Mental health screening urged for apremilast

Dermatologists have been warned of patients with psoriasis developing insomnia and psychiatric symptoms after commencing treatment with apremilast.

In one case, a 38-year-old man with whole body psoriasis was titrated up over two weeks to a twice daily dose of 30 mg. He then developed insomnia and, subsequently, suicidal ideation which lasted for three weeks. Resolution of the insomnia occurred within 2 weeks of treatment cessation.

In a second case, a 45-year-old woman with whole body psoriasis and a history of mild depression, developed insomnia and subsequent nausea and headaches within 2 weeks of commencement on apremilast. She self-ceased treatment due to the side effects and had complete resolution within a week of cessation.

An article written by doctors at the Department of Dermatology, St George’s Hospital, Sydney, noted that suicidal ideation has not been reported as an adverse event in two pivotal RCTs.

“The significance of this symptom, in addition to the knowledge that depression, is a known comorbidity of psoriasis, justifies close monitoring of patients on apremilast,” it said.

“Due to the emergence of these psychiatric symptoms in patients with no history of mental illness or other obvious risk factors, it is suggested that the risk of these symptoms is carefully explained on commencement and a mental health screen is performed at each review during their treatment course.”

They also suggested that patients be given a 2-month supply initially and then be reviewed rather than the full 6-month supply available on Medicare.

Read more in the Australasian Journal of Dermatology

Stigma may underpin body dysmorphic disorder in dermatology patients 

Body dysmorphic disorder (BDD) symptoms are more than five-fold more common in dermatological patients than in healthy skin controls, according to a European study.

The risk of BDD was even higher in patients with acne (OR 6.90), psoriasis (OR 7.65), atopic dermatitis (OR 8.08), vitiligo (OR 11.26), alopecia areata (OR 13.25) and hyperhidrosis (OR 27.73).

Commenting on the study in the British Journal of Dermatology, Australian GPs Dr Parker Magin and Dr Kate Fisher said stigmatisation appeared to underpin the associations.

“The study demonstrates significant associations of BDD with psychological stress and feelings of stigmatisation.”

However associations of BDD with suicidal ideation, depression and anxiety, and severity of the skin disease were no longer significant when stigmatisation was included in the model.

They said doctors may often underestimate the psychological implications of skin diseases.

Smart phone apps for skin cancer: handy but possibly also harmful

Smartphone apps designed to triage or diagnose skin lesions have been tested and found wanting.

A study at Memorial Sloan Kettering Cancer Centre input a range of histologically proven lesions including benign naevi and invasive melanoma into publicly available smartphone and web-based dermatology apps.

“Across top-1 measures for all apps, mean sensitivity was 0·28 [95% confidence interval (CI) 0·17–0·39)], mean specificity was 0·81 (95% CI 0·71–0·91) and mean accuracy was 0·59 (95% CI 0·55–0·62),” the study reported.

Eight apps failed to identify a single melanoma in their top-1 ranking, and four did not include melanoma in their top-3.

“Accuracy and sensitivity were highly variable and overall low, in keeping with previous literature, which recommends against their use.”

“Clinicians should be aware of app limitations and their widespread accessibility to lay users. Improved regulation and higher quality studies are necessary to bring prospectively validated algorithms to market.”

Read more in the British Journal of Dermatology