Martin A. Menter M.D.

Frieder, J., D. Kivelevitch, C. T. Fiore, S. Saad and A. Menter (2017). “The impact of biologic agents on health-related quality of life outcomes in patients with psoriasis.” Expert Rev Clin Immunol: 1-19.

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INTRODUCTION: Psoriasis is a common, immune-mediated skin disease often associated with significant physical and psychosocial impairment. Antipsoriatic biologic agents offer patients unparalleled treatment potential in regard to greater skin clearance and overall improved quality of life. Evaluation of the therapeutic efficacy of biologic agents on the full psoriasis disease burden must account for their impact on both physical symptoms, as well as patient-reported, health-related quality of life (HRQoL) measurements. Areas covered: Results from numerous clinical trials demonstrate the significant clinical efficacy of biological agents targeting tumor necrosis factor-alpha (TNF-alpha) and the interleukin (IL)-12/23 and IL-17 immune pathways. However, relatively limited data is available evaluating their full effect on quality of life outcomes. This review will discuss the most relevant and up-to-date clinical data on HRQoL measurements related to treatment with these aforementioned biologic agents. Expert commentary: Patient-reported outcomes (i.e. Dermatology Life Quality Index) are being used with increasing frequency in clinical trials, and provide valuable information on the impact of psoriasis on numerous aspects of day-to-day living. These outcomes must also be incorporated in clinical practice, in addition to physical assessment of disease severity, treatment decisions, and therapeutic response in the psoriasis patient population.

Wilder, E. G., J. Frieder, S. Sulhan, P. Michel, J. D. Cizenski, J. M. Wright and M. A. Menter (2017). “Spectrum of orocutaneous disease associations: Genodermatoses and inflammatory conditions.” J Am Acad Dermatol 77(5): 809-830.

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The oral cavity and cutaneous organ systems share a close embryologic origin. Therefore, there are numerous dermatologic conditions presenting with concomitant oral findings of which the dermatologist must be aware. The second article in this continuing medical education series reviews inflammatory orocutaneous conditions and a number of genodermatoses. It is essential for dermatologists to be familiar with oral cavity manifestations associated with dermatologic diseases for prompt diagnosis, management, and appropriate referral to stomatology and dentistry.

Cizenski, J. D., P. Michel, I. T. Watson, J. Frieder, E. G. Wilder, J. M. Wright and M. A. Menter (2017). “Spectrum of orocutaneous disease associations: Immune-mediated conditions.” J Am Acad Dermatol 77(5): 795-806.

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There are a number of diseases that manifest both on the skin and the oral mucosa, and therefore the importance for dermatologists in clinical practice to be aware of these associations is paramount. In the following continuing medical education series, we outline orocutaneous disease associations with both immunologic and inflammatory etiologies.

Michel, P., A. Menter and J. Griffin (2017). “A congenital naevus in a blaschkoid distribution.” Clin Exp Dermatol: 2017 Oct [Epub ahead of print].

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NC is a rare hamartomatous proliferation of the pilo-sebaceous unit, usually evident at birth or appearingin early childhood. Most NCs arise sporadically, with afew adult onset cases reported secondary to trauma orirritation.1Men and women are equally affected, andthere is no evidence of racial aggregation. Rare associ-ations with cataracts, skeletal defects or central ner-vous system abnormalities characterize NC syndrome.

Strober, B., M. Gooderham, E. de Jong, A. B. Kimball, R. G. Langley, N. Lakdawala, K. Goyal, F. Lawson, W. Langholff, L. Hopkins, S. Fakharzadeh, B. Srivastava and A. Menter (2017). “Depressive symptoms, depression, and the effect of biologic therapy among patients in psoriasis longitudinal assessment and registry (psolar).” J Am Acad Dermatol: 2017 Oct [Epub ahead of print].

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BACKGROUND: Patients with psoriasis are at an increased risk for depression. However, the impact of treatment on this risk is unclear. OBJECTIVE: Evaluate the incidence and impact of treatment on depression among patients with moderate-to-severe psoriasis. METHODS: We defined a study population within the Psoriasis Longitudinal Assessment and Registry and measured the incidence of depressive symptoms (Hospital Anxiety and Depression Scale-Depression score >/=8) and adverse events (AEs) of depression within cohorts receiving biologics, conventional systemic therapies, or phototherapy. Patients were evaluated at approximately 6-month intervals. Multivariate modeling determined the impact of treatment on risk. RESULTS: The incidence rates of depressive symptoms were 3.01 per 100 patient-years (PYs) (95% confidence interval [CI], 2.73-3.32), 5.85 per 100 PYs (95% CI, 4.29-7.97), and 5.70 per 100 PYs (95% CI, 4.58-7.10) for biologics, phototherapy, and conventional therapy, respectively. Compared with conventional therapy, biologics reduced the risk for depressive symptoms (hazard ratio, 0.76; 95% CI, 0.59-0.98), whereas phototherapy did not (hazard ratio, 1.05; 95% CI, 0.71-1.54). The incidence rates for AEs of depression were 0.21 per 100 PYs (95% CI, 0.15-0.31) for biologics, 0.55 per 100 PYs (95% CI, 0.21-1.47) for phototherapy, and 0.14 per 100 PYs (95% CI, 0.03-0.55) for conventional therapy; the fact that there were too few events (37 AEs) precluded modeling. LIMITATIONS: Incomplete capture of depression and confounders in the patients on registry. CONCLUSION: Compared with conventional therapy, biologics appear to be associated with a lower incidence of depressive symptoms among patients with psoriasis.