Psoriasis: Finlay AY

Smith CH, Anstey AV, Barker JN, Burden AD, Chalmers RJ, Chandler D, Finlay AY, Griffiths CE, Grifitths CE, Jackson K, McHugh NJ, McKenna KE, Reynolds NJ, Ormerod AD, Anonymous00078. · St John's Institute of Dermatology, GKT School of Medicine, St Thomas' Hospital, London SE1 7EH, UK. · Br J Dermatol. · Pubmed #16120132 No free full text.

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Finlay AY. · No affiliation provided · Arch Dermatol. · Pubmed #11255339 No free full text.

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Feldman SR, Horn EJ, Balkrishnan R, Basra MK, Finlay AY, McCoy D, Menter A, van de Kerkhof PC, Anonymous00051. · Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA. · J Am Acad Dermatol. · Pubmed #18835062 No free full text.

Abstract: Topical therapy has an important role in psoriasis treatment. It is efficacious and has a favorable safety profile as demonstrated in clinical trials. However, poor treatment outcomes from topical therapy regimens likely result from poor adherence and ineffective use of the medication. The International Psoriasis Council Topical Therapy Working Group has developed a new model to describe the complex interactions among patient, disease, and treatment characteristics, adherence behavior, and treatment outcomes. Recommendations are provided that may assist the health care provider in encouraging adherent behavior in their patients. By understanding and manipulating the factors that affect treatment adherence, improvement in adherence is possible and hence better control and outcomes in the topical treatment of psoriasis are likely.

Katugampola RP, Lewis VJ, Finlay AY. · Department of Dermatology, School of Medicine, Cardiff University, Heath Park, Cardiff, UK. · Br J Dermatol. · Pubmed #17388922 No free full text.

Abstract: BACKGROUND: Clinical trials show improvement in physical and health-related quality of life (HRQoL) measures in patients with psoriasis treated with biologics compared with placebo. However, these reports only give limited interpretation of the meaning of Dermatology Life Quality Index (DLQI) scores and provide limited comparison data. OBJECTIVES: The aim of this paper is to identify which biological therapy provides the greatest improvement in HRQoL following treatment of patients with chronic plaque psoriasis, as assessed by the DLQI. METHODS: We reviewed all data published up to August 2006 of randomized placebo-controlled trials (RCTs) of the four biologics currently licensed in some countries for clinical use in chronic plaque psoriasis (alefacept, efalizumab, etanercept and infliximab) which have used the DLQI as an outcome measure. The DLQI data were assessed based on overall improvement according to the DLQI descriptor bands and on clinically meaningful improvement of > or = 5. RESULTS: Fifteen peer-reviewed articles and 59 abstracts describing 11 multicentre, double-blind RCTs were reviewed. Treatment with any one of the four biologics led to a clinically meaningful improvement in the DLQI of > or = 5. However, when applying the DLQI banding concept, infliximab and etanercept provided the greatest improvement in the overall HRQoL from a 'very large effect on overall HRQoL' at baseline to 'a small effect on overall HRQoL' following treatment. CONCLUSIONS: The DLQI banding concept provides a further tool to assess the impact of biologics on HRQoL of patients with psoriasis. Based on retrospective application of DLQI bands to published RCT data, infliximab, followed by etanercept, showed the greatest improvement in the overall HRQoL paralleled by a 75% improvement in the Psoriasis Area and Severity Index. However, some publications did not provide absolute baseline DLQI values, making interpretation of data and comparison between the agents difficult. Side-to-side comparative studies between biologics and between biologics and nonbiological psoriasis treatments will aid evidence-based psoriasis management decisions in the future.

Griffiths CE, Katsambas A, Dijkmans BA, Finlay AY, Ho VC, Johnston A, Luger TA, Mrowietz U, Thestrup-Pedersen K. · Dermatology Centre, University of Manchester, Hope Hospital, Manchester, UK. · Br J Dermatol. · Pubmed #16774579 No free full text.

Abstract: Immune-mediated dermatoses, such as psoriasis and atopic dermatitis, affect a significant proportion of the population. Although most cases are not life threatening, these diseases can have a profound effect on the sufferer's quality of life and that of their family. Systemic therapy, such as ciclosporin, is often indicated for severe or recalcitrant disease. The efficacy of ciclosporin in the treatment of psoriasis and atopic dermatitis has been established and clinical data also demonstrate its efficacy in treating less common but equally challenging conditions such as pyoderma gangrenosum, lichen planus, autoimmune bullous disease, recalcitrant chronic idiopathic urticaria and chronic dermatitis of the hands and feet. The risk of potential adverse events associated with ciclosporin is greatly reduced if current treatment and monitoring guidelines are followed.

Lewis VJ, Finlay AY. · Department of Dermatology, Wales College of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK. · Dermatol Clin. · Pubmed #16112448 No free full text.

Abstract: Psoriasis can have a major impact on the lives of patients who have psoriasis and many different methods are described to measure this effect. This article describes four general health measures, six dermatology-specific measures, four psoriasis-specific measures, and four utility measure concepts that are used in psoriasis. For each of these, the extent of validation, including reliability of each measure and correlation with other measures, is described. The experience of use of each measure is summarized and key references listed. Advice is given concerning strategy for choosing which measures to use.

Lewis VJ, Finlay AY. · Department of Dermatology, Wales College of Medicine, Cardiff University, Cardiff, UK. · Dermatology. · Pubmed #15942210 No free full text.

Abstract: The Psoriasis Disability Index (PDI) was formed 20 years ago. Since its introduction it has been used widely as a tool for assessment of quality of life in psoriasis. This paper reviews its use in 23 peer-reviewed articles and over 35 published abstracts, and describes its use in conjunction with other general and psoriasis-specific quality of life assessments, and with a range of physical and psychological measures. The PDI is effective in demonstrating the effects of interventions, both of treatments and in health service research. The PDI has been translated into at least 16 languages and has been used in published research in 20 countries.

Finlay AY. · Department of Dermatology, Wales College of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK. · Br J Dermatol. · Pubmed #15888138 No free full text.

Abstract: This review addresses the problems of defining severity of psoriasis. Concepts of severity depend on the timescale perspective from which judgement is made. Measurement needs to include assessment of signs, impact on the patient's life and the history of the disease. The concept of severity in relationship to quality of life measurement scores has been defined, so it is now possible to postulate a standard, easily remembered concept to help define 'severe psoriasis' in the clinic. The proposed Rule of Tens for current severe psoriasis from the clinician's viewpoint is: 'Current Severe Psoriasis = Body Surface Area involved > 10% or Psoriasis Area and Severity Index score > 10 or Dermatology Life Quality Index score > 10'.

Finlay AY, Ortonne JP. · Department of Dermatology, Wales College of Medicine, Cardiff University, CF14 4XN Cardiff, Wales, U.K. · J Cutan Med Surg. · Pubmed #15868312 No free full text.

Abstract: BACKGROUND: Psoriasis is a chronic, immune-mediated skin condition that often requires lifelong treatment. Many patients report dissatisfaction with traditional nonbiologic therapies because they are ineffective for their psoriasis, are associated with side effects, or impact negatively on quality of life. OBJECTIVES: The aim of this article is to review the effect on patient quality of life of traditional nonbiologic psoriasis therapies and to discuss the impact of biologic psoriasis therapies on patient satisfaction. METHODS: A review of the literature is presented. RESULTS: Traditional nonbiologic psoriasis therapies can negatively impact quality of life due to a variety of factors including inconvenience and toxicity. Biologic agents have been developed that target the immunopathogenesis of psoriasis. Based on favorable efficacy and safety results in clinical trials, some of these agents are now approved for clinical use. Evidence suggests that patients receiving biologic therapies experience significant improvements in health-related quality of life. CONCLUSION: Biologic agents offer new hope for patients with psoriasis that their chronic condition can be controlled in a manner that improves their quality of life and may lead to high levels of satisfaction with their treatment.

Griffiths CE, Dubertret L, Ellis CN, Finlay AY, Finzi AF, Ho VC, Johnston A, Katsambas A, Lison AE, Naeyaert JM, Nakagawa H, Paul C, Vanaclocha F. · Skin Research Institute and Dermatology, Saint Louis University Hospital, Paris, France. · Br J Dermatol. · Pubmed #15115441 No free full text.

Abstract: The main recommendations for the use of ciclosporin in the management of psoriasis are: (i) intermittent short courses (average of 12 weeks duration) of ciclosporin are preferable; (ii) ciclosporin should be given in the dose range 2.5-5.0 mg kg(-1) day(-1) (doses greater than 5.0 mg kg(-1) day(-1) should only be given in exceptional circumstances); (iii) treatment regimens should be tailored to the needs of each patient; (iv) selection of patients should take into account psychosocial disability, as well as clinical extent of disease and failure of previous treatment; (v) each patient's renal function (as measured by serum creatinine) should be thoroughly assessed before and during treatment; (vi) each patient's blood pressure should be carefully monitored before and during treatment; (vii) adherence to treatment guidelines substantially reduces the risk of adverse events; (viii) long-term continuous ciclosporin therapy may be appropriate in a subgroup of patients; however, duration of treatment should be kept below 2 years whenever possible; and (ix) when long-term continuous ciclosporin therapy is necessary, annual evaluation of glomerular filtration rate may be useful to accurately monitor renal function.

Krueger GG, Langley RG, Finlay AY, Griffiths CE, Woolley JM, Lalla D, Jahreis A. · Department of Dermatology, University of Utah Health Sciences Center, 30 N. 1900 E, Salt Lake City, UT 84132-0001, USA. · Br J Dermatol. · Pubmed #16307657 No free full text.

Abstract: BACKGROUND: Etanercept, a soluble tumour necrosis factor receptor, lessens the severity of psoriasis as measured by physician-reported clinical outcomes. Equally important is the patient perspective on the effect of etanercept therapy on daily life. OBJECTIVES: To assess patient-reported outcomes (PROs) in patients with psoriasis receiving etanercept therapy. METHODS: In this multinational, randomized, phase III trial, patients with psoriasis received placebo (n = 193), etanercept 50 mg per week (n = 196) or etanercept 50 mg twice weekly (n = 194) during the initial 12-week, double-blind period. Thereafter, all patients received open-label etanercept (50 mg per week). The following PROs were assessed: Dermatology Life Quality Index (DLQI), Short Form-36 Health Survey (SF-36), patient rating of pruritus, and patient global assessment of psoriasis. RESULTS: At week 12, DLQI total score improved by 65-70% in patients receiving etanercept compared with 6% in patients receiving placebo (P < 0.0001), and improvement in DLQI was clinically meaningful (> or = 5-point improvement or 0 score) for 72-77% of patients receiving etanercept therapy. All DLQI and SF-36 subscales and the SF-36 physical and mental component summary scores demonstrated significantly greater improvement with etanercept therapy than with placebo, illustrating that etanercept benefits patients with psoriasis across multiple domains that contribute to health-related quality of life. With etanercept therapy, distributions of patient ratings of pruritus and global assessment of disease shifted from moderate to severe (baseline) to minimal to good (week 12). Etanercept-induced benefits of PROs were maintained for patients who reduced their dose after 12 weeks. CONCLUSIONS: Etanercept therapy improves PROs in patients with psoriasis and makes a meaningful difference to their lives. These results support the efficacy profile of physician-reported clinical measures while providing a more complete understanding of the benefits experienced by patients with psoriasis treated with etanercept.

Finlay AY, Salek MS, Haney J, Anonymous00415. · University of Wales College of Medicine, Cardiff, UK. · Dermatology. · Pubmed #12771471 No free full text.

Abstract: BACKGROUND: Psoriasis profoundly affects patient quality of life (QOL). Amevive (alefacept), a novel and selective biologic agent, was clinically effective and significantly improved QOL in a phase 2 study. METHODS: The present placebo-controlled, randomized phase 3 study examined the effects of a 12-week course of intramuscular alefacept on QOL in 507 patients with chronic plaque psoriasis using both dermatology-specific questionnaires [Dermatology Life Quality Index (DLQI); Dermatology Quality of Life Scales (DQOLS)] and the Short Form-36 Health Survey (SF-36), a generic, general health questionnaire. RESULTS: All 3 QOL measures (DLQI, DQOLS, SF-36) demonstrated that alefacept 15 mg was significantly more effective than placebo in improving QOL in patients with chronic plaque psoriasis. In addition, the improvements in QOL for patients in the alefacept 15 mg group were of similar magnitude for all 3 QOL measures. CONCLUSION: The findings of this study are an important addition to the QOL literature for psoriasis treatments.

Touw CR, Hakkaart-Van Roijen L, Verboom P, Paul C, Rutten FF, Finlay AY. · Institute for Medical Technology Assessment, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands. · Br J Dermatol. · Pubmed #11359382 No free full text.

Abstract: BACKGROUND: Psoriasis causes considerable patient morbidity and can seriously affect a patient's quality of life (QoL). OBJECTIVES: To investigate the relationships between changes in QoL and measures of severity and extent of disease, and itch, in patients with chronic plaque psoriasis receiving intermittent short courses of cyclosporin (Neoral). METHODS: This study was performed as part of an international trial investigating the safety, efficacy and total costs of intermittent short courses of cyclosporin (the PISCES study). All patients received cyclosporin until clearance and were then followed up until relapse. On relapsing, patients received another course. Patients were followed up for a minimum of 1 year during which they could receive as many courses of treatment as necessary. In a subgroup (n = 255) of patients in the trial, the Dermatology Life Quality Index (DLQI) was used to assess the impact of psoriasis and its treatment on the patients' health status at the beginning and end of each treatment period. At the beginning and end of each treatment period, as well as at 2-weekly visits, the extent and severity of disease, together calculated into a modified Psoriasis Area and Severity Index (PASI), and itch were recorded. Data were analysed using the Wilcoxon matched pairs test, multivariate Hotelling's T2 tests, and Spearman's rank correlation coefficients (rs). RESULTS: During treatment, a clear impact on the overall DLQI scores and in the scores in all six DLQI headings was found (i.e. an improvement in QoL; P < 0.001 in all scores). Also, significant decreases in PASI and itch scores were found (P < 0.001). Multivariate analyses confirmed that a decrease in PASI and itch scores was accompanied by an impact on the DLQI scores during and between the two treatment periods (P < 0.0001). Statistically significant but weak correlations were found between changes in QoL and changes in PASI (rs = 0.40 and 0.24 for the first and second treatment periods, respectively) and itch scores (rs = 0.31 and 0.42, respectively). CONCLUSIONS: Intermittent short courses of cyclosporin clearly improve the QoL of the patients and decrease the extent and severity of disease and itch. Changes in clinical outcome scores are accompanied by changes in QoL. The weak correlations between changes in QoL and clinical measures may suggest that no clear relationship between QoL and clinical outcomes exists. However, due to the inclusion and exclusion criteria of the study, both QoL and clinical outcome measures do not show much variation among this homogeneous group of patients. As long as the relationship between clinical outcome parameters and measures of QoL is not completely clear, both measures of health should be considered in adequate, patient-orientated clinical decision making.

Davies E, Patel C, Salek MS, Finlay AY. · Department of Dermatology, Wales College of Medicine, Cardiff University, Heath Park, Cardiff, UK. · Clin Exp Dermatol. · Pubmed #18076697 No free full text.

Abstract: BACKGROUND: There is little information concerning how much health-related quality-of-life (HRQoL) information is elicited in dermatology outpatient consultations. OBJECTIVES: To observe and record ad hoc HRQoL discussion in inflammatory skin disease consultations, to systematically measure the patient's HRQoL and to measure patient satisfaction with dermatology care. METHODS: Clinic consultations of patients with inflammatory skin conditions attending a secondary care clinic were observed by a single researcher (CP). Data were collected on the 10 subject areas of the Dermatology Life Quality Index (DLQI) and on sleep, burden, frustration and depression. Patients were sent the DLQI and Medical Interview Satisfaction Scale (MISS)-21 questionnaires after the consultation. RESULTS: In total, 100 consultations were observed (psoriasis n = 50, eczema n = 17, acne n = 13 and others n = 20). In 26% (n = 26), there was no mention of HRQoL issues. In 59% (n = 44), HRQoL discussions were initiated by the clinician. In only 26% (n = 19) of consultations were > or = 3 items on the observer's checklist raised. In all, 57 evaluable DLQI and MISS-21 questionnaires were returned. The mean +/- SD DLQI score was 7.2 +/- 7.0 (n = 18) for patients with whom there was no HRQoL discussion and 10.8 +/- 6.7 (n = 39, P = 0.038) for those with whom HRQoL was discussed. The mean +/- SD MISS-21 score was 108.8 +/- 16.5 (n = 18) for the patients with whom there was no HRQoL discussion and 111.3 +/- 13.6 (n = 39, P = 0.42) for those with whom HRQoL was discussed. The mean +/- SD patient expectation score was 5.5 +/- 1.0 (median 5, range 3-7). There was a positive correlation between the patient expectation and MISS-21 scores (r(s) = 0.815, P < 0.0001). CONCLUSIONS: Despite little extent or depth to HRQoL discussion, HRQoL issues were raised in the majority of inflammatory skin disease consultations. The consultations usually met the patients' expectations and most patients were satisfied.

Eghlileb AM, Davies EE, Finlay AY. · Department of Dermatology, Wales College of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK. · Br J Dermatol. · Pubmed #17459044 No free full text.

Abstract: BACKGROUND: Psoriasis affects the quality of life (QoL) of relatives and partners of patients with psoriasis, but little is known about this secondary impact. OBJECTIVES: To identify the different ways in which the lives of relatives and partners of people with psoriasis are affected by the disease. METHODS: Relatives and partners of patients with psoriasis participated. Subjects were excluded if they had any skin disease. The severity of the psoriasis of the patients was measured using the Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI) and Psoriasis Disability Index (PDI). Subjects either had intensive qualitative interviews with one researcher or responded to a postal questionnaire. Both methods identified ways in which their relative's or partner's psoriasis had affected their lives. RESULTS: Thirty-three subjects were interviewed and 30 replied by postal questionnaire. Twenty-eight of the 63 subjects were relatives (seven men and 21 women) and 35 were partners (16 men and 19 women). The median age was 51 years (range 20-80). The patients (n = 63) had a mean DLQI of 10, mean PDI of 13.8 and mean PASI of 5.2. Forty different aspects of QoL impairment of relatives and partners were identified. The percentage of subjects in whom any of these aspects were mentioned is illustrated in six different categories. Seventy per cent stated that the treatment of their relative or partner resulted in them having to spend extra time on housework; 57% described psychological pressures including anxiety, being upset and being worried about the patient's future; 55% described social disruption due to lack of social confidence either because of embarrassment or because of the time required for care duties; 44% described limitations to holiday plans, sport and leisure activities and evenings out; 37% described limitations on their daily activities such as shopping, work and time spent with other family members; 37% felt that their close relationships had deteriorated. Only 8% described no effect at all on their QoL. The QoL of the relatives and partners (number of categories affected) was more closely related to the patients' QoL (DLQI: r = 0.77, P < 0.001; PDI: r = 0.67, P < 0.001) than to the objective disease severity scores (PASI: r = 0.34, P < 0.05). CONCLUSIONS: The QoL of partners and relatives of people with psoriasis can be significantly affected. Many different aspects of everyday life that are affected and the psychological impacts of having a partner or relative with psoriasis have been identified. It is of great importance to identify these issues to allow clinicians to develop appropriate care strategies not only for patients with psoriasis, but also for their partner and family.

Griffiths CE, Finlay AY, Fleming CJ, Barker JN, Mizzi F, Arsonnaud S. · Dermatology Centre, Hope Hospital, University of Manchester, Manchester, UK. · J Dermatolog Treat. · Pubmed #16766333 No free full text.

Abstract: The clinical benefit of currently available tar blend shampoos for the treatment of scalp psoriasis is restricted due to their limited efficacy, low cosmetic appeal and potential for carcinogenicity. This 4-week multicentre, randomized, parallel-group, investigator-masked study included 162 subjects and aimed to compare the efficacy, safety and cosmetic acceptability of clobetasol propionate 0.05% shampoo versus a currently marketed tar blend 1% shampoo in subjects with moderate to severe scalp psoriasis. Clobetasol propionate shampoo was superior to tar blend shampoo with respect to all efficacy variables tested (p<0.001): Total and Global Severity Score; erythema; plaque thickening; desquamation; pruritus; total scalp area involved; and the subject's global assessment of clinical improvement. Both treatments were safe and well-tolerated. Furthermore, more subjects indicated that clobetasol propionate shampoo was more cosmetically acceptable than tar blend shampoo. Clobetasol propionate 0.05% shampoo is a good alternative to tar blend shampoo in the treatment of moderate to severe scalp psoriasis.

Gillard SE, Finlay AY. · Abacus International, Bicester, Oxon, UK. · Int J Clin Pract. · Pubmed #16236077 No free full text.

Abstract: The current management of psoriasis and its associated resource use in the United Kingdom (UK) was investigated in this retrospective analysis of 789,300 primary care patient records. Most patients with psoriasis (94%) were managed on topical psoriasis agents only, 4% were prescribed systemic psoriasis agents and 2% had no recorded psoriasis treatment at all during the 12-month study period. Co-medications to treat physical or psychological comorbidities were required by 22% of patients. Referral rates into secondary care were low, 5% of patients prescribed systemic psoriasis agents and 0.7% of patients prescribed topical psoriasis agents had secondary care appointments documented in their medical records. This study demonstrates that most patients with psoriasis in UK primary care are managed on topical agents even though there are surrogate markers, such as resource use and co-medication prescriptions, which indicate that their psoriasis is not optimally controlled.

Katugampola RP, Hongbo Y, Finlay AY. · Department of Dermatology, Wales College of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK. · Br J Dermatol. · Pubmed #15948990 No free full text.

Abstract: BACKGROUND: Clinical decisions over psoriasis are based on many factors. Patients' quality of life (QOL) is not directly related to disease severity alone as judged by physical signs, so decisions should not be based on physical assessments alone. This is increasingly important as new potent biological therapies become available. OBJECTIVES: This study aimed to determine whether clinicians' routine decisions in psoriasis correlate with patient-rated QOL. PATIENTS AND METHODS: Over 35 weeks all 687 outpatient psoriasis consultations by 13 clinicians were included. Each patient received a Dermatology Life Quality Index (DLQI) questionnaire following their consultation. Case notes were analysed to assign management decisions taken by clinicians to one of 11 categories. Patient-rated DLQI was correlated with the type of management decision. RESULTS: Three hundred and eighty-three completed DLQI questionnaires were analysed. Within the 'no change to main type of therapy' group the mean DLQI for patients not changing the potency, dose or frequency of main treatment was 8.9. For patients in whom the potency, dose or frequency of main treatment was increased, the mean DLQI was 11.9. For patients in whom the potency, dose or frequency of main treatment was decreased, the mean DLQI was 6.2. Major management decisions were associated with a high mean DLQI such as change of topical therapy (11.2), topical to systemic therapy (14.8), change of systemic therapy (16.7), starting photo(chemo)therapy (13) and requiring hospital admission (14.4). By contrast, patients discharged reported low DLQI values (mean 4.0). The cohort of patients in whom a decision was taken to start day treatment had a surprisingly low mean DLQI of 8.6. Significant differences in mean DLQI were seen in the cohorts classified by type of management decision. For example, when the mean DLQI values in each cohort were compared (Mann-Whitney U-test), significant differences were seen between the cohorts in whom treatment was increased in potency, dose or frequency, compared with the cohorts whose treatment was unchanged (P < 0.05) or decreased (P < 0.01) or who were discharged from clinic (P < 0.01). CONCLUSIONS: In psoriasis there is a relationship between the type of management decision and the patient-rated QOL. However, there is a very wide score scatter for each management decision, challenging the appropriateness of some clinical decisions.

Salek MS, Finlay AY, Lewis JJ, Sumner MI. · Centre for Socioeconomic Research, University of Wales, Cardiff, UK. · Qual Life Res. · Pubmed #15058791 No free full text.

Abstract: Due to concern over long term safety of continuous treatment with cyclosporin, the aim of this 1-year study was to assess the effect of intermittent therapy with cyclosporin (Neoral) on the quality of life of patients suffering from chronic plaque psoriasis. A total of 41 patients with chronic plaque psoriasis (26 male, mean age: 36 years, range: 18-61; duration of psoriasis 17 years, range: 2-31) entered a 9-centre open study in which cyclosporin was taken as an initial dose of 5 mg/kg/daily for a maximum of 12 weeks for up to three cycles. Each patient completed a psoriasis specific QOL measure (Psoriasis Disability Index, PDI) at the beginning and end of each treatment cycle and at the end of study. Clinical parameters including Psoriasis Area and Severity Index (PASI) were measured. The PDI scores showed a significant improvement (p < 0.01) between the beginning and end of all three treatment cycles. The various clinical assessments for each treatment period also showed significant improvement (p < 0.001) for all three cycles. When comparing the last follow-up value to baseline there was a clear indication of relapse, but these scores were still significantly better than at baseline (p < 0.01). Notably, the mean PASI score improved by more than 50% (p < 0.001) between first baseline and end of the study. These findings indicate that a short course of intermittent therapy with cyclosporin in microemulsion formulation, used at starting doses of 5 mg/kg/day, improves QOL of patients with chronic plaque psoriasis. Once again, the applicability and validity of the PDI as a useful QOL tool has been demonstrated.

Ayyalaraju RS, Finlay AY, Dykes PJ, Trent JT, Kirsner RS, Kerdel FA. · Department of Dermatology at University of Wales College of Medicine, Heath Park, United Kingdom. · J Am Acad Dermatol. · Pubmed #12894073 No free full text.

Abstract: BACKGROUND: Financial and managerial constraints have resulted in the rationalization of dermatology inpatient services in the United Kingdom and the United States. Therapeutic regimes may vary locally, regionally, and internationally but the clinical outcome of treatment remains the same. OBJECTIVE: We studied 2 inpatient units: the University of Wales College of Medicine, Cardiff, United Kingdom, and the University of Miami School of Medicine, Miami, Florida, to compare the use and effectiveness of the service provided. METHODS: Data were collected prospectively from inpatients during a 12-month period. The Dermatology Life Quality Index was administered on admission and after discharge. Data were recorded about the diagnosis, duration of admission, and referring dermatologist. RESULTS: In all, 295 patients (Cardiff, UK) and 366 patients (Miami, Fla) participated. The average duration of admission in Miami was 6.7 days compared with 14.2 (P <.0001) in Cardiff. In Miami, the most common reasons necessitating admission were extensive disease (54%), the patient being unwell (18%), photophoresis (14%), outpatient treatment failure (8%), and acute deterioration of disease (4%). In Cardiff, the common reasons were acute deterioration (35%), extensive disease (28%), outpatient treatment failure (22%), and liver biopsy (4%). The most common diagnoses in Cardiff were psoriasis (31%) and eczema (26%). In contrast, the most common diagnoses in Miami, were psoriasis (19%), leg ulcers (17%), and mycosis fungoides (14%). The mean Dermatology Life Quality Index value for all patients decreased after admission in Cardiff (14.9-8.2, P <.0001) and Miami (12.0-8.5, P <.0001). CONCLUSION: Despite the differences in the 2 health care systems, inpatient therapy remains an important and effective therapeutic option in the United States and the United Kingdom.

Varma S, Finlay AY. · Box 100, Department of Dermatology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK. · Br J Dermatol. · Pubmed #12534616 No free full text.

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Williamson D, Gonzalez M, Finlay AY. · University Hospital of Wales, Heath Park, Cardiff, UK. · J Eur Acad Dermatol Venereol. · Pubmed #11495520 No free full text.

Abstract: BACKGROUND: The aim of this study was to quantify the effect of hair loss on quality of life. Patients were recruited from an alopecia support group, and were assessed using the Dermatology Life Quality Index (DLQI) and an adapted version of the DLQI. Financial utility questions, an abbreviated version of the Center for Epidemiologic Studies Depression Scale and open-ended questions were also used. OBSERVATIONS: Seventy (90% response rate) questionnaires were returned. DLQI scores in responders with hair loss (mean score = 8.3, SD = 5.6, range 0-23, n = 70) were similar to those recorded in severe psoriasis. The hair loss continued to have a significant impact on life quality well after the initial event (median duration of hair loss = 138 months +/- 114; range 7-588, n = 70). Forty per cent of patients also felt dissatisfied with the way in which their doctor dealt with them. CONCLUSIONS: This study specifically identifies the feelings of loss of self-confidence, low self-esteem and heightened self-consciousness in people affected by hair loss.

Thomas CL, Finlay AY. · No affiliation provided · Br J Dermatol. · Pubmed #17854369 No free full text.

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Abdul Ghaffar S, Finlay AY. · No affiliation provided · Br J Dermatol. · Pubmed #17199597 No free full text.

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Davies S, Finlay AY. · No affiliation provided · Br J Dermatol. · Pubmed #16792791 No free full text.

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