Use of the Dermatology Life Quality Index work/study domain to estimate overall work productivity loss among patients with psoriasis: an analysis based on real-world data

Psoriasis is a chronic autoimmune disease that is associated with substantial economic burden related to work productivity loss (WPL). WPL is commonly measured using the Work Productivity and Activity Impairment (WPAI) questionnaire. However, WPAI does not measure outcomes among unemployed patients, and may therefore underestimate the burden of psoriasis. This study evaluated the relationship between the Dermatology Life Quality Index (DLQI) questionnaire work/study domain and WPL using the WPAI, as DLQI assesses the impact of psoriasis on the ability to work/study regardless of employment status, but does not estimate WPL. Data were drawn from the Adelphi Psoriasis Disease Specific Programme survey. A positive linear relationship was observed between DLQI work/study scores and WPAI results, showing that higher DLQI scores were associated with greater percent WPL. These findings suggest that the DLQI work/study domain can be used to estimate overall WPL among patients with psoriasis, including those who cannot work because of their disease.     

The microbial flora of clinically infected cutaneous metastases: a retrospective study

Symptomatic cutaneous metastases are associated with discharge, malodour, pruritus and pain, all of which may negatively impact quality of life and cutaneous health. We conducted a retrospective chart review of patients referred to the Dermatology Service at Memorial Sloan Kettering Cancer Center between August 2006 and June 2015, and characterized the microbial flora and antimicrobial management of cutaneous metastases in 64 patients. We detected pathogenic and/or opportunistic bacteria in 50% of skin lesions. The most commonly isolated organisms were Staphylococcus aureus and Pseudomonas aeruginosa. Patients treated with oral antibiotics, alone or in combination with topical agents, had a statistically significant better improvement in infectious symptoms than those treated without oral antibiotics. Our findings suggest that the normal skin microbial flora is disrupted in patients with symptomatic skin metastases. Oral antibiotics may provide benefit when used as first-line therapy for infected skin lesions in patients with symptomatic cutaneous metastases.     

A targeted response to the COVID-19 pandemic: analysing effectiveness of remote consultations for triage and management of routine dermatology referrals

During the UK’s COVID-19 pandemic lockdown there was national guidance to suspend routine dermatology work. As a consequence, over 800 patient appointments in a district general dermatology department were temporarily suspended. Remote consultations were carried out to triage and manage referrals, via telephone or video consultations. Data were prospectively recorded on 488 patient interactions. Outcomes included advice/treatment, discharge, surgery or clinic review; 25% of patients were either uncontactable or their problem had resolved. Over a third of referrals were discharged with advice/treatment initiated remotely; 56% of referred dermatoses required further clinical review; 25% of lesion referrals were booked directly to surgery. This process was time-intensive for the clinicians involved, and triage mechanisms could be improved. Sufficient referral information allows remote diagnosis; implementation of management plans and appropriate discharge of patients. This process has been shown to be feasible, and may be a temporary solution for other COVID-19 impacted dermatology departments.