Objectives Registry data suggest that people with immune-mediated inflammatory diseases (IMIDs) receiving targeted systemic therapies have fewer adverse COVID-19 outcomes compared to patients receiving no systemic treatments. We used international patient survey data to explore the hypothesis that greater risk-mitigating behaviour in those receiving targeted therapies may account, at least in part, for this observation. Methods Online surveys were completed by individuals with Rheumatic and Musculoskeletal Diseases (RMD) (UK only) or psoriasis (globally) between 4th May and 7th September 2020. We used multiple logistic regression to assess the association between treatment type and risk-mitigating behaviour, adjusting for clinical and demographic characteristics. We characterised international variation in a mixed effects model. Results Of 3,720 participants (2,869 psoriasis, 851 RMD) from 74 countries, 2,262 (60.8%) reported the most stringent risk-mitigating behaviour (classified here under the umbrella term shielding). A greater proportion of those receiving targeted therapies (biologics and JAK inhibitors) reported shielding compared to those receiving no systemic therapy (adjusted odds ratio [OR] 1.63, 95% CI 1.35-1.97) and standard systemic agents (OR 1.39, 95% CI 1.22-1.56). Shielding was associated with established risk factors for severe COVID-19 (male sex [OR 1.14, 95% CI 1.05-1.24], obesity [OR 1.38, 95% CI 1.23-1.54], comorbidity burden [OR 1.43, 95% CI 1.15-1.78]), a primary indication of RMD (OR 1.37, 95% CI 1.27-1.48) and a positive anxiety or depression screen (OR 1.57, 95% CI 1.36-1.80). Modest differences in the proportion shielding were observed across nations. Conclusions Greater risk-mitigating behaviour among people with IMIDs receiving targeted therapies may contribute to the reported lower risk of adverse COVID-19 outcomes. The behaviour variation across treatment groups, IMIDs and nations reinforces the need for clear evidence-based patient communication on risk mitigation strategies and may help inform updated public health guidelines as the pandemic continues.

Summary The two most common types of skin cancer (tumour) are called basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC). BCC and cSCC have previously been removed from U.K. national cancer statistics, collected by cancer registries, because it was difficult to accurately estimate tumour counts. Improvements to registry data collection of BCC and cSCC since 2013 have resulted in the largest and most complete dataset of BCC and cSCC in the world. Therefore, the aim of this study was to provide better estimates of BCC and cSCC tumour counts using registry data in the U.K. This study confirms that skin cancers are four times more common than any other cancer in the U.K. The authors were able to show that BCCs and cSCCs affected over 210,000 people in the U.K in 2015 with BCCs affecting 3 in 1000 people and cSCCs affecting 1 in 1000 people in 2015 alone. As they most commonly affect elderly people, it is not surprising that incidence rates are increasing by around 5% per year. Although they are less dangerous than melanomas and therefore there is less public awareness of BCC and cSCC, together, they are more than ten times more common than melanomas. This study exposes the previously unreported burden of skin cancers in the U.K. and highlights the importance of skin cancer prevention through protection against excessive ultraviolet radiation through natural (sunshine) or unnatural (tanning booths) exposure.

Background Indirect excess morbidity has emerged as a major concern in the COVID-19 pandemic. People with psoriasis may be particularly vulnerable to this because of prevalent anxiety and depression, multimorbidity and therapeutic use of immunosuppression. Objective Characterise the factors associated with worsening psoriasis in the COVID-19 pandemic, using mental health status (anxiety and depression) as the main exposure of interest. Methods Global cross-sectional study using a primary outcome of self-reported worsening of psoriasis. Individuals with psoriasis completed an online self-report questionnaire (PsoProtectMe; Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection Me) between May 2020 and January 2021. Each individual completed a validated screen for anxiety (Generalized Anxiety Disorder-2) and depression (Patient Health Questionnaire-2). Odds ratios (OR) and 95% confidence intervals (CI) were estimated using multivariable logistic regression. Results 4,043 people with psoriasis (without COVID-19) from 86 countries self-reported to PsoProtectMe (mean age 47.2 years [SD 15.1]; mean BMI 27.6kg/m2 [SD 6.0], 2,684 [66.4%] female and 3,016 [74.6%] of white European ethnicity). 1,728 (42.7%) participants (1322 [77%] female) reported worsening of their psoriasis in the pandemic. A positive screen for anxiety or depression associated with worsening psoriasis in age and gender adjusted (OR 2.04, 95% CI 1.77-2.36), and fully adjusted (OR 2.01, 95% CI 1.72-2.34) logistic regression models. Female sex, obesity, shielding behaviour and systemic immunosuppressant non-adherence also associated with worsening psoriasis. The commonest reason for non-adherence was concern regarding complications related to COVID-19. Conclusions These data indicate an association between poor mental health and worsening psoriasis in the pandemic. Access to holistic care including psychological support may mitigate potentially long-lasting effects of the pandemic on health outcomes in psoriasis. The study also highlights an urgent need to address patient concerns about immunosuppressant-related risks, which may be contributing to non-adherence.

Little is known about the predictors of healthcare utilization among US adults with atopic dermatitis (AD). We determined the proportion and predictors of utilization in outpatient, urgent care, emergency department (ED) and hospital settings in US adults. A cross-sectional, population-based study of 3,495 adults was performed. Overall, 10.42% (95% confidence interval: 8.55-12.28%; weighted frequency: 25,844,871) reported a diagnosis of AD or eczema, 7.39% (5.81-8.97%; 18,324,869) met United Kingdom Working Party criteria, and 3.56% (2.40-4.72%; 8,830,095) met both. 31.8% (2,711,690) had a severe score for POEM, PO-SCORAD and/or NRS-itch, with 4.0% (337,586) having severe scores for all three. Outpatient utilization for AD was low for mild disease (29.3-34.7%) and increased by severity (moderate: 36.2-49.8%; severe: 50.6-86.6%). Severe AD was associated with being uninsured, not having full prescription coverage, AD prescriptions being denied by insurers, and costs of AD medications being problematic. One in 10 adults with AD had 1 urgent care, ED or hospital visit in the past year. Urgent care or ED visits were significantly more common among blacks and Hispanics, lower household income, lower education level, and AD prescriptions being denied by their insurance company. In conclusion, adults with AD had low rates of outpatient and high rates of urgent care, ED and hospital visits. The major predictor of outpatient utilization for AD care was AD severity. Racial/ethnic, socio-economic and/or healthcare disparities may reduce outpatient utilization and increase urgent, ED and hospital utilization.

Hyperhidrosis is a condition that causes excessive sweating and is estimated around 15.3 million people in the USA suffer from it. However, the current knowledge on public interest and the seasonality of hyperhidrosis is limited. Therefore, the aim was to evaluate the infodemiology of hyperhidrosis. Google Trends was searched between Jan 2004-Dec 2019 for "Hyperhidrosis" in the USA and worldwide to gain information on public interest. Relative search volume (RSV) data from Northern Hemisphere countries (i.e. USA) and southern hemisphere countries (i.e. Australia) were also examined to assess trends in seasonality by a cosinor analysis to calculate amplitude {A}, phase month {P}, low point month {L}, and trend significance. Hyperhidrosis had an overall increasing trend in search volume in USA and worldwide.

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Atypical sensory processing occurs commonly in individuals with Autism Spectrum Disorder (ASD) and may impact the care these patients receive for skin conditions like acne vulgaris. This is a retrospective cohort study of acne-specific medication and outpatient utilization and costs from MarketScanª database (2015-2017) for continuously enrolled 11 to 18-year-old patients. People with acne were identified based on at least one instance of ICD-9/ICD-10 code (706.1/L70.0), then assigned to a cohort with ASD based on at least one instance of ICD-9/ICD-10 code (299, F84) or the cohort without ASD based on random selection of age and sex at a 10:1 ratio. Medication claims were based on NDC codes recorded at acne-specific visits and were controlled for age and sex. Outpatient utilization excluded ED and urgent care claims. Overall, 4,269 patients with acne and ASD and 42,690 patients with acne alone were identified.ASD patients received topical antimicrobials more often (25.06% vs 21.89%, p<0.0001) and had a higher mean 3-year cost per patient ($588.48 vs. $460.39, p<0.0001). ASD patients were prescribed topical retinoids less frequently (32.68% vs. 34.53%, p¼0.02) with a greater mean 3-year cost per person ($888.68 vs. $814.74, p<0.0001). Oral antibiotics were used less frequently for ASD patients (18.74% vs. 20.35%, p¼0.02) with a higher mean cost ($257.41 vs. $176.29, p<0.0001). Both spironolactone (0.51% vs. 1.58%, p<0.0001) and isotretinoin (8.27% vs. 11.27%, p<0.0001) were prescribed less often to ASD patients. For ASD patients, the odds of claims for topical retinoids (OR¼ 1.088, p¼0.0139), spironolactone (OR¼2.659, p<0.0001), and isotretinoin (OR¼1.351, p<0.001) were higher when age was controlled. Likewise, the odds of claims for topical retinoids (OR¼1.089, p¼0.0143), oral antibiotics (OR¼1.116, p¼0.0089), and isotretinoin (OR¼1.697, p<0.0001) were higher when adjusted for age and sex. Analysis of outpatient claims is underway and will investigate utilization differences. This study demonstrates important differences in utilization and costs for acne patients with ASD.