BackgroundThere is limited understanding of severity rating of atopic dermatitis in clinical practice.ObjectivesTo evaluate the agreement between physician- and patient-rated severity of atopic dermatitis.MethodsData were collected from the 2014 Adelphi US Atopic Dermatitis Disease Specific Programme, a cross-sectional survey of physicians and their patients with a history of moderate-to-severe atopic dermatitis; patients voluntarily completed a questionnaire. Current disease severity (mild/moderate/severe), based on personal judgment, was rated independently by patients and their physicians. The weighted kappa statistic identified level of agreement between physicians and patients. Bivariate analyses characterized agreement; multi-nomial logistic regression identified factors associated with discordance.ResultsOverall, 678 patients were included (369 [54.4%] were women, 525 [77.4%] were White, mean age was 39.3 years). Agreement was moderate (weighted kappa = 0.52): compared with physician ratings, patient-rated severity was higher in 76 patients (11.2%), lower in 137 patients (20.2%), and matched in 465 patients (68.6%). There were no differences in the rates of agreement between physician and patient ratings based on physician specialty (p = 0.6781), objective severity measures [Eczema Area and Severity Index score (p = 0.5308), percent body surface area affected (p = 0.9872), and current systemic immunosuppressant use (p = 0.9197)]. Multivariate analysis showed patients with a worse quality of life (Dermatology Life Quality Index) were more likely to rate a higher severity (relative risk ratio 1.04, 95% confidence interval 1.00–1.08; p = 0.0460). Physicians were more likely to rate a higher severity with a greater physician-reported sleep disturbance (relative risk ratio 1.71, 95% confidence interval 1.01–2.89; p = 0.0440).ConclusionsAlmost one-third of patients rated atopic dermatitis severity differently from their physicians, supporting the importance of the patient perspective in the severity assessment of atopic dermatitis and the need for greater communication between patients and physicians.Electronic supplementary materialThe online version of this article (doi:10.1007/s40257-017-0284-y) contains supplementary material, which is available to authorized users.

Since control of atopic dermatitis (AD) remains challenging but has not been adequately characterized, the objective of this study was to characterize disease control among patients with a history of moderate to severe AD. Data were from the 2014 Adelphi US AD Disease Specific Programme, a cross‐sectional survey of physicians (n = 202) and their patients with history of moderate to severe AD (n = 1064, 54% female, 75% white, mean age 40 years). Inadequately controlled AD as rated by the physician was defined as currently flaring; deteriorating/changeable AD; or physician dissatisfaction with current control. The overall inadequate control rate was 58.7% (n = 625), which increased with current AD severity and was observed in 53.4% and 83.4% of patients receiving immunosuppressants and systemic corticosteroids, respectively. Relative to controls, inadequately controlled patients had poorer disease‐specific quality of life, higher level of work impairment, greater itch and sleep interference with daily living (all P < 0.05). Multivariate analysis showed factors significantly associated with inadequate control (all P < 0.05), including Hispanic race, symptoms on the head/neck or lower limbs, itch and sleep interference with daily living. A limitation of the study was reliance on accuracy of reporting, potential selection bias and cross‐sectional study design. In summary, there was a high rate and substantial impact of physician‐rated inadequately controlled disease among patients with a history of moderate to severe AD, suggesting the need for more effective therapies.

RESUMEN El herpes zoster es el resultado de la re a c t i v ación del virus de la varicela zoster, siendo más frecuente en pacientes con edad avanzada y con la in ABSTRACT Herpes zoster results from reactivation of the varicella-zoster virus. It is more commom in elderly and inmunocompromised patients. The clinical course of herpes zoster, in patients of Primary Health Care and younger than 60 years of age, is beningn and without complications. The main complication of herpes zoster is the postherpetic neuralgia, which is pain that appears in the affected INTRODUCCIÓNEl herpes zoster es el cuadro clínico constituido por las manifestaciones dermatológicas (erupción vesiculosa) y neurológica (dolor) que se produce por la reactivación del virus varicela zoster. El dolor es el síntoma más común por el que los pacientes con herpes zoster solicitan atención médica 1 .

Objectives: To characterize unmet medical needs among adults with a history of moderate-to-severe atopic dermatitis (AD) in the United Kingdom (UK), Germany, and France. MethOds: Data were from the 2014 Adelphi AD Disease-Specific Programme, a cross-sectional survey of physicians from UK (n= 136), Germany (n= 134), France (n= 137) and their patients with history of moderate-to-severe AD (UK, n= 666; Germany, n= 649; France, n= 661). Each physician completed a Patient Record Form for up to 5 patients on demographic/disease characteristics, treatment, and physician-perceived current AD severity. AD was classified as controlled or uncontrolled, with uncontrolled defined by either currently flaring AD; deteriorating/changeable AD; or physician dissatisfaction with current control. Patients voluntarily completed a questionnaire including the Dermatology Life Quality Index (DLQI) scale. Descriptive statistics characterized the populations. Results: Patient demographics were similar across countries. Disease onset was predominantly during adolescence. Current severity was mainly moderate (54%-65%); 10% (Germany) and 16% (France, UK) were severe. Substantial proportions of patients in each country were uncontrolled (54%-59%) even though 23%-39% of uncontrolled patients were currently receiving any systemic immunosuppressant or phototherapy including cyclosporine (6%-10%). Uncontrolled AD was high regardless of current severity: 85%-88% of severe patients were uncontrolled, as were 56% (France) to 70% (UK) of moderate patients. Quality-of-life was worse among uncontrolled patients, and in particular among patients treated with immunosuppressants or phototherapy in the past 12 months: 68%, 40%, and 40% of uncontrolled patients previously on immunosuppressants or phototherapy in UK, Germany, and France, respectively, had DLQI > 10 (threshold for very large effect on patient's life). cOnclusiOns: Adults with history of moderate-to-severe AD have poor disease control even when treated with systemic agents. A substantial proportion of uncontrolled patients previously treated with immunosuppressants or phototherapy report a very large effect of AD on their quality-of-life. These results demonstrate high unmet medical needs associated with AD.

Previous studies have suggested that psoriasis is associated with liver disease, possibly related to metabolic co-morbidities, alcohol consumption, treatment toxicity, and chronic inflammation. The objective of this study was to determine if psoriasis increases risk for incident liver disease after controlling for traditional risk factors for liver disease. We conducted a population-based cohort study in the United Kingdom using The Health Improvement Network (THIN) data from 1994-2014 to investigate the risk of liver disease in psoriasis patients. Patients with a history of liver disease were excluded from the analyses. Diagnostic codes were used to identify psoriasis patients. Patients who received systemic or phototherapy were classified as having moderate to severe psoriasis. Each exposed patient had up to 5 matched controls. Cox proportional hazards models were used to estimate hazard ratios with 95% confidence intervals. Psoriasis patients were at a significantly higher risk for developing liver disease (mild PsO: