Background: Accurately documenting pediatric atopic dermatitis (AD) severity is important, but research tools, such as Eczema Area and Severity Index (EASI), are too time consuming for clinical settings. Product of the Physician Global Assessment and affected percentage of body surface area (PGA3BSA) is a new, rapid measure of psoriasis severity.Objective: To evaluate an Investigator Global Assessment and body surface area product (IGA3BSA) as an easy-to-use severity measure for pediatric AD.Methods: Patient-reported and objective disease severity measures were collected from 195 caretaker/ child dyads (child age range, 5-17 years) with almost clear (Validated Investigator Global Assessment for AD [vIGA] of 1) to severe (vIGA of 4) AD. Data were assessed with Spearman coefficients and plots. Severity strata were proposed by using an anchoring approach based on the EASI.Results: IGA3BSA correlates better with the EASI than IGA alone (r = 0.924 vs r = 0.757, P \ .001). Bland-Altman plot indicates high and consistent agreement between IGA3BSA and the EASI. Suggested severity strata for IGA3BSA are 0-30, mild; 30.1-130, moderate; and 130.1-400, severe (k = 0.760).
Limitations:The patient cohort was predominantly from the midwestern United States.Conclusions: IGA3BSA (using the vIGA) is a simple measure that correlates well with the EASI in patients with mild to severe pediatric AD. Future work is needed to affirm reliability across IGA scales and responsiveness to change.
Wasting syndrome, the extreme loss of lean muscle mass, is one symptom associated with HIV/AIDS commonly treated with testosterone, which has undesirable side effects such as gynecomastia, testicular atrophy, hair loss, and various allergic reactions.Studies report disproportionately frequent cases of erectile dysfunction (ED) in HIV males on antiretrovirals, particularly protease inhibitors. Low testosterone levels were reported in those with ED, and testosterone is used in treatment. Since lab tests are beyond the acupuncture scope of practice in Illinois, we used the diagnosis of ED as an indicator of low testosterone.Since both wasting and ED impact HIV men and low testosterone is a common symptom, stimulating natural production of testosterone with acupuncture should treat both without side effects. We used a standardized 5-needle acupuncture treatment, which appears robust to combination with other acupuncture treatments and various clinicians. The case is a study of a 54-year-old male diagnosed with AIDS, wasting, and ED, with an antiretroviral regimen including 2 protease inhibitors. His viral load is undetectable and his T-cell count is over 500. The patient has had ED for 5 years, wasting for 11, and uses appetite stimulation rather than testosterone for treatment. There were 6 bi-weekly treatments using the ED/wasting protocol and a 6-month follow-up assessment. There was immediate and dramatic relief from ED, lasting for a week after the initial treatment, increasing to 3 by the 6th. We intend to seek support to incorporate lab tests, extend the term of the investigation, and increase the number of participants to better assess the impact on wasting.
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