Donald Lei

Antineutrophilic cytoplasmic antibody (ANCA)‐associated vasculitis (AAV) is a condition characterized by vessel inflammation and may have a variety of etiologies. Among these, cocaine and its common adulterant, levamisole, have been described to contribute to the development of AAV with distinct cutaneous manifestations. Classically, these manifestations involve purpuric or necrotic lesions involving the ears, nose, and extremities. However, we present a case of cocaine‐induced AAV presenting with violaceous nodules on the dorsal hands in order to demonstrate that this condition may not always present with retiform purpura and skin necrosis.

Background: Atopic dermatitis (AD) is associated with chronic pruritus, skin pain, sleep deprivation, depression, and anxiety, which may lead to decreased physical activity (PA). Objective: The aim of the study is to elucidate the impact of disease and itch severity on PA in adult AD. Methods: This is a prospective dermatology practice–based study of 955 AD patients (ages 18–97 years). Results: In multivariable logistic regression models controlling for age, sex, race/ethnicity, and asthma history, patient-reported global AD severity (PtGA), Patient-Oriented Eczema Measure, Eczema Area and Severity Index (EASI), and Investigator's Global Assessment (IGA) were associated with itch impairing light PA, moderate PA, and vigorous PA, as well as higher Patient-Reported Outcomes Measurement Information System Itch Questionnaire PA T -scores. Higher objective Scoring AD (O-SCORAD) was associated with itch impairing moderate PA. In bivariable analyses, performing greater than or equal to 30 minutes of light PA greater than or equal to 1 day a week was decreased with higher PtGA, Patient-Oriented Eczema Measure, and EASI; greater than or equal to 30 minutes of moderate PA greater than or equal to 1 day a week was decreased with PtGA, EASI, O-SCORAD, and IGA; and greater than equal to 30 minutes of vigorous PA was decreased with patient-reported AD severity, EASI, O-SCORAD, and IGA. In multivariable logistic regression models, the impact of itch on PA was inversely associated with light PA, moderate PA, and vigorous PA. Conclusion: Adult AD patients with more severe disease have decreased levels of PA secondary to itch.

Background: Sleep disturbance (SD) is common in atopic dermatitis (AD). We examined the longitudinal course of SD and relationship with itch in AD patients. Methods: A prospective, dermatology practice–based study was performed (N = 1295) where patients were assessed at baseline and follow-up visits. Results: At baseline, 16.9% of the patients had severe SD based on Patient-Reported Outcomes Information System (PROMIS) SD T scores, 19.1% had difficulty falling asleep, 22.9% had difficulty staying asleep, and 34.2% had SD from AD. A total of 31.4% of the patients with difficulty staying asleep at baseline experienced persistent difficulties (for 3 follow-ups or more). Only 17.7% with baseline difficulty falling asleep had persistent disturbance. Despite significant fluctuation in sleep scores, SD generally improved over time. Of the patients facing baseline SD from AD, 31.5% experienced SD at the first visit, and only 12.3% experienced persistent SD at the second follow-up visit. Predictors of increased PROMIS sleep-related impairment T scores over time included baseline PROMIS sleep-related impairment T scores (0.74 [0.68–0.80]), having 3 to 6 nights of itch (2.22 [0.85–3.59]), and severe/very severe AD (4.40 [2.60–6.20]). Conclusions: A significant proportion of adult AD patients, particularly those with moderate-severe AD and frequent itch, had baseline SD. Although sleep scores generally improved over time, many patients experienced a fluctuating or persistent course.

Background The real-world course of health-related quality of life (HRQOL) in atopic dermatitis (AD) is not well established. Objective To examine predictors, longitudinal course, and phenotypes of HRQOL in adult AD patients. Methods A prospective dermatology-practice based study of 955 AD patients (age 18-97 years). Patients were assessed at baseline and approximately 6, 12, 18 and 24 months. Health-related quality of life was assessed using PROMIS Global Health (PGH) 10-item short-form. AD severity and impact was assessed by patient-reported global AD severity, Patient-Oriented Eczema Measure (POEM), Eczema Area and Severity Index (EASI), objective-SCORing AD (SCORAD), Investigator’s Global Assessment (IGA), Numerical Rating Scale (NRS) average and worst-itch, PROMIS sleep-related impairment, and Patient Health Questionnaire (PHQ)-9. Repeated-measures regression models were constructed to examine itch over time. Results In multivariable linear regression models controlling for age, race/ethnicity, history of asthma, hay fever, and food allergy, baseline PGH-physical T-scores were inversely associated with patient-reported global AD severity, POEM, EASI, objective-SCORAD, IGA, NRS average and worst-itch, PROMIS SRI, and PHQ-9, with stepwise decreases of physical health with worsening severity. PGH-mental T-scores were associated with all aforementioned severity measures aside from POEM. In multivariable repeated measures linear regression models, decreased PGH-mental and PGH-physical T-scores and mapped EQ-5D over time were associated with self-reported global AD severity, NRS worst and average-itch, POEM, PROMIS SD and SRI, EASI, objective-SCORAD, IGA, and PHQ-9 scores. Latent class analysis identified six classes of HRQOL, which were associated with measures of AD severity, non-white race, Hispanic ethnicity, and public insurance, but not age or sex. Conclusion AD patients have a heterogeneous longitudinal course and distinct patterns of HRQOL. Many patients had fluctuating HRQOL over time. Most patients with moderate-severe disease at baseline had persistent HRQOL impairment over time.

Itch is a complex symptom that is both common and burdensome in atopic dermatitis (AD). Yet, little is known about the longitudinal course of itch in AD. A prospective, dermatology practice-based study was performed of adults with AD (n = 463). Patients were assessed at baseline and approximately 6, 12, 18 and 24 months. Itch was assessed using Numeric Rating Scale (NRS) average and worst-itch scores, and frequency of itch in the past week. Repeated-measures regression models were constructed to examine itch over time. Overall, 31.5% and 22.5% had moderate (4–6) or severe (7–10) NRS average-itch scores; 27.4% and 36.4% had moderate (4–6) or severe (7–10) NRS worst-itch scores; 12.7% and 62.0% had itch from eczema 3–4 and ≥ 5 days in the past week; 27.4% and 45.1% reported sometimes and often/almost always having itch, respectively. Among patients with baseline moderate (4–6) or severe (7–10) NRS average-itch scores, 21.2% and 16.3% continued to have moderate or severe scores at ≥ 1 follow-up visits. In repeated-measures regression models, persistent NRS average-itch scores were associated with baseline NRS average-itch [adjusted β (95% CI): 0.75 (0.68, 0.82)] and food allergy [− 0.45 (− 0.84, − 0.07)]. Persistent NRS worst-itch was associated with baseline worst-itch NRS [0.73 (0.66, 0.80)] and Medicaid insurance [1.06 (0.17, 1.94)]. AD patients had a heterogeneous longitudinal course with fluctuating and complex overlapping patterns of average- and worst-itch intensity, and frequency.

Pityriasis rubra pilaris (PRP) is a rare papulosquamous disorder that normally manifests with hyperkeratotic follicular-based papules, scaling erythematous plaques with areas of sparing, and palmoplantar keratoderma.¹ Considerable heterogeneity exists in the clinical features of PRP. Not all patients experience progression to erythroderma, and PRP is sometimes associated with a seronegative arthritis.^1,2 The prevalence of arthropathy in PRP or frequency of other known disease features such as alopecia or anhidrosis is unknown.^3,4 In addition, the prevalence of other medical diagnoses in patients with PRP is incompletely described.

SummaryBackground. Multiple strategies have been used to evaluate the minimal important change (MIC) of the Eczema Area and Severity Index (EASI) and Scoring At

Background: Multiple clinician‐reported outcome measures exist for atopic dermatitis (AD) severity. However, there is no gold standard for use in clinical practice.Objectives: To determine the measurement properties of the product of validated Investigator's Global Assessment for AD (vIGA) and body surface area (BSA) overall or divided into six categories (cBSA: 0%/0.1, n = 653).Results: vIGA*BSA and vIGA*cBSA had good convergent validity with BSA (Spearman's ρ = 0.97 and 0.93), eczema area and severity index (ρ = 0.94 and 0.92), and objective SCORAD (ρ = 0.88 and 0.89); and weak‐to‐good convergent validity with Numeric Rating Scale average itch (ρ = 0.22 and 0.22) and worst itch (ρ = 0.27 and 0.28), Patient‐Oriented Eczema Measure (ρ = 0.44 and 0.43), Dermatology Life Quality Index (ρ = 0.48 and 0.49), ItchyQOL (ρ = 0.45 and 0.46), PROMIS Sleep Disturbance (ρ = 0.46 and 0.37) and sleep‐related impairment (ρ = 0.31 and 0.31) in adults and/or children; very good discriminant validity for physician‐reported global AD severity; good responsiveness to change of severity of AD and itch; and good reliability (intraclass correlation coefficient [95% confidence interval]: 0.72 [0.60–0.81] and 0.74 [0.62–0.82]) with no floor or ceiling effects. Thresholds for interpretability bands and clinically important difference were established.Conclusions: vIGA*BSA and vIGA*cBSA scores showed good convergent and discriminant validity, reliability, responsiveness and interpretability in adults and children with AD, and were feasible for use in clinical practice. vIGA*BSA and vIGA*cBSA had slightly lower convergent validity than EASI or objective SCORAD, but might be more efficient to collect and score.

Background Sleep disturbances (SD) are common in adults with atopic dermatitis (AD). Patient‐Reported Outcomes Measurement Information System (PROMIS™) SD and Sleep‐Related Impairment (SRI) are validated questionnaires to assess sleep in adults. Little is known about their measurement properties in adults with AD. Objective To assess the measurement properties of PROMIS SD and SRI 8‐item short‐forms in AD. Methods We performed a prospective dermatology practice‐based study using questionnaires and evaluation by a dermatologist (n=420). Results PROMIS SD/SRI showed moderate correlations to each other (r=0.57), and weak correlations with Patient‐Oriented Eczema Measure (rho=0.43/0.39), average (rho=0.31/0.30) and worst numerical rating scale for itch (rho=0.32/0.30), Eczema Area and Severity Index (rho=0.41/0.31) and Scoring AD (SCORAD) (rho=0.44/0.30) (Spearman correlations, P<0.0001). PROMIS SD and SRI increased significantly and stepwise with more frequent sleep disturbance, severe itch and self‐reported global AD severity (analysis of covariance, P<0.0001). PROMIS SD and SRI showed good internal consistency (Cronbach’s alpha=0.84, 0.91). Changes from baseline in PROMIS SD and SRI were weakly to moderately correlated with each other and changes of multiple patient‐reported and clinical‐reported AD outcomes. There were no floor or ceiling effects for PROMIS SD or SRI. The median completion time for PROMIS SD and SRI was 2 minutes. Conclusions PROMIS SD and SRI showed good construct validity, internal consistency, responsiveness and feasibility to assess sleep in adult AD patients.