Conversations on psoriasis–what patients want and what physicians can provide: a qualitative look at patient and physician expectations.
Humans; *Attitude of Health Personnel; Treatment Outcome; Dermatology/*organization & administration; *Communication; *Physician-Patient Relations; *Patient Satisfaction; Psoriasis/complications/psychology/*therapy
BACKGROUND: The role of the patient-physician relationship is a key issue in the management of lifelong, chronic conditions such as psoriasis, with each side bringing different perspectives. OBJECTIVE: To explore areas of congruence and disconnection in the relationship between psoriasis patients and dermatologists, with a focus on communication issues. METHODS: Three discussion group sessions were held in four centers across the United States with dermatologists, patients, and a follow-up of the dermatologists after watching the patient discussion. RESULTS: Patients want more information on psoriasis, fast treatments, clear expectations from the onset of therapy, and recognition of the emotional burden. Dermatologists found that patients do not receive or internalize adequate information and need further explanation of treatment regimens to increase compliance and patient satisfaction. LIMITATIONS: This was a qualitative study assessing the range of responses and was not a quantitative study designed to test specific hypotheses. The study may not be informative about the experiences of people with psoriasis not actively seeing a physician. CONCLUSIONS: Encounters between physicians and psoriasis patients can be enhanced by providing information on what psoriasis is, choosing fast-acting treatments that patients are willing to use, and providing written materials about the disease and treatment plan.
Uhlenhake Elizabeth E; Kurkowski David; Feldman Steven R
The Journal of dermatological treatment
2010
2010-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3109/09546630903085328" target="_blank" rel="noreferrer noopener">10.3109/09546630903085328</a>
Efficacy and safety of ustekinumab and etanercept for the treatment of psoriasis.
Humans; Treatment Outcome; Severity of Illness Index; Risk Assessment; Evidence-Based Medicine; Patient Selection; Ustekinumab; Antibodies; Anti-Inflammatory Agents/adverse effects/*therapeutic use; Etanercept; Immunoglobulin G/adverse effects/*therapeutic use; Immunosuppressive Agents/adverse effects/*therapeutic use; Psoriasis/*drug therapy/immunology; Receptors; Humanized; Monoclonal; Monoclonal/adverse effects/*therapeutic use; Tumor Necrosis Factor/*therapeutic use
IMPORTANCE OF THE FIELD: TNF-alpha inhibitors such as etanercept have been used for psoriasis for years. A fairly well defined efficacy and safety profile has developed. A new biologic agent, ustekinumab, an IL-12 and IL-23 inhibitor, has recently been released in the US for the treatment of moderate-to-severe psoriasis. The purpose of this article is to compare the efficacy and safety profiles of ustekinumab and etanercept. AREAS COVERED IN THIS REVIEW: We examined safety and efficacy data regarding ustekinumab and etanercept from clinical reports, a head-to-head trial, review articles, and databases and registries from the last 20 years. WHAT THE READER WILL GAIN: Evidence is reviewed about the efficacy for the treatment of psoriasis as well as the safety profiles for both agents, ustekinumab and etanercept. TAKE HOME MESSAGE: Both drugs have data to confirm efficacy and safety in patients with moderate-to-severe psoriasis in the short-term. The limited long-term data on the safety profile of ustekinumab requires careful judgment on the clinician's part, weighing well-defined benefits and potential unknown risks.
Uhlenhake Elizabeth E; Feldman Steven R
Expert opinion on biological therapy
2010
2010-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1517/14712598.2010.487061" target="_blank" rel="noreferrer noopener">10.1517/14712598.2010.487061</a>
Managing psoriasis: what's best for your patient?
Humans; Male; Middle Aged; Adrenal Cortex Hormones/therapeutic use; Immunosuppressive Agents/therapeutic use; Ultraviolet Therapy; Combined Modality Therapy; *Patient Compliance; Anti-Inflammatory Agents/therapeutic use; Dermatologic Agents/therapeutic use; Photochemotherapy; Psoriasis/drug therapy/radiotherapy/*therapy; Administration; Cutaneous; ANTISEPTICS; DRUG side effects; PHOTOTHERAPY; PSORIASIS treatment; QUALITY of life; SKIN disease treatment
Whether the symptoms are mild, moderate, or severe, the optimal treatment plan is the one the patient is most likely to follow.
Uhlenhake Elizabeth E; Mehregan David A
The Journal of Family Practice
2012
2012-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Spreading pigmented actinic keratosis: a review.
Actinic/diagnosis/*pathology; Biopsy; Carcinoma; Dermoscopy/methods; Diagnosis; Differential; Disease Progression; Female; Humans; Hutchinson's Melanotic Freckle/diagnosis/*pathology; Immunohistochemistry; Keratosis; Male; Needle; Neoplasm Staging; Precancerous Conditions/*pathology; Risk Assessment; Skin Neoplasms/diagnosis/*pathology; Squamous Cell/diagnosis/*pathology
INTRODUCTION: Spreading pigmented actinic keratosis (SPAK) is a common, but uncommonly reported or appreciated, variant of classic actinic keratosis (AK). It can mimic different pigmented lesions, which may be benign (eg, solar lentigo) or malignant (eg, lentigo maligna). OBJECTIVE: We sought to review current data and identify areas needing further research to establish diagnostic guidelines for SPAK and to increase awareness of this common entity. METHODS: A literature search was performed in both PubMed and MEDLINE databases using the search terms "spreading pigmented actinic keratosis," "pigmented solar keratosis," "pigmented actinic," and "pigmented solar." Each article was retrieved, reviewed, and summarized. RESULTS: SPAK is a rarely reported lesion that can be difficult to distinguish from other benign and malignant pigmented lesions, including seborrheic keratosis, melanoma in situ (lentigo maligna type), and lentigo maligna melanoma. Located mainly on sun-exposed areas and with a size greater than 1.5 cm, the lesion typically spreads laterally. Pathologically, the lesion resembles classic AK with increased basal melanization. The malignancy potential has not yet been elucidated but destructive therapies such as cryotherapy are recommended. LIMITATIONS: Reports not yet published or not included in the comprehensive databases we used may exist that were not analyzed. CONCLUSIONS: SPAK can be associated with adjacent melanoma in situ; therefore, its diagnosis merits increased suspicion for coexisting melanoma.
Uhlenhake Elizabeth E; Sangueza Omar P; Lee Andrew D; Jorizzo Joseph L
Journal of the American Academy of Dermatology
2010
2010-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jaad.2009.07.026" target="_blank" rel="noreferrer noopener">10.1016/j.jaad.2009.07.026</a>