Faculty Bibliography

BACKGROUND:Assessment of chronic hand eczema (CHE) is complex and warrants standardization. OBJECTIVE:We sought to guide clinicians on the assessment of CHE. METHODS:An electronic questionnaire regarding the diagnosis and assessment of CHE was completed by councilors (n=45) of the International Eczema Council, an international group of clinicians and researchers with expertise in CHE. The survey consisted of 52 statements for consensus. RESULTS:Overall, nine statements (17.3%) had strong, twenty-three (44.2%) moderate, 12 (23.1%) low, and 8 (15.4%) very low levels of agreement. Five statements had considerable disagreement, including the value of conducting a skin biopsy (62.2% disagreement), investigating for possible type 1 reactions (60.0%), conducting a fungal culture (44.4%), finding no history of relevant allergens and/or irritants (31.1%) in most or all cases, and performing patch testing irrespective of lesion location and morphology (28.9%). Agreement was generally highest among respondents from Europe (28.6-77.8% agreement), followed by Asia (7.1%-35.7% agreement), North America (0%-35.5% agreement), and other (0%-13.3% agreement). CONCLUSIONS:There were substantial differences of agreement, suggesting there are many knowledge and/or practice gaps with respect to CHE. Future research is needed to inform evidence-based and/or consensus guidelines for CHE.

Occupation contact dermatitis (CD) is a common inflammatory skin condition impacting every professional industry in the United States. It is associated with significant personal and professional distress, loss of revenue, and decreased productivity. Occupational CD is further subdivided into irritant CD and allergic CD. Frequently, workers may suffer from a combination of both types. Numerous workplace exposures are implicated, but there are several themes across professions, such as CD related to frequent handwashing and wet work. A detailed occupational history, physical examination, and patch testing can help to make the diagnosis. Treatment includes identification of the substance and avoidance, which often is quite challenging.

Psoriasis prevalence has long been considered to be 2-4% in the United States (US). Recently, prevalence rates of 0.5-0.6% were reported in Medicare patients and 0.128% in commercially insured children. We investigated psoriasis prevalence among commercially insured individuals younger than 65 years. The Truven Health Analytics MarketScan Commercial Claims and Encounters databases, which includes beneficiaries of employer-based commercial insurance in the US, was interrogated for continuously enrolled beneficiaries from 2011-2017. Psoriasis cases were identified using >=1 or >=2 inpatient or outpatient claims by any physician (ICD-9-CM code 696.1; ICD-10-CM codes L40.0-L40.4, L40.8, L40.9). Annual prevalence and 95% confidence intervals (CI) were calculated for each year separately. Information on gender and age range was also collected. Defining psoriasis as >=1 claim yielded a prevalence of 0.529% (95% CI 0.526-0.531) in 2011 and 0.718% (95% CI 0.714-0.721) in 2017. Women (51.7-53%) were slightly more represented than men (48.3-47%). Prevalence rose in the 18-34 years and 45-54 years age groups, reflecting a bimodal distribution of onset of psoriasis. When using >=2 claims of psoriasis as the definition, the prevalence fell to 0.220% (95% CI 0.219-0.222) to 0.329% (95% CI 0.326-0.331) during the study period. This study suggests that psoriasis is possibly up to 4-fold less prevalent than previously believed with a prevalence of 0.5-0.7% using >=1 claim of psoriasis as our criterion. When using 2 claims for psoriasis, a more clinically vigorous case definition, prevalence dropped to 0.2-0.3%. This replicates observations of previous studies and reflects the greater positive predictive value of using multiple claims for psoriasis as compared to one claim. Limitations of our study include diagnosis misclassification and the restriction to commercial insurance beneficiaries. Given the effects of psoriasis on quality of life, comorbid conditions, and health care utilization, a re-appraisal of the prevalence of psoriasis in the US is a necessary consideration.
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