDC > 80% than patients with QD dosing (adjusted OR: 0.69; 95% CI: 0.508-0.934). Among MET and CAR patients, age <60 years was associated with lower adherence (p<0.001) while prior use of index medication was associated with higher adherence (p≤0.001) to the index medication. Conclusion: Medication adherence to MET and CAR was higher with QD than BID dosing. Quality initiatives that reduce the dosing frequency of treatment regimens may improve medication adherence among NVAF patients.

scholarly journals Allergic contact dermatitis in atopic dermatitis

2018 ◽  
Vol 19 (4) ◽  
pp. 304
Author(s):  
Sandipan Dhar ◽  
SahanaM Srinivas ◽  
AshokK Bajaj
Keyword(s):  
Atopic Dermatitis ◽  
Contact Dermatitis ◽  
Allergic Contact Dermatitis ◽  
Allergic Contact

Systemic Monotherapy Treatments for Generalized Pustular Psoriasis: A Systematic Review

2018 ◽  
Vol 22 (6) ◽  
pp. 591-601 ◽  
Author(s):  
Linghong Linda Zhou ◽  
Jorge R. Georgakopoulos ◽  
Arvin Ighani ◽  
Jensen Yeung
Keyword(s):  
Treatment Options ◽  
Treatment Algorithm ◽  
Pustular Psoriasis ◽  
Treatment Modalities ◽  
High Morbidity ◽  
Eligibility Criteria ◽  
Level Of Evidence ◽  
Treatment Regimens ◽  
Generalized Pustular Psoriasis ◽  
Pubmed Search

Generalized pustular psoriasis (GPP) is a rare but serious and difficult to treat cutaneous disease, with high morbidity and mortality rates. Despite the numerous treatment regimens available, the overall quality of evidence-based research is limited with a lack of an algorithmic approach available. In this review, we aim to evaluate the current level of evidence regarding the efficacy and safety/tolerability of systemic monotherapies available in the treatment of GPP. A comprehensive MEDLINE, EMBASE, and PubMed search of clinical studies examining systemic monotherapy treatment options for GPP was conducted. In total, 31 studies met eligibility criteria. Described treatment modalities included retinoids, cyclosporine, biologics, and dapsone. Despite the lack of high-quality evidence or a well-accepted treatment algorithm for GPP, systemic retinoids, cyclosporine, biologics, and dapsone are all possible first-line agents, with retinoids being one of the best-supported treatment options and biologics as an emerging therapeutic field with great potential requiring additional data. However, the final choice of treatment should be considered within the unique context of each patient.

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