- Email: [email protected]
Association between disease control in patients with psoriasis and socioeconomic factors in the PSOLAR registry
5210
5514
Assessment of skin barrier recovery via reflectance confocal microscopy using acute tape-stripping Ji Yeon Han, MS, Amorepacific R&D Center; Eunjoo Kim, PhD, Amorepacific R&D Center; Hae Kwang Lee, PhD, Amorepacific R&D Center Background: In vivo reflectance confocal microscopy (RCM) is a useful technique for noninvasive biometry of cutaneous inner structures and allows evaluating morphologic skin change without unnecessary biopsy. In this study, we used an acute tape-stripping model and RCM imaging to develop a method that can assess structural and morphological skin damage and recovery of barrier function.
Associated factors and emergency department and urgent care utilization for sunburn Fan Di Xia, BA, Brigham and Women’s Hospital; Harvard Medical School; Mary Fuhlbrigge, Brigham and Women’s Hospital; Michael Waul, BA, Harvard Medical School; Cara Joyce, PhD, Loyola University Chicago; Arash Mostaghimi, MD, Brigham and Women’s Hospital
Method: Twelve healthy Korean volunteers were enrolled and serial tape-stripping was applied on their forearms. The skin was imaged with RCM to evaluate the epidermal thickness and structural change and we also measured transepidermal water loss (TEWL) to validate the relation to barrier recovery at intervals of 24 hour for 2 weeks. Results: Acute tape-stripping immediately removed all the stratum corneum (SC) layers and the thickness of SC recovered the original state after 1 week. It was doubled after 10 days due to hyperproliferation of keratinocyte. The living epidermal layers tended to increase till 72 hours after stripping. As a result of hyperproliferation and wound recovery, parakeratosis, epidermal atypia, and spongiosis were observed 1 week after acute skin damage. TEWL increased twice after barrier disruption and it was not significantly recovered until 1 week along with the structural change of the skin. Conclusion: We demonstrated that noninvasive RCM in combination with tapestripping could be used as a model to obtain in vivo morphological data on epidermal wound healing. This method would be applied to evaluate the efficacy of cosmetic products and other materials on skin barrier recovery. Commercial support: 100% is sponsored by Amorepacific.
Sunburn is a preventable condition for which usage of emergency department (ED) and urgent care (UC) centers can be largely avoided. No data exists regarding the utilization and associated factors for sunburn presenting to the ED/UC. In this study, we evaluate ED/UC utilization for sunburn as well as associated factors and treatment at the Brigham and Women’s Hospital, Massachusetts General Hospital and associated clinics from 2000-2015. We identified 204 ED/UC visits for sunburn. The mean age was 43.6 6 16.1 years, and 48.5% (n ¼ 97) were women. Blistering (37.3%, n ¼ 76), presence of constitutional symptoms (18.6%, n ¼ 38), and suprainfection (1.0%, n ¼ 2) were present in the minority of cases. Along with vacationing (13.7%, n ¼ 28) and falling asleep in the sun (12.3%, n ¼ 25), psychiatric illness (9.3%, n ¼ 19), alcohol use (6.4%, n ¼ 13), and homelessness (6.4%, n ¼ 13) were important factors associated with sunburn ED/UC utilization. Tanning bed use was the reason for sunburn in 4 (2.0%) cases. The majority was treated with pain control with nonsteroidal inflammatory drugs/acetaminophen with or without opioids (58.3%, n ¼ 119). Documented sun protection counseling was provided in less than half of the visits (33.3%, n ¼ 68). These findings suggest that the majority of ED/UC usage for sunburn may not have been clinically necessary and could have been avoided. Sunburn risks and protection may not be adequately addressed in vulnerable populations such as those with psychiatric illness, alcohol use, and homelessness. Increased public initiatives such as free sunscreen dispensers, designated shade structures, and improved awareness may be needed to reduce risks in these populations. In addition, improvement in the rates of patient counseling at the time of ED/UC presentation is needed, especially since research has demonstrated that behavioral intervention is more effective at the time of disease as compared to random intervention. These efforts should help reduce unnecessary usage of emergent and urgent resources for sunburn, which should improve patient wellbeing while decreasing overall societal costs of treatment. Commercial support: None identified.
5110 Association between disease control in patients with psoriasis and socioeconomic factors in the PSOLAR registry Alexa B. Kimball, MD, Harvard Medical School and Beth Israel Deaconess Medical Center; Matthias Augustin, MD, University Medical Center Hamburg; Kenneth Gordon, MD, Northwestern University, Feinberg School of Medicine; Gerald G. Krueger, MD, University of Utah; David Pariser, MD, Eastern Virginia Medical School and Virginia Clinical Research, Inc; Steven Fakharzadeh, MD, Janssen Scientific Affairs, LLC; Seina Lee, PharmD, Janssen Scientific Affairs, LLC; Wayne Langholff, PhD, Janssen Research & Development, LLC; Lyn Guenther, MD, Western University Background: There is a paucity of data correlating disease control and socioeconomic characteristics in patients with psoriasis.
4803 Assessment of tomato shave biopsy training for medical students Vanessa Voss, MD, Saint Louis University; A. Mary Guo, MD, Saint Louis University; Eric Armbrecht, PhD, Saint Louis University; Claudia Vidal, MD, Saint Louis University Background: Biopsy training using models enables students to practice in low-acuity settings with time for refinement and feedback. Objectives: To assess a tomato training model for shave biopsies. Methods: Following an introductory lecture on shave biopsies, preclinical students (n ¼ 110) practiced on tomatoes with drawn-on shapes. Faculty were available for guidance and evaluated student skills using a 5-point scale. Students completed pre/postworkshop surveys. Results: The percentage of students self-rating their current skill in performing shave biopsy as competent or better increased from 2.7% to 62.8%; the novice rating decreased from 88.1% to 5.5%. Analysis of specific postsurvey items showed the highest level of self-rated competence (‘‘completely able’’) was achieved in: listing steps for shave biopsies (71.8%), listing needed supplies (64.5%), and listing layers of skin (96.4%). Notably fewer students reported self-rated competence with shave biopsy limitations (45.5%) and complications (25.5%). All observed improvements were statistically significant (P \.05). 43.7% of students received highest facultyrated scores for biopsy skills (5-point scale); 35.5% received the next best score.
Objectives: To assess whether correlations exist between control of psoriasis and socioeconomic characteristics among patients with historically severe psoriasis in the Psoriasis Longitudinal and Assessment (PSOLAR) registry. Methods: A total of 4037 patients enrolled in PSOLAR in the United States sites had historically severe psoriasis (PGA 4,5 and/or [ 10%BSA at peak disease activity). These patients were grouped into quartiles based on disease control at enrollment: Group 1 (well-controlled; PGA ¼ 0, 1 and/or #3% BSA; n ¼ 899); Group 2 (moderately controlled; PGA ¼ 2 and/or BSA 3-10%; n ¼ 962); Group 3 (poorly controlled; PGA ¼ 3 and/or BSA [10% #20; n ¼ 964); or Group 4 (very poorly controlled; PGA ¼ 4, 5 and/or BSA [20%; n ¼ 1212). The relationship between disease control and socioeconomic characteristics was examined using multivariate logistic regression by comparing each of the individual Groups 2, 3, or 4 vs Group 1; Groups 3 and 4 combined were also compared to the combined Groups 1 and 2. Multiple socioeconomic indicators were analyzed including education level (# high school degree vs [ high school degree), annual income (#$41,000 vs [$41,000), and insurance type (public/none vs private). Results: Compared with well-controlled psoriasis (Group 1), very poor control (Group 4) was significantly associated with lower education level (odds ratio ¼ 1.548; P \.001). The association of poor control with lower education level was similarly observed when Groups 3 and 4 were compared with Groups 1 and 2 (odds ratio ¼ 1.227; P ¼.0083). Other comparisons, including all comparisons for annual income and insurance type, were not statistically significant.
Limitations: The study lacked control groups and assessment of skill translation to humans. Conclusions: The simulated tomato workshop is an effective shave biopsy training model for medical students with strength in teaching technical skills such as steps and supplies.
Conclusions: Poor control of historically severe psoriasis correlated with lower education level, but not with insurance type or annual income among PSOLAR patients in the United States. Insurance type and annual income did not correlate with control of psoriasis in this analysis. Outreach efforts directed towards patients with severe psoriasis and lower education level may improve disease control.
Commercial support: None identified.
Commercial support: Janssen Research & Development, LLC supported this study 100%.
AB50
J AM ACAD DERMATOL
JUNE 2017
5514
Assessment of skin barrier recovery via reflectance confocal microscopy using acute tape-stripping Ji Yeon Han, MS, Amorepacific R&D Center; Eunjoo Kim, PhD, Amorepacific R&D Center; Hae Kwang Lee, PhD, Amorepacific R&D Center Background: In vivo reflectance confocal microscopy (RCM) is a useful technique for noninvasive biometry of cutaneous inner structures and allows evaluating morphologic skin change without unnecessary biopsy. In this study, we used an acute tape-stripping model and RCM imaging to develop a method that can assess structural and morphological skin damage and recovery of barrier function.
Associated factors and emergency department and urgent care utilization for sunburn Fan Di Xia, BA, Brigham and Women’s Hospital; Harvard Medical School; Mary Fuhlbrigge, Brigham and Women’s Hospital; Michael Waul, BA, Harvard Medical School; Cara Joyce, PhD, Loyola University Chicago; Arash Mostaghimi, MD, Brigham and Women’s Hospital
Method: Twelve healthy Korean volunteers were enrolled and serial tape-stripping was applied on their forearms. The skin was imaged with RCM to evaluate the epidermal thickness and structural change and we also measured transepidermal water loss (TEWL) to validate the relation to barrier recovery at intervals of 24 hour for 2 weeks. Results: Acute tape-stripping immediately removed all the stratum corneum (SC) layers and the thickness of SC recovered the original state after 1 week. It was doubled after 10 days due to hyperproliferation of keratinocyte. The living epidermal layers tended to increase till 72 hours after stripping. As a result of hyperproliferation and wound recovery, parakeratosis, epidermal atypia, and spongiosis were observed 1 week after acute skin damage. TEWL increased twice after barrier disruption and it was not significantly recovered until 1 week along with the structural change of the skin. Conclusion: We demonstrated that noninvasive RCM in combination with tapestripping could be used as a model to obtain in vivo morphological data on epidermal wound healing. This method would be applied to evaluate the efficacy of cosmetic products and other materials on skin barrier recovery. Commercial support: 100% is sponsored by Amorepacific.
Sunburn is a preventable condition for which usage of emergency department (ED) and urgent care (UC) centers can be largely avoided. No data exists regarding the utilization and associated factors for sunburn presenting to the ED/UC. In this study, we evaluate ED/UC utilization for sunburn as well as associated factors and treatment at the Brigham and Women’s Hospital, Massachusetts General Hospital and associated clinics from 2000-2015. We identified 204 ED/UC visits for sunburn. The mean age was 43.6 6 16.1 years, and 48.5% (n ¼ 97) were women. Blistering (37.3%, n ¼ 76), presence of constitutional symptoms (18.6%, n ¼ 38), and suprainfection (1.0%, n ¼ 2) were present in the minority of cases. Along with vacationing (13.7%, n ¼ 28) and falling asleep in the sun (12.3%, n ¼ 25), psychiatric illness (9.3%, n ¼ 19), alcohol use (6.4%, n ¼ 13), and homelessness (6.4%, n ¼ 13) were important factors associated with sunburn ED/UC utilization. Tanning bed use was the reason for sunburn in 4 (2.0%) cases. The majority was treated with pain control with nonsteroidal inflammatory drugs/acetaminophen with or without opioids (58.3%, n ¼ 119). Documented sun protection counseling was provided in less than half of the visits (33.3%, n ¼ 68). These findings suggest that the majority of ED/UC usage for sunburn may not have been clinically necessary and could have been avoided. Sunburn risks and protection may not be adequately addressed in vulnerable populations such as those with psychiatric illness, alcohol use, and homelessness. Increased public initiatives such as free sunscreen dispensers, designated shade structures, and improved awareness may be needed to reduce risks in these populations. In addition, improvement in the rates of patient counseling at the time of ED/UC presentation is needed, especially since research has demonstrated that behavioral intervention is more effective at the time of disease as compared to random intervention. These efforts should help reduce unnecessary usage of emergent and urgent resources for sunburn, which should improve patient wellbeing while decreasing overall societal costs of treatment. Commercial support: None identified.
5110 Association between disease control in patients with psoriasis and socioeconomic factors in the PSOLAR registry Alexa B. Kimball, MD, Harvard Medical School and Beth Israel Deaconess Medical Center; Matthias Augustin, MD, University Medical Center Hamburg; Kenneth Gordon, MD, Northwestern University, Feinberg School of Medicine; Gerald G. Krueger, MD, University of Utah; David Pariser, MD, Eastern Virginia Medical School and Virginia Clinical Research, Inc; Steven Fakharzadeh, MD, Janssen Scientific Affairs, LLC; Seina Lee, PharmD, Janssen Scientific Affairs, LLC; Wayne Langholff, PhD, Janssen Research & Development, LLC; Lyn Guenther, MD, Western University Background: There is a paucity of data correlating disease control and socioeconomic characteristics in patients with psoriasis.
4803 Assessment of tomato shave biopsy training for medical students Vanessa Voss, MD, Saint Louis University; A. Mary Guo, MD, Saint Louis University; Eric Armbrecht, PhD, Saint Louis University; Claudia Vidal, MD, Saint Louis University Background: Biopsy training using models enables students to practice in low-acuity settings with time for refinement and feedback. Objectives: To assess a tomato training model for shave biopsies. Methods: Following an introductory lecture on shave biopsies, preclinical students (n ¼ 110) practiced on tomatoes with drawn-on shapes. Faculty were available for guidance and evaluated student skills using a 5-point scale. Students completed pre/postworkshop surveys. Results: The percentage of students self-rating their current skill in performing shave biopsy as competent or better increased from 2.7% to 62.8%; the novice rating decreased from 88.1% to 5.5%. Analysis of specific postsurvey items showed the highest level of self-rated competence (‘‘completely able’’) was achieved in: listing steps for shave biopsies (71.8%), listing needed supplies (64.5%), and listing layers of skin (96.4%). Notably fewer students reported self-rated competence with shave biopsy limitations (45.5%) and complications (25.5%). All observed improvements were statistically significant (P \.05). 43.7% of students received highest facultyrated scores for biopsy skills (5-point scale); 35.5% received the next best score.
Objectives: To assess whether correlations exist between control of psoriasis and socioeconomic characteristics among patients with historically severe psoriasis in the Psoriasis Longitudinal and Assessment (PSOLAR) registry. Methods: A total of 4037 patients enrolled in PSOLAR in the United States sites had historically severe psoriasis (PGA 4,5 and/or [ 10%BSA at peak disease activity). These patients were grouped into quartiles based on disease control at enrollment: Group 1 (well-controlled; PGA ¼ 0, 1 and/or #3% BSA; n ¼ 899); Group 2 (moderately controlled; PGA ¼ 2 and/or BSA 3-10%; n ¼ 962); Group 3 (poorly controlled; PGA ¼ 3 and/or BSA [10% #20; n ¼ 964); or Group 4 (very poorly controlled; PGA ¼ 4, 5 and/or BSA [20%; n ¼ 1212). The relationship between disease control and socioeconomic characteristics was examined using multivariate logistic regression by comparing each of the individual Groups 2, 3, or 4 vs Group 1; Groups 3 and 4 combined were also compared to the combined Groups 1 and 2. Multiple socioeconomic indicators were analyzed including education level (# high school degree vs [ high school degree), annual income (#$41,000 vs [$41,000), and insurance type (public/none vs private). Results: Compared with well-controlled psoriasis (Group 1), very poor control (Group 4) was significantly associated with lower education level (odds ratio ¼ 1.548; P \.001). The association of poor control with lower education level was similarly observed when Groups 3 and 4 were compared with Groups 1 and 2 (odds ratio ¼ 1.227; P ¼.0083). Other comparisons, including all comparisons for annual income and insurance type, were not statistically significant.
Limitations: The study lacked control groups and assessment of skill translation to humans. Conclusions: The simulated tomato workshop is an effective shave biopsy training model for medical students with strength in teaching technical skills such as steps and supplies.
Conclusions: Poor control of historically severe psoriasis correlated with lower education level, but not with insurance type or annual income among PSOLAR patients in the United States. Insurance type and annual income did not correlate with control of psoriasis in this analysis. Outreach efforts directed towards patients with severe psoriasis and lower education level may improve disease control.
Commercial support: None identified.
Commercial support: Janssen Research & Development, LLC supported this study 100%.
AB50
J AM ACAD DERMATOL
JUNE 2017