Percentage Of Body Surface Area Research Articles

Hyperactivation of the JAK2/STAT5 Signaling Pathway and Evaluation of Baricitinib Treatment Among Patients With Eosinophilic Cellulitis

The pathogenesis of eosinophilic cellulitis (EC) is poorly understood, limiting available treatment options. The current treatment paradigm focuses on delayed type 2 hypersensitivity reaction to various triggers. To gain further insight into the nature of EC inflammation and into the cellular signal transduction pathways that are activated in the context of EC. This case series was conducted in Lyon, France, from January 2018 to December 2021. Analysis of archival skin biopsy samples from patients with EC and from healthy control participants was performed using histology, Janus kinase (JAK)-signal transducer and activator of transcription (STAT) immunohistochemistry, and gene profiling. Data analysis was conducted between January 2020 and January 2022. Pruritus (visual analog score), percentage of body surface area with lesional skin, and RNA transcripts of inflammatory biomarkers from the skin (threshold cycle) were assessed in 1 index patient with refractory EC who received oral JAK1/JAK2 inhibitor baricitinib (4 mg/d). This study included samples from 14 patients with EC (7 men and 7 women) and 8 healthy control participants (4 men and 4 women). The mean (SD) age of patients was 52 (20) years. Marked type 2 inflammation (chemokines CCL17, CCL18, and CCL26 and interleukin 13) with preferential activation of the JAK1/JAK2-STAT5 pathways in EC lesions was observed. In the 1 index patient with refractory EC, complete clinical remission of skin lesions was observed after 1 month of treatment with baricitinib. These findings suggest that EC is a type 2 inflammatory disease with preferential activation of the JAK1/JAK2-STAT5 pathways. In addition, these results suggest the potential of treatment approaches targeting JAK1/JAK2 for patients with EC.

438 Potentially greater efficacy with CBP-201 for adults with severe vs. moderate atopic dermatitis at baseline: subgroup analyses from the WW001 phase 2 randomized trial

Abstract CBP-201 is a next-generation monoclonal antibody targeting the IL-4Rα subunit. Rapid efficacy with CBP-201 was demonstrated in global phase 2 (WW001) and China-only pivotal trials (CN002) in patients with moderate-to-severe atopic dermatitis (AD). Previous studies of AD therapy demonstrated similar efficacy between moderate and severe disease, with a trend toward greater improvement in moderate patients. It is unknown whether there are differences in clinical response to CBP-201 with moderate vs.severe AD. We report post hoc efficacy analyses at Week 16 with CBP-201 300 mg from WW001 in baseline severity subgroups, based on validated Investigator Global Assessment (vIGA™) scores of 3 (moderate) and 4 (severe). In WW001 (NCT04444752), adults with moderate-to-severe AD were enrolled in a RDBPC 16-week trial of subcutaneous CBP-201 or placebo. For post hoc analysis, data for 300 mg every 2- and 4-week dose regimens were pooled. Investigators assessed AD severity using Eczema Area and Severity Index (EASI), SCORing AD (SCORAD), percent Body Surface Area (BSA) of AD involvement and vIGA. Patient-reported outcomes were assessed with the Dermatology Life Quality Index (DLQI) and Patient Oriented Eczema Measure (POEM). Least squares mean (LSM) score changes were analysed using ANCOVA modeling (including treatment, baseline score and baseline vIGA), with missing data interpolated by last observation carried forward. Responder endpoints were analysed using Clopper–Pearson methodology and, for missing values, nonresponder imputation. P-values are for CBP-201 vs. placebo, per baseline severity subgroup, at Week 16. At baseline, 113 patients had moderate AD (n = 74 CBP-201, n = 39 placebo) and 56 patients had severe AD (n = 39 CBP-201, n = 17 placebo). Baseline EASI scores were lower in the moderate subgroup [mean (SD): CBP-201, 21.5 (7.0); placebo, 22.2 (6.3)] vs. the severe subgroup [CBP-201, 33.6 (11.9); placebo, 31.9 (10.8)]. In both the moderate and severe AD subgroups, significant improvements with CBP-201 vs. placebo were observed. Except for the proportion of patients achieving vIGA 0/1, numerically greater CBP-201 responses were observed in patients with severe vs. moderate AD at Week 16; placebo responses were comparable per subgroup. In the severe and moderate subgroups, LSM SCORAD scores decreased by −42.8% (severe) and −29.8% (moderate), and LSM percent BSA decreased by −29.8% and −17.3%, respectively. Clinically meaningful 2-point improvement in vIGA was reported for 48.7% and 27.0% of patients with severe and moderate AD, respectively. The proportions of patients achieving vIGA 0/1, with 2-point improvement, were 20.5% and 27.0% with severe and moderate AD, respectively. Numerically greater proportions of patients with severe vs. moderate AD experienced EASI responses with CBP-201: EASI-50, 66.7% vs. 54.1%; EASI-75, 53.8% vs. 39.2%; EASI-90, 28.2% vs. 23.0%. Patients with severe vs. moderate AD reported greater improvements in patient reported outcomes with CBP-201: DLQI, −8.7 vs. −7.0; POEM, −12.5 vs. −8.7. Clinically meaningful improvements were observed in patients with AD with either moderate or severe AD after 16 weeks of treatment with CBP-201 300 mg at either 2- or 4-week dosing. There were no differences noted between moderate and severe patients in the placebo treatment group. In most severity readouts, greater proportions of patients with AD with severe disease on study entry experienced clinically meaningful improvements with CBP-201. In future CBP-201 trials, a more severe AD population needs to be examined to determine if this same observation is also noted. Collectively, the WW001 findings support further investigation of CBP-201, at both the 2- and 4-week dosing schedules enrolling larger numbers of moderate and severe patients with AD and with prespecified analyses by baseline AD severity.

Suboptimal Clinical and Quality of Life Outcomes in Patients with Psoriasis Undertreated with Oral Therapies: International Physician and Patient Survey.

Psoriasis is a chronic, inflammatory, immune-mediated disease. This study assessed the time at which patients switched from a conventional oral systemic treatment to a biologic therapy; patient clinical and quality of life (QoL) outcomes associated with oral systemic treatments; and the proportion of patients who persisted on oral therapy (nonswitchers), despite reported suboptimal clinical and QoL outcomes. This data analysis used the Adelphi Real World Psoriasis Disease Specific Programme, a non-interventional, retrospective, cross-sectional survey conducted in the USA, France, Germany, and United Kingdom (August 2018-April 2019). Kaplan-Meier (KM) analysis assessed switching from oral to biologic therapy in patients treated ≥ 3years at survey completion (n = 597). The severity of psoriasis was reported by physicians as the percentage of body surface area (BSA) affected by psoriasis. Dermatology Life Quality Index (DLQI) scores were calculated for three groups: nonswitchers who met treatment failure criteria, nonswitchers who did not meet failure criteria, and switchers to a biologic therapy. In KM analysis, approximately 50% of the patient population switched by 24months. A substantial portion of nonswitchers continued to have moderate-to-severe psoriasis. Among nonswitchers, 57-77% had BSA ≥ 3% and 16-24% had BSA ≥ 10% at the time of the survey compared with 37% of switchers who had BSA of ≥ 3% and 9% who had BSA of ≥ 10%. QoL was poor among nonswitchers. The mean [standard deviation (SD)] DLQI scores for nonswitchers meeting treatment failure criteria, nonswitchers not meeting failure criteria, and switchers were 6.11 (4.55), 2.62 (3.29), and 2.25 (4.23), respectively. There is a clear unmet need for more effective oral therapies, and further research into the reasons for patients remaining undertreated, which may include patient preference for oral treatments (despite lack of response), contraindications, or insurance/formulary-related barriers to access, are needed.

Efficacy and Safety of Abrocitinib in Patients with Severe and/or Difficult-to-Treat Atopic Dermatitis: A Post Hoc Analysis of the Randomized Phase 3 JADE COMPARE Trial.

Traditional systemic immunosuppressants and advanced therapies improve signs and symptoms of moderate-to-severe atopic dermatitis (AD). However, data are limited in severe and/or difficult-to-treat AD. In the phase 3 JADE COMPARE trial of patients with moderate-to-severe AD receiving background topical therapy, once-daily abrocitinib 200mg and 100mg showed significantly greater reductions in the symptoms of AD than placebo and significantly greater improvement in itch response (with abrocitinib 200mg) than dupilumab at week2. This study assessed the efficacy and safety of abrocitinib and dupilumab in a subset of patients with severe and/or difficult-to-treat AD in a posthoc analysis of the JADE COMPARE trial. Adults with moderate-to-severe AD received once-daily oral abrocitinib 200mg or 100mg, dupilumab 300mg subcutaneous injection every 2weeks, or placebo with concomitant medicated topical therapy. Severe and/or difficult-to-treat AD subgroups were classified by baseline characteristics [Investigator's Global Assessment (IGA) 4, Eczema Area and Severity Index (EASI) > 21, failure or intolerance to prior systemic agents (excluding patients who took only corticosteroids), percentage of body surface area (%BSA) > 50, upper quartiles of EASI (EASI > 38) and %BSA (%BSA > 65), and combined subgroup of IGA 4, EASI > 21, and %BSA > 50, and failure or intolerance to prior systemic agents (excluding patients who took only corticosteroids)]. Assessments included IGA score of 0 (clear) or 1 (almost clear) and a ≥2-point improvement from baseline, ≥75% and ≥90% improvement from baseline in EASI (EASI-75 and EASI-90), ≥4-point improvement from baseline in Peak Pruritus-Numerical Rating Scale (PP-NRS4), time to PP-NRS4, least squares mean (LSM) change from baseline in 14-day PP-NRS (days2-15), Patient-Oriented Eczema Measure (POEM), and Dermatology Life Quality Index (DLQI) up to week16. The proportion of patients achieving IGA 0/1, EASI-75, and EASI-90 responses was significantly greater with abrocitinib 200mg than placebo (nominal p <0.05) across all subgroups with severe and/or difficult-to-treat AD. Across most subgroups, PP-NRS4 response was significantly greater with abrocitinib 200mg than placebo (nominal p <0.01); the time to achieve this response was shorter with abrocitinib 200mg (range 4.5-6.0days) than abrocitinib 100mg (range 5.0-17.0days), dupilumab (range 8.0-11.0 days), and placebo (range 3.0-11.5days). LSM change from baseline in POEM and DLQI was significantly greater with abrocitinib 200mg than placebo (nominal p <0.001) across all subgroups. Clinically meaningful differences were observed between abrocitinib and dupilumab for most evaluated endpoints across several subgroups, including in patients who failed or were intolerant to prior systemic therapy. Abrocitinib provided rapid and substantially greater improvements in skin clearance and quality of life compared with placebo and dupilumab in subgroups of patients with severe and/or difficult-to-treat AD. These findings support the use of abrocitinib for severe and/or difficult-to-treat AD. ClinicalTrials.gov, NCT03720470.

Attrition of Well-Healed Burn Survivors to a 6-Month Community-Based Exercise Program: A Retrospective Evaluation.

The purpose of this study was to evaluate whether burn survivors have lower adherence compared to non-burned control individuals during a 6-month community-based exercise program. In burn survivors, we sought to answer if there was a relation between the size of the burn injury and dropout frequency. Fifty-two burn survivors and 15 non-burned controls (n = 67) were recruited for a 6-month community-based (ie, non-supervised), progressive, exercise training program. During the exercise program, 27% (ie, 4 of the 15 enrolled) of the non-burned individuals dropped out of the study, while 37% (ie, 19 of the 52) of the burn survivors dropped out from the study. There was no difference in the percentage of individuals who dropped out between groups (P = .552). There was no difference in size of the burn injury, expressed as percent body surface area burned (%BSA) between the burn survivors that dropped out versus those who completed the exercise regimen (P = .951). We did not observe a relation between %BSA burned and dropouts (log odds = -0.15-0.01(%BSA), B = -0.01, SE = 0.015, P = .541). There was no effect of %BSA burned on the probability of dropout [Exp (B) = 0.991, 95% CI (0.961, 1.020)] and there were no differences in the percentage of individuals who dropped out of the study based on %BSA burned (χ2(1) = 0.44, P = .51). These data demonstrate that burn survivors have similar exercise adherence relative to a non-burned group and the extent of a burn injury does not affect exercise program adherence.

Quantification of Patient-Reported Pain Locations: Development of an Automated Measurement Method.

Patient-reported pain locations are critical for comprehensive pain assessment. Our study aim was to introduce an automated process for measuring the location and distribution of pain collected during a routine outpatient clinic visit. In a cross-sectional study, 116 adults with sickle cell disease-associated pain completed PAINReportItⓇ. This computer-based instrument includes a two-dimensional, digital body outline on which patients mark their pain location. Using the ImageJ software, we calculated the percentage of the body surface area marked as painful and summarized data with descriptive statistics and a pain frequency map. The painful body areas most frequently marked were the left leg-front (73%), right leg-front (72%), upper back (72%), and lower back (70%). The frequency of pain marks in each of the 48 body segments ranged from 3 to 79 (mean, 33.2 ± 21.9). The mean percentage of painful body surface area per segment was 10.8% ± 7.5% (ranging from 1.3% to 33.1%). Patient-reported pain locations can be easily analyzed from digital drawings using an algorithm created via the free ImageJ software. This method may enhance comprehensive pain assessment, facilitating research and personalized care over time for patients with various pain conditions.

P184 A 24-month prospective psoriatic arthritis observational study of persistence of treatment - interim analysis of baseline characteristics

Abstract Background/Aims Ixekizumab (ixe), a highly selective interleukin (IL)-17A monoclonal antibody, has been approved for treatment of psoriatic arthritis (PsA). However, there is limited real-world evidence (RWE) available for ixe. PRO-SPIRIT is the first large-sample prospective observational study to provide RWE for ixe in patients (pts) with PsA. PRO-SPIRIT’s primary objective is to describe treatment persistence at 24 months (M) among pts with PsA who initiate or switch to a new biologic Disease-Modifying Arthritis Rheumatic Drugs (bDMARDs) or targeted synthetic (tsDMARDs), including ixe. This abstract describes the interim baseline (BL) characteristics. Methods PRO-SPIRIT is a prospective observational study, conducted in FR, ES, IT, DE, UK, and CA, enrolling adults with PsA (≥6M) to be initiated or switched to a new b/tsDMARD, locally approved for PsA. Treatment groups include ixe, secukinumab, IL-12/IL-23 inhibitors (i) (ustekinumab) or IL-23i (guselkumab), tumour necrosis factor (TNFi) (adalimumab, etanercept, infliximab or biosimilar), Janus kinase (JAKi) (tofacitinib or upadacitinib). Pt demographic, disease activity and therapy characteristics are collected at BL; clinical and patient-reported outcomes measures are collected at BL and at a routine post-BL visit. BL descriptive statistics are reported. Results From December 2019 until this interim data cut (June 2021), a total of 477 pts (305 female; mean age 52) were enrolled. Mean age ranged from 48 (IL-12/23i and IL-23i) to 55 (JAKi), with a majority of female pts in each group. Pts in the IL-12/23i and IL-23i and TNFi groups showed the shortest time since PsA diagnosis (5.2±4.5; 6.5±7.9), while pts in the JAKi group showed the longest time (10.6±9.4). The lowest proportion of pts with a prior b/tsDMARDs use was observed in the TNFi group (31%), the highest in the IL-12/23i and IL-23i group (71%). Pts in the ixe and IL-12/23i and IL-23i groups were more likely to be on monotherapy. Tender Joint Count (9.1-11.3) and Swollen Joint Count (3.3-5.8) were comparable across groups, with the highest values in the ixe and JAKi groups, respectively. Pt proportion with enthesitis and dactylitis was higher in the ixe, secukinumab and JAKi groups. Percentage of Body Surface Area affected by psoriasis was higher in the ixe, secukinumab and IL-12/23i and IL-23i groups. Pt proportion with nail psoriasis was higher in the ixe and secukinumab groups. Physician's Global Assessment Visual Analog Scale (VAS), Patient’s Global Assessment VAS and Patient's Assessment of Joint Pain VAS reflected a high burden of illness. Conclusion The reported BL characteristics offer preliminary information about which pts initiate or switch to a b/tsDMARD in a real-life setting. Future disclosures (at 12 and 24M) will provide RWE regarding persistence, effectiveness, and healthcare resource use of available treatments for PsA, which will help pts and physicians to make better informed treatment decisions. Disclosure J. Morel: Consultancies; J. Morel has been a speaker and/or consultant for: AbbVie, Amgen, Biogen, Bristol Myers Squibb, Eli Lilly and Company, Fresenius, Galapagos, Glaxo Smith Kline, Médac, Novartis, Sandoz, and Sanofi. Grants/research support; J. Morel has received grant funding/research support from: Biogen, Bristol Myers Squibb, Eli Lilly and Company, Novartis, and Pfizer. L. Dagna: Consultancies; L. Dagna has been a speaker and/or consultant for: AbbVie, Amgen, AstraZeneca, Biogen, Bristol Myers Squibb, Celltrion, Lilly, Galapagos, GSK, Janssen, Kiniska, Pfizer, Roche, Sobi, and Sanofi. B. Ibañez: Grants/research support; B. Joven-Ibáñez has been a speaker for and has received grant funding/research support from: Eli Lilly and Company. T. Holzkaemper: Shareholder/stock ownership; T. Holzkaemper is a shareholder and employee of: Eli Lilly and Company. C. El Baou: Consultancies; C. El Baou has worked as a consultant for: Eli Lilly and Company. L. Unger: Other; L. Unger has been a speaker for: Eli Lilly and Company. A. Semeraro: None. N. Gullick: Consultancies; N. Gullick has been a speaker and/or consultant for: AbbVie, Celgene, Eli Lilly and Company, Janssen, Novartis, and UCB. Grants/research support; N. Gullick has received grant funding/research support from: AbbVie, AstraZeneca, Eli Lilly and Company, Izana, and Novartis. T. Treuer: Shareholder/stock ownership; T. Truer is a shareholder and employee of: Eli Lilly and Company.

301 Tapinarof cream 1% once daily for the treatment of extensive atopic dermatitis in adolescents and children: 4-week maximal use trial

Abstract There is a need for efficacious non-steroidal topical therapies for atopic dermatitis (AD) without restrictions relating to duration, the extent of use and application sites. Tapinarof (VTAMA®; Dermavant Sciences, Inc., USA) is a first-in-class, non-steroidal, topical, aryl hydrocarbon receptor agonist approved by the Food and Drug Administration for the treatment of plaque psoriasis in adults and under investigation for the treatment of psoriasis in children down to 2 years of age and for AD in adults and children down to 2 years of age. Tapinarof cream 1% once daily (QD) demonstrated significant efficacy vs. vehicle at 12 weeks and was well tolerated in adults and adolescents and with moderate to severe AD in a previously reported phase 2b trial (NCT02564055). To assess the safety, tolerability, pharmacokinetics (PK) and efficacy of tapinarof cream 1% QD in adolescents and children with extensive AD. In this open-label, maximal use, phase 2 trial (NCT05186805), adolescents and children, aged 2–17 years, with a clinical diagnosis of AD, a validated Investigator Global Assessment in Atopic Dermatitis™ (vIGA-AD™) score ≥3, and percent body surface area (%BSA) involvement of ≥ 25% for adolescents (12–17 years) or ≥35% for children (2–11 years) were assigned tapinarof cream 1% QD for 27 days. Primary endpoints include adverse events, mean investigator-assessed local tolerability scores (overall and sensitive areas) and PK parameters. Secondary endpoints include a change in vIGA-AD™, Eczema Area Severity Index (EASI), %BSA affected, and Peak Pruritus-Numeric Rating Scale scores at each trial visit. Eligible patients completing this trial have the option to enrol in an open-label, long-term extension trial (NCT05142774) to receive up to an additional 48 weeks of tapinarof cream 1% QD treatment. Overall, 36 patients aged 2–17 years were enrolled at nine sites in the US and Canada. Of these patients, equal proportions (33.3% [12/36]) were young children (2–6 years), children (7–11 years) and adolescents (12–17 years); 66.7% (24/36) were male and mean age (standard deviation [SD]) was 8.9 (4.9) years. At baseline, 77.8% (28/36) had a vIGA-AD™ score of 3 (moderate) and 8/36 (22.2%) had a score of 4 (severe). At baseline, the mean (SD) %BSA affected was 52.4% (19.1%), 42.0% (10.0%) and 33.9% (8.6%) for young children, children and adolescents, respectively. The overall mean (SD) EASI score was 23.8 (9.2). This trial will assess the safety, tolerability, PK and efficacy of tapinarof cream 1% QD in 36 adolescents and children down to 2 years of age with extensive, moderate-to-severe AD.

Characterizing risk factors for hospitalization for psoriasis patients.

Psoriasis is a chronic autoimmune disease with a large economic impact. Inpatient care is a significant expense, and about one-third of patients admitted for psoriasis are readmitted. Reducing hospitalizations and readmissions is an important goal for improving outcomes for psoriasis patients. The objective of this study is to characterize patients who are hospitalized for psoriasis, and differentiate features for patients with a single hospitalization from those who were hospitalized multiple times during the study period. Hospitalized psoriasis patients were identified from an in-patient database at a single academic institution. Differences between psoriasis patients with one hospitalization and those with multiple hospitalizations were characterized, as were differences between patients who were hospitalized primarily for psoriasis and those who were admitted primarily for other reasons. Patients who were primarily hospitalized for psoriasis had fewer comorbidities, shorter hospitalizations, and a lower death rate than those hospitalized for other reasons. Patients with multiple hospitalizations had more comorbidities and worse outcomes than patients with a single hospitalization. Patients who are hospitalized primarily for psoriasis are more likely to be pustular, and tend to have fewer comorbidities and better outcomes than patients with psoriasis who are hospitalized with psoriasis as a secondary diagnosis. One limitation of this study is the lack of data available to consistently quantify disease severity, such as percent of body surface area affected by psoriasis or Physician's Global Assessment score.

Admission Pattern of Burn Patients of Various Aetiologies in the Burn Unit of a Tertiary Care Hospital in COVID-19 and Pre-COVID-19 Period: A Retrospective Study

Introduction: Worldwide the Coronavirus Disease-2019 (COVID19) pandemic has brought with it many changes and challenges in the healthcare scenario. While restricted movement during the lockdown period had its effect in the reduction of outdoor burn incident such as industrial burn, overcrowding at residential units led to an increase in domestic burns. Aim: To evaluate various changes in acute burns reflected in the admission pattern in a tertiary care hospital during pre-COVID19 and COVID-19 period. Materials and Methods: The present study was a retrospective observational study conducted in the burn unit of a tertiary care teaching hospital in Kolkata, West Bengal, India, from September 2018 to February 2020 (Pre-COVID-19) and March 2020 to August 2021 (COVID-19). Data of burns patients such as age, sex, aetiology of burn, mode of burn injury, percentage of body surface area involved, duration of hospital stay, number of patients undergoing surgical management, discharge, and death were reviewed and analysed using MS Excel and Z-test. Results: There was a decrease in the admission rates in the COVID-19 period (462 v/s 317). Flame burn 43.51% v/s 48.26% (p=0.67); scald burn 38.10% v/s 41.01% (p=0.19); electric burn 15.8% v/s 4.73% (p=0.00001); chemical burn 2.59% v/s 5.99% (p=0.0173) for pre-COVID-19 v/s COVID-19 periods, respectively. The proportion of accidental burn injuries remained the same because of overcrowding at home (50.22% v/s 47.63%) (p=0.477) which was compensated by a decrease in workplace accidental burns during the lockdown period. The percentage of suicidal injuries had increased during the COVID19 period (35.06% v/s 48.27%) (p=0.00022). The percentage of homicidal burn injuries had significantly reduced during COVID19 time (14.72% v/s 4.1%) (p=0.00001). There was a statistically significant increase in the paediatric population of burn injuries during COVID-19 (35% v/s 62.7%) (p=0.00001). Conclusion: Decrease in admission rates and comparable accidental flame and scald burn injuries and a drop in workplace burn injuries with women and children being the most vulnerable population.

Assessing pain catastrophizing and functional disability in pediatric epidermolysis bullosa patients.

The primary objective was to assess pain catastrophizing and functional disability in pediatric patients with epidermolysis bullosa (EB) and their parents/guardians. Secondary objectives included examining relationships between pain catastrophizing, functional disability, and correlations with other factors (e.g., age, disease severity, and percent of body surface area (BSA) involved). Patients with EB ages 8-16 and their parents/guardians who were English or Spanish speaking completed a one-time online survey. Parent measures included: demographics questionnaire, Pain Catastrophizing Scale-Parent (PCS), and Parent Functional Disability Inventory (FDI). Child measures included: PCS child and child FDI. Higher scores on both scales indicate higher levels of catastrophizing and functional disability. Of 31 children, the mean age was 11.47 years and the majority (70.97%) had dystrophic EB. Mean scores were: 35.84=PCS parent; 34.58=PCS child; 30.87=parent FDI; 29.77=child FDI. Total scores for PCS parent, parent FDI, and child FDI increased significantly with disease severity and percentage of involved BSA (p < .01 for all). Total scores for PCS child increased significantly with percent of EB skin involvement (p=.04) but not disease severity. Older children reported more functional disability than their parents and younger children (p=.02). Our results demonstrate significant positive correlations between negative thoughts related to pain and the experience of functional difficulties in patients with EB and their caregivers. Psychological, psychiatric, and/or behavioral interventions to help managing chronic pain may be effective for patients with EB.

Real-world treatment patterns, patient-reported outcomes, and effectiveness of flexibledosing etanercept in patients with plaque psoriasis in Greece.

Etanercept is approved for continuous or intermittent use and flexible dosing in plaque psoriasis (PsO). The objectives of this study were to investigate real-world treatment patterns with etanercept in Greek adults with moderate-to-severe PsO. This non-interventional multicenter study included a retrospective-to-prospective (RP) cohort, previously treated with etanercept for ≥24 months and followed for an additional 6 months, and a biologic-naïve, prospective-only (PO) cohort, followed for 6 months after treatment initiation. Parameters assessed included Psoriasis Area and Severity Index (PASI), percentage of body surface area (BSA) affected, Dermatology Life Quality Index (DLQI), and adverse events (AEs). This study enrolled 123 patients (RP, n = 56; PO, n = 67), who mostly adhered to continuous treatment (RP, 68%; PO, 95%). The two cohorts had similar mean baseline-to-endpoint decreases in PASI (-9.5 vs -10.1) and BSA (-11.9 vs -12.3). The PO-CTP population had a mean DLQI baseline-to-endpoint score decrease of -5.8, which was statistically significant and clinically meaningful. Treatment-emergent AE rates were 58.9% (RP) versus 26.9% (PO). These real-world data suggest a similar effectiveness of continuous and intermittent etanercept treatment in Greek patients with PsO.

Estimation of percent body surface area in cats with use of computed tomography.

To establish a baseline reference and create a user-friendly chart for normal body surface area (BSA) in the adult domestic cat similar to the "Rule of Nines" chart. Prospective cadaveric study. University Teaching Hospital. Seven adult domestic short-haired feline cadavers of normal body condition (4-6/9) and body weight. Individual whole-body computed tomography (CT) scan was performed on all cats. Images were analyzed with 3-dimensional technology to measure the BSA. A chart was created, illustrating the individual surface area of each body part. Obtained measurements of the cats are different from surface areas of people and dogs. Percentage of total BSA for cats was as follows: head 13%, neck 5%, thorax 20%, abdomen 15%, pelvis and tail 9%, front legs 7% each, and pelvic legs 12% each. The distribution of BSA between body parts is different in cats compared to dogs and people. A species-specific chart was created to assure a more accurate estimation of BSA in cats.

Early Impact of COVID-19 Pandemic on Burn Injuries, Admissions, and Care in a Statewide Burn Service

Anecdotal evidence from specialist burn clinicians suggested patient numbers and workloads increased during lockdown periods. This study aimed to describe the impact of the early COVID-19-related public health control measures (i.e., lockdowns) on burn injuries, hospital admissions, and care in a statewide burn service. We examined admissions data from The Victorian Adult Burns Service (located at the Alfred Hospital) and the Royal Children’s Hospital Burns Service—both of which contribute to the Burns Registry of Australia and New Zealand—during lockdown periods between March and October 2020, compared to the same periods in previous years. There were 714 patients admitted during the control period and 186 during the COVID-19 period. Burns sustained during COVID-19 lockdowns were larger in size. During COVID-19 lockdowns a greater proportion of patients were admitted to intensive care. Although the number of burn-related admissions did not increase during lockdowns, burn injuries that did occur were more severe (i.e., affected a greater percentage of body surface area). These more severe injuries placed an additional and significant burden on an already strained healthcare system. Future public health messaging should include prevention information to minimize the number of injuries occurring during lockdowns and other responses.

RWD3 Real-World Use of Biologics and Prescription Topical Medications in a Pediatric Psoriasis Population

A third of psoriasis (PsO) cases report onset during childhood, but few treatments are FDA-approved specifically for use in pediatric patients. The purpose of this analysis was to describe prescription topical and biologic treatment and percent body surface area (%BSA) in a real-world pediatric PsO population.

Real-World Effectiveness of Dupilumab in Atopic Dermatitis Patients: Analysis of an Electronic Medical Records Dataset.

IntroductionWhile the efficacy of dupilumab for the treatment of adults with moderate-to-severe atopic dermatitis (AD) has been demonstrated in several clinical trials, patients in such trials may not necessarily reflect the real-world clinical practice setting. This study evaluated the real-world effectiveness of dupilumab in adults with moderate-to-severe AD based on physician global assessment, percent body surface area affected, and patient-reported itch.MethodsFrom Modernizing Medicine’s Electronic Medical Assistant dermatology-specific electronic medical records, adults (≥ 18 years) were identified with a diagnosis of AD and ≥ 1 dupilumab prescription (index event) between 1 April 2017 and 31 January 2019. Three cohorts were identified based on 3-month pre-index (1) Investigator Global Assessment (IGA) score ≥ 3, (2) an itch severity numerical rating scale (NRS) score ≥ 3, and (3) body surface area (BSA) affected ≥ 10%. Changes from pre-index on the outcome within each cohort were evaluated at 4 months post-index. Patients were also stratified for evaluation of outcomes by baseline demographic (sex, age) and prior AD treatments (topical therapy only or no treatment, any systemic therapy).ResultsMore than 70% of the 435 AD patients with baseline IGA score ≥ 3 improved to an IGA score of ≤ 2 at month 4 post-dupilumab initiation, including 42.8% who achieved IGA 0/1 (clear/minimal). Among 112 patients with a pre-index itch severity NRS ≥ 3, scores were reduced from mean (SD) 7.0 (2.4) pre-index to 2.8 (2.8) at month 4 (p < 0.0001); 70.5% of patients had a reduction ≥ 3 points. In the BSA cohort (n = 387), affected BSA was significantly reduced from a pre-index mean (SD) of 39.3% (26.1%) to 16.3% (21.2%) at month 4 (p < 0.0001). Significant improvements in IGA, itch NRS, and BSA were observed regardless of demographic (age and sex) or clinical characteristics such as treatment history (all p < 0.0001 compared with pre-index).ConclusionsConsistent with outcomes observed in clinical trials, patients treated with dupilumab in real-world clinical settings achieved clinically meaningful improvements in severity and extent of AD and severity of itch comparable to those reported in clinical trials at a similar time point.

Estimation error of the body surface area in psoriasis: a comparative study of physician and computer-assisted image analysis (ImageJ).

Assessing the area involved in a skin disease, i.e. the body surface area (BSA), is essential in diagnosing disease severity, including in psoriasis. However, in psoriasis, BSA tends to be overestimated by physicians and has shown high inter-rater and intrarater variability. Furthermore, there are no reports suggesting the cause and clinical significance of overestimating BSA in psoriasiss. To investigate the errors in estimating BSA in psoriasis by comparing physicians' results with those of computer-assisted image analysis (CAIA) and to provide suggestions regarding the clinical implications of such errors. Using 43 images, 36 physicians visually estimated BSA in psoriasis, and subsequently, the images were evaluated using a CAIA program (ImageJ); the BSA values determined by the physicians and CAIA were then compared and matched. The BSA percentage was also graded on a scale from 0 to 6, as follows: Grade 0 = no lesion, Grade 1 = 1%-9%, Grade 2 = 10%-29%, Grade 3 = 30%-49%, Grade 4 = 50%-69%, Grade 5 = 70%-89% and Grade 6 = 90%-100%. Each grade range was divided, with the bottom and top 50% defined as the 'first half' and 'second half,' respectively. The mean proportion of correct assessments by physicians was 49.4%. Physicians tended to overestimate the BSA of psoriatic lesions by 8.76% ± 8.82% compared with CAIA. The largest estimation error (proportion incorrect 75.7%) was observed in Grade 3 (30%-49% involvement). Estimates in the second half of the range demonstrated a higher proportion of inaccuracies compared with those in the first half. An overestimating error occurred in certain morphological characteristics of the psoriatic lesions. The inaccuracy of BSA estimation by physicians may be related to the fact that information from the human eye is perceived to be exaggerated compared with the actual size. Further research into using artificial intelligence technology is needed to reduce quantification error and develop an ideal BSA assessment system. Additionally, education and training are needed for physicians to measure BSA accurately.

Perineal burns: Epidemiology, severity factors, management issues and outcome

BackgroundPerineal burns have a direct bearing on the quality of life with physical, functional, sexual, and psychological ramifications. These are defined as major burns requiring referral to a burn centre for management. Isolated genital burns are unusual, and are typically seen as part of larger burns with longer hospital stays and high morbidity and mortality. Materials and methodsThe study was conducted in the Department of Plastic Surgery and Burns (SKIMS), Srinagar, India from 2016 to 2020. Results10.1% of patients (51/503) qualified as perineal burns. The average age was 16.92 ± 45.18 years with a male to female ratio of 3:1. 59% of patients were of the pediatric group and 60% of them were scalds, while flame burns predominate (71.4%) in the adults. 13% were caused by firepot/hot-air blower. The average percentage of body surface area involved was 38.40 ± 114. Most burns were second-degree superficial (70.6%). Intensive Care Unit (ICU) admission was required in 21.6% of patients. Surgery was required in 17.6% of cases. The mortality rate was 21.6%. ConclusionsThe real incidence of perineal burns might be much higher than reported. They act as a predictor for the need for ICU care and mortality in the adult population. Firepot/hot air blower causing full-thickness burns are not infrequent in colder places; so, these hold a promising position when dispensing preventive measures. Conservative management has excellent results.

Seasonal effects on the mechanisms of burn injuries.

This study aimed to evaluate seasonal effects on the mechanisms of burn injuries in patients requiring hospitalization. A retrospective evaluation was made using the information of 419 hospitalized burns patients, including demographic data, degree and percentage of burn injury, cause and mechanism of burn injury, morbidity and mortality. Burn mechanisms were grouped as thermal burns (flame, boiling liquid, contact), chemical burns and electrical burns. When calculating the percentage of body surface area burned, the rule of nines was applied. Seasonal classification was made appropriate to the northern hemisphere. According to the seasons, the most burns were seen in spring months (n= 130, 31.0%). In the examination of the mechanism of burn injury, the most common type of injury was boiling liquid in 159 patients followed by flame injury in 146 patients. There was an increase in electrical and chemical burns in spring and summer. A statistically significant difference was determined between the types of burns according to the seasons (p= 0.024). The burn injury occurred as a result of a workplace accident in 82 cases, the majority of which were in autumn, and summer, and the difference in the seasons was determined to be statistically significant (p= 0.045). There was a statistically significant increase in the exposure of individuals aged >65 years to boiling liquid burns in winter and summer months (p= 0.014). The results of this study showed a seasonal effect on the types of burn injuries. A higher rate of thermal burns was expected to be found in winter, but this was not the case in patients with indications for hospitalization, as chemical and electrical burns in workplace accidents were seen more frequently in warmer seasons of spring and summer. In this context, burns units should be prepared for patient profiles to vary according to the season.

Sustained and improved guselkumab response in patients with active psoriatic arthritis regardless of baseline demographic and disease characteristics: pooled results through week 52 of two phase III, randomised, placebo-controlled studies

ObjectivesTo evaluate the efficacy through 52 weeks of guselkumab, an interleukin 23-p19 subunit inhibitor, in subgroups of pooled psoriatic arthritis (PsA) patients from the DISCOVER-1 and DISCOVER-2 trials defined by...