Psoriasis: Augustin M

Nast A, Kopp IB, Augustin M, Banditt KB, Boehncke WH, Follmann M, Friedrich M, Huber M, Kahl C, Klaus J, Koza J, Kreiselmaier I, Mohr J, Mrowietz U, Ockenfels HM, Orzechowski HD, Prinz J, Reich K, Rosenbach T, Rosumeck S, Schlaeger M, Schmid-Ott G, Sebastian M, Streit V, Weberschock T, Rzany B, Anonymous00272, Anonymous00273. · Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin, Germany. · J Dtsch Dermatol Ges. · Pubmed #17615051 No free full text.

Abstract: Psoriasis vulgaris is a common and often chronic inflammatory skin disease. The incidence of psoriasis in Western industrialized countries ranges from 1 to 2%. Patients afflicted with severe psoriasis vulgaris may experience a significant reduction in quality of life. Despite the large variety of treatment options available, patient surveys have revealed lack of satisfaction with the efficacy of available treatments and a high rate of non-compliance. To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologische Gesellschaft (DDG) and the Berufsverband Deutscher Dermatologen (BVDD) initiated a project to develop evidence-based guidelines for the management of psoriasis. These resulting Guidelines focus on induction therapy in cases of mild, moderate, and severe plaquetype psoriasis in adults. The Guidelines include evidence-based evaluation of the efficacy of all currently available therapeutic options in Germany. In addition, they offer detailed information on how best to administer the various treatments and give information on contraindications, adverse drug reactions, and drug interactions as well as estimates of practicability and cost. The Guidelines were developed following the recommendations of the Arbeitsgemeinschaft wissenschaftlicher medizinischer Fachgesellschaften (AWMF). The therapeutic recommendations were developed by an expert group and finalized during interdisciplinary consensus conferences.

Nast A, Kopp I, Augustin M, Banditt KB, Boehncke WH, Follmann M, Friedrich M, Huber M, Kahl C, Klaus J, Koza J, Kreiselmaier I, Mohr J, Mrowietz U, Ockenfels HM, Orzechowski HD, Prinz J, Reich K, Rosenbach T, Rosumeck S, Schlaeger M, Schmid-Ott G, Sebastian M, Streit V, Weberschock T, Rzany B. · Division of Evidence Based Medicine, Klinik für Dermatologie, Venerologie, Allergologie, Charité-Universitätsmedizin Berlin, Schumannstrasse 20/21, Berlin, Germany. · Arch Dermatol Res. · Pubmed #17497162 links to  free full text

Abstract: Psoriasis vulgaris is a common and chronic inflammatory skin disease which has the potential to significantly reduce the quality of life in severely affected patients. The incidence of psoriasis in Western industrialized countries ranges from 1.5 to 2%. Despite the large variety of treatment options available, patient surveys have revealed insufficient satisfaction with the efficacy of available treatments and a high rate of medication non-compliance. To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologische Gesellschaft and the Berufsverband Deutscher Dermatologen (BVDD) have initiated a project to develop evidence-based guidelines for the management of psoriasis. The guidelines focus on induction therapy in cases of mild, moderate, and severe plaque-type psoriasis in adults. The short version of the guidelines reported here consist of a series of therapeutic recommendations that are based on a systematic literature search and subsequent discussion with experts in the field; they have been approved by a team of dermatology experts. In addition to the therapeutic recommendations provided in this short version, the full version of the guidelines includes information on contraindications, adverse events, drug interactions, practicality, and costs as well as detailed information on how best to apply the treatments described (for full version, please see Nast et al., JDDG, Suppl 2:S1-S126, 2006; or http://www.psoriasis-leitlinie.de ).

Nast A, Kopp IB, Augustin M, Banditt KB, Boehncke WH, Follmann M, Friedrich M, Huber M, Kahl C, Klaus J, Koza J, Kreiselmaier I, Mohr J, Mrowietz U, Ockenfels HM, Orzechowski HD, Prinz J, Reich K, Rosenbach T, Rosumeck S, Schlaeger M, Schmid-Ott G, Sebastian M, Streit V, Weberschock T, Rzany B, Anonymous00487. · Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin. · J Dtsch Dermatol Ges. · Pubmed #17187649 No free full text.

This publication has no abstract.

Augustin M, Reich K, Reusch M, Luger T, Franzke N, Schafer I, Rustenbach SJ, Radtke MA. · No affiliation provided · Dermatology. · Pubmed #19270443 No free full text.

This publication has no abstract.

Augustin M. · No affiliation provided · J Dtsch Dermatol Ges. · Pubmed #18377562 No free full text.

This publication has no abstract.

Radtke MA, Augustin M. · Department of Dermatology and Venerology, University-Hospital Hamburg-Eppendorf, Hamburg, Germany. · Clin Dermatol. · Pubmed #18755360 No free full text.

Abstract: With a prevalence of 2% to 3%, psoriasis is a very common chronic disease worldwide and generates therapy costs and continuing cost for health insurance and patients and their families. Cost-political changes in health care and the ever increasing health-economic demands in all areas of the health system make it necessary to differentiate between the two when recording the expenses for a disease. The main characteristics of the pharmacoeconomic evaluation are the record of costs, the cost-benefit and cost-effectiveness ratio, and efficiency of various treatment forms. Numerous publications discuss the cost of individual forms of therapy in the treatment of psoriasis, but there are fewer studies on the total cost of psoriasis therapy, especially studies that take both direct and indirect costs into account. The scientific articles on pharmacoeconomy and quality of life in psoriasis have proven (without a doubt) that, despite the lack of a vital threat, psoriasis is highly important to the national economy and to those who have the disease. This justifies appropriate monetary expenditure for treatment. Studies that address the cost of therapies (especially for chronic diseases) will be necessary in the future and will create the required transparency to guarantee reasonable medical care that takes the cost-benefit ratio and the best outcome for the patient's quality of life into account.

Augustin M, Peeters P, Radtke M, Moehling U, Lapp C. · Klinik und Poliklinik fur Dermatologie und Venerologie, Universitatsklinikum Hamburg-Eppendorf, Hamburg, Germany. · Dermatology. · Pubmed #17823519 No free full text.

Abstract: BACKGROUND: Psoriasis vulgaris requires lifelong treatment associated with considerable health cost. Studies showed that a combination of a steroid and a vitamin D(3) analogue is more effective than both compounds in monotherapy. OBJECTIVE: To determine the cost-effectiveness of a fix calcipotriol/betamethasone combination (Daivobet/Dovobet/Taclonex) compared to a morning/evening non-fix calcipotriol/betamethasone combination in psoriasis treatment. METHODS: A Markov model (discrete-time stochastic process based on transitions between health states) with 2 treatment arms (Daivobet/Dovobet/Taclonex vs. non-fix calcipotriol/betamethasone) over a 48-week time period was developed. The effectiveness criterion was the number of days with clearance or marked improvement. Clinical and health resource utilisation data were derived from randomised studies. RESULTS: Treatment with Daivobet/Dovobet/Taclonex showed a higher cost-effectiveness compared to the non-fix combination, even when assuming a maximum compliance for the twice daily non-fix combination and varying the effectiveness of Daivobet/Dovobet/Taclonex by 10%. CONCLUSION: Psoriasis treatment with a fix calcipotriol/betamethasone combination is more cost-effective than a non-fix morning/evening combination.

Augustin M, Andrees U, Grimme H, Schöpf E, Simon J. · Universitäts-Hautklinik Freiburg. · Forsch Komplementarmed. · Pubmed #10352377 No free full text.

Abstract: OBJECTIVE: To examine the effects of topical therapy with Mahonia aquifolium on the expression of pathogenetically relevant molecules in psoriatic skin by immunohistochemistry. STUDY DESIGN: Prospective-randomized, half-side comparison study with subsequent immunohistochemical assessment of biopsies. METHODS: The study areas were treated with Mahonia aquifolium ointment 3( daily and with dithranol in rising concentrations 1( daily, respectively. Biopsies of lesional skin from the test areas were carried out in 49 patients a) prior to therapy and b) 4 weeks after the start of therapy. Immunohistochemical stainings were performed with the following monoclonal antibodies: anti-ICAM-1, -CD3, -HLA-DR, -keratin 6, -keratin 16, -Ki-67. Evaluation of staining was made by two independent examiners using established semiquantitative scores. RESULTS: Marked staining with all of the cited monoclonal antibodies was observed in the lesional skin prior to therapy. After 4 weeks of therapy there was a marked reduction in the expressions of ICAM-1, CD 3, HLA-DR and keratin 6 and 16. There were significantly greater reductions of ICAM-1, CD3, and HLA-DR at sites treated with dithranol. The expression of Ki-67 was not reduced by either therapy. CONCLUSIONS: These results indicate efficacy of Mahonia aquifolium and dithranol in psoriatic skin both on cellular cutaneous immune mechanisms and on the hyperproliferation of keratinocytes. The effect of dithranol appears to be more potent than that of Mahonia aquifolium.

Radtke MA, Reich K, Blome C, Rustenbach S, Augustin M. · German Center for Health Services Research in Dermatology, Health Economics and QoL Research Group, Department of Dermatology, University Clinics of Hamburg, Hamburg, Germany. · J Eur Acad Dermatol Venereol. · Pubmed #19309433 No free full text.

Abstract: BACKGROUND: Psoriatic arthritis (PsA) is a chronic, systemic, inflammatory disorder characterized by the association of arthritis with psoriasis. Patients with PsA may have a heterogeneous and variable clinical course. Evidence that affected patients can have significant radiographic joint damage, functional impairment, reduced quality of life and long-term work disability is increasing. OBJECTIVES: This study aims to determine the prevalence and clinical features of psoriatic arthritis and joint complaints in patients with psoriasis examined in a German national survey. METHODS: This study is a non-interventional, cross-sectional analysis on 2009 patients with psoriasis from 13 dermatological hospitals and 129 dermatological private practices and outpatient clinics in Germany. Patients showing rheumatological symptoms were further recorded with respect to active arthritis and PsA symptoms according to Group for Research and Assessment of Psoriasis and Psoriatic Arthritis criteria. RESULTS: Nineteen per cent of the patients had PsA, including 14.8% previously confirmed and 4.2% newly diagnosed disease. Another 7.7% had intermittent but clinically unspecific joint symptoms, which could not be clearly attributed to PsA. About half (49.7%) of the patients with PsA had at least 1 swollen joint and 84.9% (n = 287) suffered from joint pain. Patients suffering from pain marked an average of 8.7 joints on a diagram as painful out of a possible 28. The mean number of swollen joints among the affected patients amounted to an average of 6.8. CONCLUSION: Our results show that there is still a significant number of patients suspected of having joint involvement without ever having been diagnosed with PsA. Recently published data indicate that progression of joint damage and functional disability can be prevented if adequate treatment is started promptly. Early diagnosis and interdisciplinary care are thus crucial.

Radtke MA, Schäfer I, Gajur A, Langenbruch A, Augustin M. · Department of Dermatology, CVderm - German Center for Health Services Research in Dermatology, University Clinics of Hamburg, Martinistrasse 52, Hamburg 20246, Germany. · Br J Dermatol. · Pubmed #19298268 No free full text.

Abstract: BACKGROUND: Vitiligo is a chronic pigmentary disorder of the skin, affecting 1-2% of the general population. Although not life threatening, vitiligo may considerably influence patients' health-related quality of life (QoL) and psychological well-being. Willingness-to-pay (WTP) is a construct reflecting disease burden and QoL reduction which has not yet been used in vitiligo. OBJECTIVES: To assess the WTP and the QoL of patients with vitiligo. METHODS: Patients with vitiligo were included in a nationwide German postal survey. WTP was assessed by two standardized items, and QoL was evaluated using the Dermatology Life Quality Index (DLQI) and the EuroQol (EQ-5D) questionnaire. QoL data were compared with n = 1,511 patients from a national survey on psoriasis. RESULTS: The questionnaire was completed by 1,023 patients (71.5% women, mean age 44.4 years, mean disease duration 20.3 years) with vitiligo. The mean DLQI was 7.0 (7.5 in women, 5.5 in men) compared with 8.6 in psoriasis. Of the patients with vitiligo, 24.6% had a DLQI > 10 which indicates severe QoL reductions, compared with 34.1% in patients with psoriasis. The highest mean DLQI value was observed in the patient group aged 20-29 years. EQ-5D mean score was 83.6 compared with 75.3 in psoriasis. Of the patients with vitiligo, 32.9% would pay more than 5,000 Euro in order to achieve complete disease remission. WTP was highest among middle-aged patients (30-60 years). There was a significant correlation between DLQI scores and WTP (chi(2) = 65.43, P < 0.001). Moreover, WTP significantly correlated with duration of disease, and with body surface area affected (P < 0.001). CONCLUSIONS: Vitiligo causes substantial disease burden as reflected by QoL impairment and high WTP, especially in women. These results should draw the attention of physicians to this disease, as appropriate education and treatment are likely to improve the QoL of patients with vitiligo and may support patients' compliance and empowerment.

Augustin M, Radtke M, van Engen A, Ruedig C, Lapp C, Moehling U. · Clinic and Polyclinic for Dermatology and Venerology, University Clinic Hamburg-Eppendorf, Germany. · J Dtsch Dermatol Ges. · Pubmed #19243481 No free full text.

Abstract: BACKGROUND: Psoriasis vulgaris is one of the most common dermatologic diseases in Germany with a prevalence of about 2%. Along with efficacy and safety, costs are an important criterion for selecting appropriate therapy for this chronic disease. The majority of the patients with mild to moderate psoriasis vulgaris can be successfully treated with topical therapy alone. The most important agents are vitamin D(3) analogs and corticosteroids either as single agents or in a fixed combination (Daivobet). METHODS: For the evaluation of the cost-effectiveness of different topical psoriasis treatments, a Markov model was developed that compares a fixed combination treatment followed by calcipotriol with a morning/evening application of the individual agents, as well as a comparison with tacalcitol. RESULTS: The pharmacoeconomic evaluation showed a higher cost-effectiveness of the fixed combination treatment compared to using single agents (morning/evening) and to the tacalcitol. Treatment with the fix combination is more effective and more economic. Additional sensitivity analyses demonstrated that the advantage remains even when assuming a maximum compliance for twice daily usage, and varying the effectiveness of the fixed combination by 10%. CONCLUSIONS: The treatment of mild to moderate psoriasis with a fixed calcipotriol/betamethasone combination is a more cost-effective treatment than a treatment with the single agents or tacalcitol monotherapy.

Reich K, Krüger K, Mössner R, Augustin M. · Dermatologikum Hamburg, Stephansplatz 5, 20354 Hamburg, Germany. · Br J Dermatol. · Pubmed #19210498 No free full text.

Abstract: BACKGROUND: Because psoriatic arthritis (PsA) usually develops years after the first manifestation of skin symptoms, in many cases the initial diagnosis of PsA depends on the dermatologist. OBJECTIVES: To investigate the prevalence and clinical pattern of PsA in a daily practice population of patients with psoriasis. METHODS: Patients were enrolled in an observational prospective cross-sectional cohort study at 48 community and academic centres. Demographic and medical parameters were recorded, including severity of skin symptoms (Psoriasis Area and Severity Index, PASI), previous and current treatments, concomitant diseases, and the impact of psoriasis on productivity and health-related quality of life (Dermatology Life Quality Index, DLQI). Patients with joint symptoms were referred to a rheumatologist for diagnosis and to record the activity and pattern of arthritis. RESULTS: Among 1511 patients 20.6% had PsA; in 85% of the cases PsA was newly diagnosed. Of these patients more than 95% had active arthritis and 53.0% had five or more joints affected. Polyarthritis (58.7%) was the most common manifestation pattern, followed by oligoarthritis (31.6%) and arthritis mutilans (4.9%). Distal interphalangeal involvement was present in 41.0% and dactylitis in 23.7% of the patients. Compared with patients without arthritis, patients with PsA had more severe skin symptoms (mean PASI 14.3 vs. 11.5), a lower quality of life (mean DLQI 11.6 vs. 7.7) and greater impairment of productivity parameters. CONCLUSIONS: The findings are consistent with a high prevalence of undiagnosed cases of active PsA among patients with psoriasis seen by dermatologists. As many of these patients also have significant skin symptoms, treatment strategies are required that are equally effective in the control of skin and joint symptoms of psoriasis.

Augustin M, Reich K, Reich C, Purwins S, Jeff Rustenbach S, Schäfer I, Radtke M. · CVderm, Department of Dermatology and Venereology, University Clinics Hamburg-Eppendorf, Germany. · J Dtsch Dermatol Ges. · Pubmed #18801145 No free full text.

Abstract: BACKGROUND: Many different forms of treatment are available for psoriasis. The German standard is the national AWMF S3 guideline. A national survey on psoriasis care in 2005 indicated deficits in psoriasis care in Germany. AIM: Assessment of the health care situation of patients with psoriasis in Germany. METHODS: Nation-wide cross-sectional study, in 142 dermatological practices and clinics. The following data were documented: a) Doctor Questionnaire: Treatment, illnesses, clinical characteristics and severity (PASI). b) Patient Questionnaire: Quality of life (QoL), patient relevant therapeutic benefits and satisfaction with the quality of the care. A panel of experts developed and analyzed 8 criteria as indicators of the quality of care. RESULTS: Of the 2009 evaluated patients, 11.6% suffered from severe psoriasis (PASI > 20) and 27.4% from moderate psoriasis (PASI 10-20). The average PASI value was 10.1, and the DLQI 7.5. 32.2% of patients had a serious reduction in their QoL (DLQI > 10). The share of patients with preceding systemic therapy was 47.3%, in severe psoriasis 62.1%, while 20.1% of the patients had received inpatient treatment. The average number of days absent from work was 3.4. Compared to 2005, all 8 indicators improved. CONCLUSION: Significant numbers of psoriasis patients show serious quality of life reductions and high grades of clinical severity. In comparison to 2005, there has been a notable, nation-wide improvement in psoriasis care.

Schaefer I, Rustenbach SJ, Zimmer L, Augustin M. · Department of Dermatology, German Center for Health Services Research in Dermatology, University Clinics of Hamburg, Hamburg, Germany. · Dermatology. · Pubmed #18525204 No free full text.

Abstract: BACKGROUND: Epidemiological data are important for planning medical care. Thus far, only few prevalence data for skin diseases have been published in Germany, most of them not population based. OBJECTIVES: Estimation of prevalences of common skin diseases in a sample of employees of German companies. METHODS: Whole-body examinations were performed by trained dermatologists in 150 companies as part of skin cancer screenings. Using a standardized and computerized data entry, all clinical dermatological findings were documented. Explicitly skin lesions requiring current treatment were noted. The retrospective evaluation of the data was descriptive, using the diagnoses defined a priori in the data entry mask. RESULTS: 48,665 persons (52.8% male) with a mean age of 43.2 years were examined. The following frequencies of chronic and acute inflammatory skin diseases were observed: contact eczema 8.9%, acne 4.2%, seborrhoeic eczema 3.4%, rosacea 2.2%, psoriasis vulgaris 2.1%, atopic eczema 1.4% and lichen ruber 0.07%. In total, dermatological findings needing treatment were observed in 19% of the study cohort; 1.3% of the participants presented a suspicious finding requiring diagnostics for skin malignoma. CONCLUSIONS: There is a high frequency of chronic inflammatory skin diseases in the general working population and a high need for dermatological treatment.

Augustin M, Krüger K, Radtke MA, Schwippl I, Reich K. · Health Economics and Quality of Life Research Group, Department of Dermatology, University Clinics of Hamburg, Hamburg, Germany. · Dermatology. · Pubmed #18319601 No free full text.

Abstract: BACKGROUND: Plaque-type psoriasis produces significant morbidity, has negative effects on patients' health-related quality of life (HRQoL), and represents an economic burden. OBJECTIVES: The assessment of disease severity, HRQoL and health care in plaque-type psoriasis in everyday German medical practice. METHODS: Details of patients with plaque-type psoriasis were recorded by 48 dermatologists in Germany. During the visit, demographic data, medical history, previous and current treatments, occupational impairment, the current state of the disease (measured by the Psoriasis Area and Severity Index; PASI), overall lesion severity, and HRQoL were evaluated. RESULTS: In total, 1,511 plaque-type psoriasis patients were included. The average PASI score was 12.0. The average Dermatology Life Quality Index score was 8.6. Among the patients with the severest psoriasis (PASI >20), only 45.4% had ever been prescribed systemic treatments. CONCLUSIONS: Psoriasis patients have a reduced HRQoL and are not sufficiently treated in practice. A more widespread use of systemic treatment and the definition of treatment goals are essential to improve the standard of care for psoriasis patients.

Schulte-Herbrüggen O, Fölster-Holst R, von Elstermann M, Augustin M, Hellweg R. · Department of Psychiatry and Psychotherapy, Charité-University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany. · Int Arch Allergy Immunol. · Pubmed #17579279 No free full text.

Abstract: BACKGROUND: Nerve growth factor (NGF) is known to act as a potent mediator in neuroinflammatory processes. Recent studies point to a role of NGF in the skin pathophysiology of atopic dermatitis (AD) and psoriasis. Hereby, NGF was found to interact with the major cellular components (mast cells and eosinophils) of both skin diseases. OBJECTIVES: In order to investigate NGF serum levels as a possible clinical marker of disease activity and immunological status, we determined serum NGF, eosinophil cationic protein (ECP), total IgE and score of AD (SCORAD) in 57 patients with AD as well as NGF and the psoriasis area and severity index (PASI) in 17 patients with psoriasis. Fifty healthy subjects served as controls. METHODS: We used a highly sensitive improved fluorometric two-site ELISA system for serum NGF detection. IgE and ECP were measured by CAP-FEIA and radioimmunoassay. RESULTS: We did not find a significant correlation between NGF and either ECP, total IgE, or severity of disease assessed by SCORAD. Also in patients with psoriasis, there was no significant correlation with disease activity determined by PASI. CONCLUSION: Even though there is increasing evidence showing NGF to be involved in the local inflammatory pathophysiology of AD within skin lesions, our findings suggest that NGF systemic serum concentration is not a suitable parameter to estimate the clinical or immunological status of AD or psoriasis patients. This result is inconsistent with some previous studies showing a positive correlation of serum NGF with AD severity, which might be, for example, due to the fact that the present results are corrected for unspecific binding.

Nijsten T, Meads DM, de Korte J, Sampogna F, Gelfand JM, Ongenae K, Evers AW, Augustin M. · Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands. · J Invest Dermatol. · Pubmed #17495953 links to  free full text

Abstract: The dermatology life questionnaire index (DLQI) and the Skindex are the most commonly used dermatology-specific health-related quality of life (HRQOL) instruments. Although these tools are used in international surveys and clinical trials, the cross-cultural equivalence of their items has not been documented. We used differential item functioning (DIF), which is part of the Rasch model, to assess the impact of cultural background on the items of the DLQI and Skindex-29 and-17. The data of the 450 psoriasis patients, who attended in- and outpatient dermatology centers, was collected retrospectively from five European and one US center. The DLQI and Skindex-29 scales did not fit the Rasch model (P<0.0008) and 10/10 of the DLQI and 19/29 of the Skindex-29 items displayed significant DIF. Although the psychosocial scale of the Skindex-17 fitted the Rasch model, half or more of the items of the psychosocial (6/12) and the symptom scale (4/5) showed significant DIF across countries. These findings suggest that psoriasis patients from different countries respond differently to a substantial proportion of DLQI and Skindex items despite having the same level of underlying HRQOL impairment. Therefore, these instruments should not be used in their current form in international studies.

Schöffski O, Augustin M, Prinz J, Rauner K, Schubert E, Sohn S, Reich K. · University of Erlangen-Nuremberg, Germany. · J Dtsch Dermatol Ges. · Pubmed #17338796 No free full text.

Abstract: BACKGROUND: This study evaluated costs, disease severity and health-related quality of life (QoL) in patients with moderate to severe plaque-type psoriasis. PATIENTS AND METHODS: Patients with a 'psoriasis area and severity index' (PASI) > 12 and/or a body surface area (BSA) > 10 were enrolled in dermatological practices and hospital outpatient departments (n = 184) and the total costs of illness generated during the last 12 months were retrospectively calculated. QoL was assessed using the SF-36 and the DLQI. Participants were stratified into three subgroups according to the treatment received during the 1 year documentation period; a) patients without and b) patients with phototherapy or standard systemic therapy, and c) patients who had failed, were intolerant or had contraindications to at least two standard systemic therapies. The study was performed before biologics became available for the treatment of psoriasis in Germany. RESULTS: Included patients had severe skin symptoms (mean PASI 18.2) and a highly impaired QoL (mean DLQI 10.6). Total annual costs amounted to euro 6,709. Patients belonging to subgroup C had the most severe skin symptoms (mean PASI 22.2), the lowest QoL (mean DLQI 12.6), the highest hospitalization rate and largest loss of productivity.These patients produced the highest total costs of 8.831 euro/y. CONCLUSIONS: Patients who cannot (or can no longer) be adequately managed with standard treatments are characterized by high disease activity, high costs and reduced QoL. Improved treatment options particularly for these patients are medically necessary and appear economically sensible.

Sohn S, Schoeffski O, Prinz J, Reich K, Schubert E, Waldorf K, Augustin M. · Chair for Health Management, University of Erlangen-Nuremberg, Lange Gasse 20, DE-90403 Nuremberg, Germany. · Dermatology. · Pubmed #16484820 No free full text.

Abstract: BACKGROUND: There is little information concerning the costs of psoriasis and patients' quality of life (QoL) in Germany. OBJECTIVE: To obtain data on the annual costs and QoL(to follow in a further publication) of patients with moderate to severe plaque psoriasis. METHODS: Between October 2003 and February 2004, six office-based dermatologists and eight dermatology outpatient departments retrospectively documented cost-of-illness data from a societal cost perspective in 184 patients over a 12-month period. Patients were stratified into three subgroups according to their treatment scheme. RESULTS: Mean total costs amounted to euro 6,709 per patient and year. The mean PASI score was 18.2 and PBSA 28.9%. Annual costs were highest with euro 8,831 in high-need patients. They also showed the highest PASI score (22.2). CONCLUSION: Moderate to severe plaque psoriasis is associated with tremendous costs, particularly in patients not adequately controlled by conventional therapies, while the outcomes of patients were unsatisfactory.

Berger K, Ehlken B, Kugland B, Augustin M. · MERG, Forschungsgruppe Medizinische Okonomie. · J Dtsch Dermatol Ges. · Pubmed #15967010 No free full text.

Abstract: BACKGROUND: Data regarding costs of outpatient and office-based care, as well as out-of-pocket expenses, for psoriasis patients in Germany are not available. Aim of this study was to assess average annual cost and cost per flare of outpatient and office-based care for patients with moderate to severe chronic psoriasis vulgaris from several perspectives. METHODS: In this multi-center, cross-sectional, retrospective and prospective cost-of-illness study, direct (medical and non-medical) and indirect costs were considered from patient, third-party payer (TPP) and societal perspectives. RESULTS: Out of 227 patients enrolled consecutively in 17 centers, 192 cases could be analyzed. On average, TPP reimbursed 864 per patient annually, 60 % for prescribed medication and 22 % for hospitalization. Patients spent 596 yearly mainly for alternative therapies and OTC-medication/skin care products as well as for additional expenses (e. g. ultraviolet lamp, clothes or cleaning agents). Indirect costs per patient amounted to 1,440 yearly. Total annual costs per patient were 2,866 and 4,985 if treated with systemic drugs additionally. 1,173 if treated topically and/or with phototherapy. CONCLUSIONS: The relatively high average annual costs per patient indicate need for efficient control of psoriasis. This cost-of-illness study provides basic data for further decision making, including economic assessment of innovative therapies for psoriasis.

Zschocke I, Hammelmann U, Augustin M. · IFKS, Institut für Forschungsmanagement und klinische Studien, Freiburg. · Hautarzt. · Pubmed #15700156 No free full text.

Abstract: BACKGROUND: The patient's opinion has received only little consideration in current health-political discussions so far. This study examines the question of agreement between physicians and patients regarding their expectations of therapy and evaluation of its' usefulness. PATIENTS AND METHODS: 133 patients with psoriasis vulgaris (n=73) or atopic dermatitis (n=60) as well as medical personnel (n= 119) were assessed concerning the priority of therapy goals by means of a specially-designed questionnaire. RESULTS: There was overall agreement on the definition of therapy goals in the improvement of clinical symptoms and the importance of side effects between medical personnel and patients. Psychological distress and social improvements were clearly overrated by the medical staff, whereas the need for less therapeutic expenditure was clearly underestimated. CONCLUSIONS: The conventional evaluation of drugs and therapies covers the effectiveness and the side effects, topics about which patients and physicians are in general accordance. As far as further evaluation criteria are concerned, discussions should reflect the patient's opinion's, since it cannot be assumed that their perspective is adequately represented by physicians.

Augustin M, Wenninger K, Amon U, Schroth MJ, Küster W, Chren M, Kupfer J, Gieler U. · Department of Dermatology, University Clinics of Freiburg, Freiburg, Germany. · Dermatology. · Pubmed #15237262 No free full text.

Abstract: BACKGROUND: Health-related quality of life (HRQOL) has increasingly been recognized as an important aspect of a comprehensive clinical assessment in dermatology. OBJECTIVE: The aim of the present study was to translate and validate one of the most frequently used and established skin disease-specific HRQOL questionnaires originally developed in English for the German language area: the Skindex-29. METHODS: 295 in-patients with psoriasis and atopic dermatitis completed the German translation of the Skindex as well as a number of additional skin disease-specific questionnaires. Data from 2 subsamples were analysed separately to test for the robustness of results. RESULTS: Results from principal component analyses supported the scale structure of the original Skindex. Internal consistency coefficients were high for all scales. Further analyses supported the convergent validity of the German adaptation of the Skindex-29 as well as its sensitivity to change. CONCLUSION: The study provides evidence for the validity and reliability of the Skindex-29.

Augustin M, Lange S, Wenninger K, Seidenglanz K, Amon U, Zschocke I. · Department of Dermatology, University Clinics of Freiburg, Hauptstrasse 7, 79104 Freiburg, Germany. · Eur J Dermatol. · Pubmed #15197001 links to  free full text

Abstract: Health related quality of life (HRQOL) has become an important re- search topic in dermatology. We developed a series of modular, dermatology-specific HRQOL questionnaires: the Freiburg Life Quality Assessment (FLQA). Each FLQA questionnaire consists of a core module (FLQA-c) applicable to all skin diseases plus a number of items specific to distinct dermatological diseases. The objectives of the present study were: 1) to test the psychometric properties of the FLQA-c, and 2) to define a threshold indicating a significantly reduced HRQOL. 394 psoriasis patients, 253 atopic dermatitis patients, and 240 control subjects completed the FLQA-c. Cronbach's alphas were above 0.75 for all six scales except for "treatment". Discriminant validity, sensitivity to change, and convergent validity were satisfactory. On the different scales, the threshold indicating a marked reduction in HRQOL detected 33% to 68% of the patients. These data support the reliability and validity of the FLQA-c.

Lange S, Zschocke I, Langhardt S, Amon U, Augustin M. · Interdisziplinäres Therapiezentrum PsoriSol GmbH, Fachklinik für Dermatologie und Allergologie. · Hautarzt. · Pubmed #10591789 No free full text.

Abstract: The present study examined the effectiveness of combined dermatological and behavioural medicine therapy on the skin status and disease-specific stress of eighty-six patients with psoriasis and fifty-eight patients with atopic dermatitis who were hospitalized in the PsoriSol Clinic, Hersbruck, Germany. In addition to receiving instruction about their stain disease, the patients were offered, practice in relaxation techniques, social contacts and scratching control as well as individual psychological counselling. The clinical change was assessed by PASI and SCORAD, respectively. The Marburg questionnaire for coping with skin diseases (MHF) and a questionnaire for health-related control attributes (GKU-S) served as psychometric measures. Patients showed significant improvement in skin status and psychosocial parameters in pre-post comparison. Social fears, avoidance and helplessness were reduced by significant improvement of the emotional status in both groups. Patients with psoriasis also showed an increase in internal control attributes. Dermatological treatment combined with behavioural medicine therapy can be considered an effective method in patients with atopic dermatitis and psoriasis.

Augustin M, Zschocke I, Lange S, Seidenglanz K, Amon U. · Universitäts-Hautklinik Freiburg. · Hautarzt. · Pubmed #10550357 No free full text.

Abstract: Aim of the present study was a comparison of four quality of life (QoL) questionnaires in 228 patients with psoriasis (PSO, n = 148) and atopic dermatitis (AD, n = 80) regarding feasibility, discriminant validity and sensitivity to change. Evaluating were performed before and after treatment in clinic. The following questionnaires were compared. 1) Freiburg Quality of Life Assessment for Dermatoses (FLQA-d), 2) Dermatology Life Quality Index (DLQI), 3) Chronic Skin Disease Questionnaire (CSDQ) and 4) questionnaire on everyday life (ALLTAG). All questionnaires were able to discriminate significant reductions of QoL in PSO and AD, as compared to controls. In parallel to the clinical improvement, all questionnaires showed QoL improvements as well, i.e. the questionnaires were sensitive to change. However, not all of the DLQI and ALLTAG scales were sensitive to change. Also, in some cases part of the scales of these questionnaires could not be calculated due to missing data. Otherwise, all questionnaires were valid and easy to handle. Thus, QoL of patients with PSO and AD can reliably be assessed by various questionnaires. Decisive for selection are the aim and the design of the study.