P1207Trends in incidence of psoriasis over three decades: A population-basedstudy

Murat Icen, MD, Mayo Clinic, Rochester, MN, United States; Marian McEvoy, MD,Mayo Clinic, Rochester, MN, United States; Hilal Maradit Kremers, MD, MS, MayoClinic, Rochester, MN, United States; Cynthia Crowson, MS, Mayo Clinic,Rochester, MN, United States

Background: Psoriasis (PsO) is a common systemic inflammatory disorder thataffects at least 2% of the general population. In contrast to other systemicinflammatory disorders, incidence studies of PsO are lacking, mainly because ofthe lack of established epidemiologic criteria and the variable disease course. Theobjective of this study is to determine time trends in incidence of PsO over 3 decadesin a population-based setting.

Methods: We identified a population-based incidence cohort of subjects aged $18first diagnosed with PsO between January 1, 1970 and December 31, 1999. Thecomplete (inpatient and outpatient) medical records for each potential PsO subjectwere reviewed by trained nurse abstractors. PsO diagnosis was validated by either aconfirmatory diagnosis in the medical record by a dermatologist or review of themedical record by the dermatologist investigator (MTE). Data were collected on PsOdisease characteristics. Age- and sex-specific incidence rates were calculated andwere age- and sex-adjusted to the 2000 US white population.

Results: We identified 3633 subjects with diagnosis codes consistent with PsO andreviewed the medical records of 64% of these subjects. Nine hundred and sixty(61%) subjects were confirmed to have PsO, of which the majority (82%) wereidentified based on in-chart dermatologist confirmation of PsO. The overall age- andsex-adjusted annual incidence of PsO was 72.9 per 100,000 (95% confidenceinterval [CI], 68.1-77.6). When PsO diagnosis was restricted to dermatologist-confirmed subjects, the incidence was 59.0 per 100,000 (95% CI, 54.8-63.2). In the1970 to 1979 period, the incidence was 33.6 per 100,000 and displayed anincreasing trend in the second decade to 66.1 per 100,000 which remained relativelyconstant through 1980 to 1999. This incidence trend was similar in females andmales. Average age at incidence increased across the 3 decades (mean 37.9 in 1970-79; 42.2 in 1980-89; 45.6 in 1990-99; P\.001). Chronic plaque PsO constituted 80%of the incident PsO subjects followed by guttate PsO in 11%.

Conclusion: These population-based data indicate that the incidence of dermatol-ogist-confirmed PsO almost doubled between the 1970s and the 1980s and wasconstant thereafter. The reasons for this increase in incidence are currentlyunknown, but could include a variety of factors, including a true change inincidence or changes in the diagnosing patterns in this population.

AB78

d by Amgen Inc.

Supporte

P1208Understanding incentives for research subjects in clinical trials

Maryanne Kazanis, Massachusetts General Hospital, Boston, MA, United States;Alexandra Kimball, MD, MPH, Massachusetts General Hospital, Boston, MA,United States; April Armstrong, MD, Massachusetts General Hospital, Boston,MA, United States

An important component to the successful completion of a clinical trial is therecruitment and retention of a large enough number of subjects to provide thepower to draw an evidence-based conclusion. Studies have shown that varyingstrategies have worked in this regard. For example, Russell et al conducted a studylooking at the opinions of healthy, unpaid study participants on the payment ofresearch subjects which concluded that research subjects are more interested inknowing that their time and effort are recognized and appreciated than receivingmonetary compensation. Similarly, Hellard et al found that participants rated that thereasons why they remained on a study included being kept well informed of a study’sprogress and feeling that the study was efficiently run. Further, Bentley et al foundthat monetary payment made respondents more willing to participate in research.To date, little is known about the use of incentives in dermatology trials. Wetherefore administered a voluntary and anonymous survey to 185 people selected atrandom from dermatology clinics and the general population. The survey, althoughdesigned to ask people about their opinions regarding the use of sunscreen but wasin fact used as a tool to evaluate incentives and response rates from participants. Tothis end, the survey was distributed in various ways (electronically, US mail), sent todifferent populations (dermatology clinic patients and general population), andunder different circumstances (with reminders to complete the survey and withoutreminders; with monetary compensation and without). The goal of the study is todetermine the difference in response rates when employing each of the varyingtechniques. We hypothesize that higher response rates will be seen using certainmethods and that these provide greater incentives for people to participate asresearch subjects. This information will be useful in the development of futureclinical trials by providing insight into the factors involved in motivating therecruitment, retention, and participation of research subjects.

cial support: None identified.

Commer

J AM ACAD DERMATOL

P1209Twelve new leprosy cases at the University of Miami/Jackson MemorialHospital Hansen’s disease program

Ivan Camacho, MD, University of Miami, Miami, FL, United States; Anne Burdick,MD, MPH, University of Miami, Miami, FL, United States

Leprosy or Hansen’s disease is a rare, slowly progressive infection caused byMycobacterium leprae that affects the skin, eyes, peripheral nerves, and otherorgans. The incubation period ranges from a few months to 20 years. Cell-mediatedimmunity to M leprae determines the extent of infection in the RidleyeJoplingspectrum: tuberculoid (TT), borderline tuberculoid (BT), midborderline (BB),borderline lepromatous (BL), and lepromatous (LL). Global travel and immigrationpatterns are bringing patients with leprosy to nonendemic areas. The University ofMiami/Jackson Memorial Hansen’s Disease Program (HDP), one of 11 federallyfunded US National Hansen’s Disease Programs, provides medical care and multi-drug therapy to suspected and confirmed leprosy patients and household contacts.From May 2006 to May 2007, 12 new cases of leprosy were diagnosed at the HDP: 9male (75%) and 3 female (25%); age range from 28 to 77 years (mean 52, median 52).All patients were immigrants: 42% from Cuba, 33% from Brazil, 17% from India, and8% from Colombia. They had lived in the United States between 2 and 42 years(mean 14, median 10). The patients were diagnosed as indeterminate (1), TT (1), BT(4), BB (1), BL (4), and LL (1). Three of the 4 BT patients were Cuban and 3 of the 4BL patients were Brazilian. One BL case presented as pure neural leprosy withoutskin lesions. Skin lesions were plaques (58%), macules (33%) and nodules (8%). Fiftypercent (50%) of patients developed a type 1 leprosy reaction (2 BT, 1 BB, and 3 BL)requiring prednisone. No type 2 leprosy reactions occurred. Two patients reporteda positive family history of leprosy and 1 patient reported exposure to armadillos.Previous diagnoses given to 5 patients were rheumatoid arthritis (2), parapsoriasis(1), mycosis fungoides (1), and sarcoidosis (1). While the global incidence of leprosydecreased 27% from 2004 to 2005, in the United States there was a 20% increase,with 166 new cases reported in 2005. In nonendemic areas, leprosy is oftenmisdiagnosed, and the diagnosis delayed an average of 3 years. A high suspicion forleprosy in patients who were born or who lived in endemic areas will lead to promptdiagnosis and prevention of nerve damage, deformities, and disability with theimplementation of appropriate management.

cial support: None identified.

Commer

P1210Atopic dermatitis in childhood: What dermatological future for thesechildren

Charles Taieb, MD, MBA, Pierre Fabre, Boulogne Cedex, France; PierreSchooneman, PhD, Eau Thermale Avene, Lavaur, France; Sami Boussetta, PhD,Pierre Fabre, Boulogne, France

Introduction: Atopic dermatitis (AD) (or constitutional eczema) is a commonchronic pruriginous inflammatory trouble that affects both children and youngadults. AD is dependent upon hereditary factors, although its increase in prevalencein the last decade is mainly explained by environmental factors which are not fullyunderstood to this day.

Objectives: To understand the ‘‘dermatologic future’’ of subjects having sufferedfrom AD as a child.

Methodology: In each of 8 European countries (France, Italy, Spain, Portugal,Germany, Switzerland, Belgium, and Greece) a sample of the population (P),representative of the P over the age of 15, was established by CSA Sante.

Results: Hence, 4506 individuals were interviewed. More than 10% (12.5%) of oursample (54% of women) declared having suffered from AD; this figure is relativelystable in each country with two extremes: the lowest rate was found in Portugal(6.5%) and the highest rates were seen in Belgium (14.8%) and France (14.4%).These subjects with a history of AD are younger; 37.6% are between 15 and 34 yearsold whereas they are only 31% in the general P. Similarly, 17.8% said they had neverconsulted a dermatologist, whereas they are 31% in the general P. Fifty-one percentdeclared having today dry skin (38% in the general P) and 57% said they had sensitiveor very sensitive skin (31.8% in the general P). In our sample of subjects with ahistory of AD, 10.3% said they were currently suffering from AD (2.3%) or contacteczema (8%), which is 3 times more than in the global P (AD 0.7% and contacteczema 2.4%). Similarly, 27% declared a coexisting pathology during the interview,they are only 12.3% in the general P (acne, 5%; psoriasis, 3.3%; seborrheic dermatitis,1.35%). These results are twice those observed in the general P.

Conclusion: All epidemiologic studies showed a rapid increase in the prevalence ofatopy-related diseases in Europe. Recent studies have indicated AD in 10% to 25% ofchildren whereas studies performed in the 1960s gave prevalence rates on the orderof 5%. Our results (12%) therefore confirm these figures. Furthermore, according toour results, it appears that subjects with a history of AD are more exposed than thegeneral P to dermatoses such as AD, eczema, and psoriasis, which is why preventivepatient management and adapted education measures are of particular interest.

orted by Eau Thermale Avene and 50% by Pierre Fabre.

50% supp

FEBRUARY 2008