Faculty Bibliography

Patients with psoriasis have high rates of depression and may be at increased risk for suicidal ideation and behavior (SIB). Attempted and completed suicides during clinical trials and other studies of psoriasis therapies, including brodalumab, highlight the importance of understanding psychiatric risk factors in patients with psoriasis. Recent meta-analyses, research studies, and published data from brodalumab clinical studies were reviewed. We also summarize research on effects of brodalumab on depression symptoms and occurrences of SIB in brodalumab clinical trials. Psoriasis elevates the risk for depression and possible suicide. Brodalumab has a boxed suicide warning; however, it states that there is no established causal association between treatment with brodalumab and increased risk for SIB. Clinicians are urged to evaluate patients with psoriasis for psychiatric risk factors regardless of their therapy and to consider the package insert and a comprehensive evaluation of relevant literature to make a well-balanced decision.

BACKGROUND:Prescription medications are among the most common causes of sexual dysfunction, and patients are often hesitant to seek help when experiencing these symptoms. OBJECTIVE:In this review, we identified the available evidence of sexual side effects in men using systemic dermatologic medications and suggest screening protocols and actions that may improve a patient's symptom where possible. METHODS:A systematic review was conducted of all articles in the PubMed database published from the time of inception to May 2018 to identify studies evaluating use of systemic dermatologic medications in men with evidence of sexual side effects. Subsequently, a secondary in-depth literature review was performed for each individual medication. RESULTS:5497 articles were reviewed in the primary systematic review. A total of 59 articles covering 11 systemic dermatologic medications met inclusion criteria. We identified level 1 evidence for sexual side effects as a primary outcome in patients taking finasteride. LIMITATIONS/CONCLUSIONS:Many included studies were limited by sample size and methodology. CONCLUSION/CONCLUSIONS:The information in this review may serve as a reference of side effects when deciding on a therapeutic agent and a guide to identify patients to screen for sexual dysfunction.

BACKGROUND:This systematic review assesses effects of paternal exposure of dermatologic medications, using the former US Food and Drug Administration (FDA) pregnancy categories as a benchmark. OBJECTIVE:To assess whether systemic dermatologic medications can cause infertility and teratogenicity when taken by men. METHODS:Category D and X dermatologic medications were identified; a systematic review of the literature and reviews of the FDA Adverse Events Reporting System (FAERS) and prescribing information were performed to identify effects on male fertility and teratogenicity. Secondary search was performed to assess for other systemic dermatologic medications causing teratogenicity or infertility following paternal exposure. RESULTS:Thirteen medications met inclusion criteria. Nineteen of 1,032 studies were included after systematic review of the literature. Studies evaluating medication effects with paternal exposure were identified for 10 of 13 evaluated medications, and evidence of a negative effect was identified for 6 medications. LIMITATIONS/CONCLUSIONS:We did not encounter any studies for 3 medications that met inclusion criteria. Information submitted to the FAERS may not reflect incidence of side effects. CONCLUSIONS:Many former pregnancy category D and X systemic dermatologic medications also have effects on male fertility. More research and better-quality studies are required in this area, particularly assessing potential teratogenicity.

BACKGROUND:Spin-reporting that distorts the interpretation of results-is not unusual within scientific literature. OBJECTIVE:To appraise strategies of spin among placebo-controlled double-blind clinical trials of topical treatments for photoaged skin. METHODS:A systematic review of literature was performed to identify placebo-controlled double-blind clinical trials of topical treatments for photoaged skin. A survey of spin strategies was developed and applied to the cohort of identified studies. RESULTS:Systematic review identified 20 studies, all of which employed various spin strategies, broadly classified as either inappropriate statistical analysis or inappropriate interpretation of results. Most commonly used strategies included use of multiple primary outcomes (95%), inappropriate extrapolation of the results from specific outcome to global improvement (95%), focus on within-group comparison (75%), and focus on interim analyses to give more weight to nonsignificant findings (65%). LIMITATIONS/CONCLUSIONS:Classification of spin strategies is subjective and may not encompass all methods used by studies in the published literature. CONCLUSIONS:Findings in this study may inform efforts to reduce spin in the dermatologic literature.

Introduction: Google Search is an important tool for patients researching skin care treatments and finding dermatologists. Data from individual patient’s searches are aggregated by Google and yield powerful data sets that can be used to trend population behaviors. This study investigates the correlations between the volume of Google searches and the number of procedures performed annually for both botulinum toxin type A and hyaluronic acid tissue fillers.

Psoriasis is a chronic systemic inflammatory skin disease, which has been associated with an increased risk of numerous medical and psychiatric comorbidities, including suicidality. Suicidality, which can be divided into the categories of suicidal ideation, suicide attempt, and completed suicide, is highly prevalent in the psoriasis population, and multiple studies have been published on the subject of psoriasis and suicidal ideation and behavior (SIB), including two recent meta-analyses. However, the available literature is limited and inconsistent, and the association between the two remains incompletely understood. The present review aims to cohesively synthesize and summarize the available evidence, while making a clinically relevant distinction between the sub-categories of suicidality, by examining not only the epidemiology of the association but also the plausible molecular mechanisms and the potential influence of biologic therapies. Additionally, this review aims to critically examine and understand the potential contribution of depression in the psoriasis and suicidality relationship. This will allow us to better understand the complex and multi-faceted relationship between psoriasis and suicidality, to identify those who may be most at risk for SIB, to make evidence-based clinical decisions regarding treatment and management, and to more completely address the needs of psoriasis patients.