Background-Severe psoriasis is associated with excess mortality and increased risk of cardiovascular death. Population-based data evaluating cause-specific mortality in patients with psoriasis are limited.

Importance Atopic dermatitis (AD) is a common illness of childhood Objective The goal of this study was to evaluate the natural history of AD and determine the persistence of symptoms over time. Design A cross-sectional and cohort study. Setting A nation-wide long-term registry of children with AD. Participants Children enrolled in the Pediatric Eczema Elective Registry (PEER). Main outcome Self-reported outcome of whether or not a child’s skin was AD symptom-free for 6 months at 6 month intervals. Results 7,157 subjects were enrolled in the PEER study for a total of 22, 550 person-years. At least 2 years of follow-up was observed for 4,248 and at least 5 years of follow-up was observed for 2,416 children. Multiple demographic and exposure variables were associated with more persistent AD. At every age (i.e. 2 to 26 years), more than 80% of PEER subjects had symptoms of AD and/or were using medication to treat their AD. It was not until age 20 years that 50% of subjects had at least one lifetime six-month symptom and treatment free period. Conclusions and Relevance Based on this large longitudinal cohort study, symptoms associated with AD appear to persist well into the second decade of a child’s life and likely longer. AD is likely a life-long illness.

ObjectiveTo investigate whether adults with atopic eczema are at an increased risk of cardiovascular disease and whether the risk varies by atopic eczema severity and condition activity over time.DesignPopulation based matched cohort study.SettingUK electronic health records from the Clinical Practice Research Datalink, Hospital Episode Statistics, and data from the Office for National Statistics, 1998–2015.ParticipantsAdults with a diagnosis of atopic eczema, matched (on age, sex, general practice, and calendar time) to up to five patients without atopic eczema.Main outcome measuresCardiovascular outcomes (myocardial infarction, unstable angina, heart failure, atrial fibrillation, stroke, and cardiovascular death).Results387 439 patients with atopic eczema were matched to 1 528 477 patients without atopic eczema. The median age was 43 at cohort entry and 66% were female. Median follow-up was 5.1 years. Evidence of a 10% to 20% increased hazard for the non-fatal primary outcomes for patients with atopic eczema was found by using Cox regression stratified by matched set. There was a strong dose-response relation with severity of atopic eczema. Patients with severe atopic eczema had a 20% increase in the risk of stroke (hazard ratio 1.22, 99% confidence interval 1.01 to 1.48), 40% to 50% increase in the risk of myocardial infarction, unstable angina, atrial fibrillation, and cardiovascular death, and 70% increase in the risk of heart failure (hazard ratio 1.69, 99% confidence interval 1.38 to 2.06). Patients with the most active atopic eczema (active >50% of follow-up) were also at a greater risk of cardiovascular outcomes. Additional adjustment for cardiovascular risk factors as potential mediators partially attenuated the point estimates, though associations persisted for severe atopic eczema.ConclusionsSevere and predominantly active atopic eczema are associated with an increased risk of cardiovascular outcomes. Targeting cardiovascular disease prevention strategies among these patients should be considered.

Background There is a need to better understand the safety of TNF inhibitors in patients with psoriatic disease in whom TNF inhibitors are frequently used as monotherapy. Objective Examine the risks of infection and malignancy with the use of TNF antagonists in adult patients with psoriatic disease. Methods Systematic search for trials of TNF antagonists for adults with plaque psoriasis (PsO) and psoriatic arthritis (PsA). We included randomized, placebo-controlled trials of etanercept, infliximab, adalimumab, golimumab, and certolizumab for the treatment of PsO and PsA. 20 out of 820 identified studies with a total of 6,810 patients were included. Results were calculated using fixed effects models and reported as pooled odds ratios (OR). Results ORs for overall infection and serious infection over a mean of 17.8 weeks were 1.18 (95% CI: 1.05, 1.33) and 0.70 (95% CI: 0.40, 1.21), respectively. When adjusting for patient-years, the incidence rate ratio for overall infection was 1.01 (95% CI: 0.92, 1.11). The OR for malignancy was 1.48 (95% CI: 0.71, 3.09), and 1.26 (95% CI: 0.39, 4.15) when non-melanoma skin cancer was excluded. Limitations Short duration of follow-up and rarity of malignancies and serious infections. Conclusions There is a small increased risk of overall infection with the short-term use of TNF antagonists for psoriasis that may be attributable to differences in follow-up time between treatment and placebo groups. There was no evidence of an increased risk of serious infection and a statistically significant increased risk in cancer was not observed with short-term use of TNF inhibitors.

Background There are sparse and conflicting data regarding the long-term clinical course of atopic dermatitis (AD). Although often described as a childhood disease, newer population-based estimates suggest the prevalence of pediatric and adult disease may be similar. Methods Our objective was to determine whether there is a decline in the prevalence of AD in population-based cohorts of patients followed longitudinally beyond childhood. We conducted a systematic review and meta-analysis including studies assessing AD prevalence across 3 or more points in time. The primary outcome was weighted overall risk difference (percentage decrease in AD prevalence). Results Of 2080 references reviewed, 7 studies with 13 515 participants were included. Participants were assessed at 3–6 time points, ranging from age 3 months to 26 years. The percentage decrease in prevalence after age 12 was 1%, which was not significantly different from zero (95% confidence interval −2 – 5%). Similar results were found with other age cut-offs. Conclusion The prevalence of AD in longitudinal birth cohort studies is similar in childhood and adolescence/ early adulthood.

Summary This article is a report of the fourth meeting of the Harmonising Outcome Measures for Eczema (HOME) initiative held in Malmö, Sweden on 23–24 April 2015 (HOME IV). The aim of the meeting was to achieve consensus over the preferred outcome instruments for measuring patient‐reported symptoms and quality of life for the HOME core outcome set for atopic eczema (AE). Following presentations, which included data from systematic reviews, consensus discussions were held in a mixture of whole group and small group discussions. Small groups were allocated a priori to ensure representation of different stakeholders and countries. Decisions were voted on using electronic keypads. For the patient‐reported symptoms, the group agreed by vote that itch, sleep loss, dryness, redness/inflamed skin and irritated skin were all considered essential aspects of AE symptoms. Many instruments for capturing patient‐reported symptoms were discussed [including the Patient‐Oriented SCOring Atopic Dermatitis index, Patient‐Oriented Eczema Measure (POEM), Self‐Administered Eczema Area and Severity Index, Itch Severity Scale, Atopic Dermatitis Quickscore and the Nottingham Eczema Severity Score] and, by consensus, POEM was selected as the preferred instrument to measure patient‐reported symptoms. Further work is needed to determine the reliability and measurement error of POEM. Further work is also required to establish the importance of pain/soreness and the importance of collecting information regarding the intensity of symptoms in addition to their frequency. Much of the discussion on quality of life concerned the Dermatology Life Quality Index and Quality of Life Index for Atopic Dermatitis; however, consensus on a preferred instrument for measuring this domain could not be reached. In summary, POEM is recommended as the HOME core outcome instrument for measuring AE symptoms.

Background Psoriasis is a common disease frequently studied in large databases. To date the validity of psoriasis information has not been established in The Health Improvement Network (THIN). Objectives To investigate the validity of THIN for identifying psoriasis patients and to determine if the database can be used to determine the natural history of disease. Patients/Methods First we conducted a cross sectional study to determine if psoriasis prevalence in THIN is similar to expected. Second we created a cohort of 4900 patients, aged 45–65, with a psoriasis diagnostic Read Code and surveyed their GPs to confirm the diagnosis clinically. Third we created models to determine if psoriasis descriptors (extent, severity, duration, and dermatologist confirmation) could be accurately captured from database records. Results Psoriasis prevalence was 1.9%, and showed the characteristic age distribution expected. GP questionnaires were received for 4,634 of 4,900 cohort patients (95% response rate), and psoriasis diagnoses were confirmed in 90% of patients. Duration of disease in the database showed substantial agreement with physician query (kappa = 0.69). GPs confirmed that the psoriasis diagnosis was corroborated by a dermatologist in 91% of patients whose database records contained a dermatology referral code associated with a psoriasis code. We achieved good discrimination between patients with and without extensive disease based on the number of psoriasis codes received per year (Area Under Curve, AUC = 0.8). Conclusions THIN is a valid data resource for studying psoriasis and can be used to identify characteristics of the disease such as duration and confirmation by a dermatologist.

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