Browsing by Author "Vera-Kellet, Cristian"

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    Access to psoriasis treatment in Brazil and Chile: A cross-sectional multicentre Global Healthcare Study on Psoriasis
    (2023) Maul, Julia-Tatjana; Froehlich, Fabienne; Maul, Lara Valeska; Stunnenberg, Rieka; Valenzuela, Fernando; De La Cruz, Claudia; Vera-Kellet, Cristian; Armijo, Daniela; Cesar, Wagner G.; Carvalho, Andre; Didaskalu, Johannes Alexander; Graf, Nicole; Egeberg, Alexander; Wu, Jashin J.; Thyssen, Jacob P.; Romiti, Ricardo; Griffiths, Christopher E. M.
    Background Sufficient data on access to systemic treatment for patients with psoriasis living in Latin America (LA) including Brazil and Chile are lacking. Understanding the availability and limiting factors of access to treatments can help to improve patient care and decrease long-term healthcare costs. Objectives In association with the Global Psoriasis Atlas, this cross-sectional survey study analysed the availability and insurance reimbursement of systemic treatments for adult patients with psoriasis in Brazil and Chile. Methods A multicentre, cross-sectional Global Healthcare Study on Psoriasis was performed in Brazil and Chile in 2020. For each eligible adult patient with psoriasis, doctors and nurses completed a 48-item questionnaire about clinical aspects of psoriasis including the Psoriasis Area Severity Index (PASI), body surface area (BSA) score and the Dermatology Life Quality Index (DLQI), as well as the availability of systemic treatments and insurance reimbursement status. Between-country differences were compared with Wilcoxon rank sum tests for continuous variables, and a chi(2)-test or Fisher's exact test, where appropriate, for categorical variables. The median and interquartile range (IQR) was calculated for non-normal distributed data. Results A total of 1424 patients with psoriasis from 43 centres [27 centres in Brazil (n = 826) and 16 in Chile (n = 598)], were included with a mean (SD) age of 49.1 (16.3) and 49.2 (15.1) years, respectively. Unstratified analyses revealed that patients with psoriasis in Chile had more severe disease than those in Brazil [PASI 11.6 vs. 8.4 (P < 0.001) and BSA 14.7 vs. 12.0 (P = 0.003), respectively]. For patients with moderate-to-severe psoriasis, defined as PASI and/or BSA >= 10, systemic nonbiologic drugs were available (81.2% in Brazil and 65.3% in Chile, P <= 0.001), but only 37.0% of patients in Brazil and 27.3% in Chile received biologics (P = 0.01). Lack of availability and/or lack of insurance reimbursement for biologic drugs for patients with moderate-to-severe psoriasis was reported for 22.2% (50 of 225) in Brazil and 67.9% (148 of 218) in Chile (P < 0.001). Patients with no access to biologic therapies due to lack of availability/insurance reimbursement had a median PASI of 9.15 (IQR 3.00-14.25) in Brazil and 12.0 (IQR 5.00-19.00) in Chile (P = 0.007), as well as a median BSA of 7.0 (IQR 3.00-15.00) and 12.0 (IQR 5.00-22.50) (P = 0.002), and median DLQI of 11.0 (6.00-15.00) and 21.0 (6.50-25.00) (P = 0.007), respectively. Conclusions Chilean patients had significantly more severe psoriasis compared with Brazilian patients in our study. While nonbiologic treatments for moderate-to-severe psoriasis were available in both LA countries, there is a high need for improvement in access to more effective psoriasis treatments including biologics. Our results highlight a significant gap between treatment recommendations in international psoriasis guidelines and real-world situations in Brazil and Chile.
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    Comorbidities in Chilean patients with psoriasis: a Global Healthcare Study on Psoriasis
    (2022) Valenzuela, Fernando; De La Cruz, Claudia; Lecaros, Cristobal; Fernandez, Javier; Hevia, Gonzalo; Maul, Lara Valeska; Thyssen, Jacob P.; Vera-Kellet, Cristian; Egeberg, Alexander; Armijo, Daniela; Pizarro, Cristian; Riveros, Tatiana; Correa, Hernan; Guglielmetti, Antonio; Didaskalu, Johannes A.; Wu, Jashin J.; Griffiths, Christopher E. M.; Romiti, Ricardo; Maul, Julia-Tatjana
    Background Psoriasis is a chronic inflammatory skin disease associated with several important medical comorbidities. There are scant data available on the comorbidities of patients with psoriasis in South America. Aim To examine the comorbidity profile of adult patients with psoriasis in Chile and its association with severity of psoriasis. Methods This was a multicentre, cross-sectional study involving 16 hospitals and clinics in Chile, which used a 48-item questionnaire to study clinician- and patient-reported outcomes and comorbidities. Inferential analyses were performed by psoriasis severity, using Fisher exact test, Student t-test and multivariable logistic regression. Results In total, 598 adult patients with psoriasis were included (51.1% male; mean age 49.2 +/- 15.1 years); 48.5% mild and 51.4% moderate to severe; Psoriasis Area and Severity Index 11.6 +/- 11.5; body surface area 14.7 +/- 18.2%. Plaque psoriasis was the most common phenotype (90.2%), followed by guttate (13.4%). Psoriatic arthritis occurred in 27.3% of patients. Comorbidities were reported in 60.2% of all patients with psoriasis. Frequent concomitant diseases were obesity (25.3%), hypertension (24.3%), Type 2 diabetes mellitus (T2DM) (18.7%), dyslipidaemia (17.4%), metabolic syndrome (16.7%) and depression (14.4%). After adjustment, significant associations were found between moderate to severe psoriasis and obesity, T2DM and nonalcoholic fatty liver disease (NAFLD) compared with mild psoriasis. Conclusions We report a large study of comorbidities, including depression, dyslipidaemia, T2DM and NAFLD, in people with psoriasis in Chile. The prevalence of comorbidities with psoriasis in Chile appears similar to that found in Western countries, and emphasizes the importance of assessing patients with psoriasis for risk factors for and presence of, comorbid disease in a multidisciplinary setting.
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    Cutaneous inflammation as a marker of malignant transformation in a patient with linear unilateral basaloid follicular hamartoma
    (2019) Del Barrio-Diaz, Pablo; Meza-Romero, Rodrigo; Gonzalez, Sergio; Vera-Kellet, Cristian
    Basaloid follicular hamartoma is a rare, benign and superficial malformation of hair follicles, characterized histologically by epithelial proliferation of basaloid cells with radial disposition. It can be mistaken for basal cell carcinoma. Even though these hamartomas are considered benign lesions, malignant transformation has rarely been reported. We report the case of a 45-year-old healthy woman, with linear, unilateral basaloid follicular hamartoma which developed inflamed papules histologically suggestive of basal cell carcinoma. We believe that identification of local inflammation could be a clinical clue to guide us towards a malignant transformation of basaloid follicular hamartoma.
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    Low effectiveness of methotrexate in the management of localised scleroderma (morphea) based on an ultrasound activity score
    (2021) Vera-Kellet, Cristian; Meza-Romero, Rodrigo; Moll-Manzur, Catherina; Ramirez-Cornejo, Cristian; Wortsman, Ximena
    Background: The effectiveness of methotrexate (MTX), a first-line treatment for localised scleroderma (morphea), has not been assessed using colour Doppler ultrasonography (CDU). Objectives: We aimed to ultrasonographically monitor disease activity in patients with morphea treated with MTX, assessing its effectiveness using an Ultrasound Morphea Activity Score (US-MAS). Materials& Methods: Aretrospective cohort of 22 patients was studied between July 2014 and July 2019. The morphea of each patient, treated with MTX, was confirmed by histology and all patients had at least two CDU examinations. The US-MAS is based on published ultrasound signs of disease activity validated by histology. A weight-adjusted average MTX dose (mg/kg/wk) was used to standardize dosage, weight, and time between CDU examinations. The difference in US-MAS between two CDU examinations was determined. Statistical analyses includedWilcoxon and Fisher exact tests, the Spearman correlation coefficient, and risk ratios with 95% confidence intervals. To create two groups, we determined the median of the sample as the cut-off point for MTX dose (0.265 mg/kg/week). Significance was set at p <= 0.05; Results: In all cases, CDU examinations showed subclinical signs of activity beyond the visible lesional borders, either in the same or adjacent corporal segments. A negative correlation was found between the change in US-MAS andMTXdose (Spearman coefficient, -0.45; p = 0.035). The group dosed at >= 0.265 mg/kg/wk showed a non-significant change in US-MAS (2-point decrease). No case became inactive. Conclusion: MTX is a treatment with a low effectiveness for morphea, causing only slight decreases in ultrasound activity at higher doses.
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    Morphea After Liposuction Ultrasonography
    (2022) Araneda-Ortega, Paulina; Jose Poblete-Villacorta, Maria; Munoz-Lopez, Camila; Vera-Kellet, Cristian; Wortsman, Ximena
    Liposuction is a common aesthetic procedure; however, to date, liposuction has not been linked to morphea. The aim was to review cases with a history of liposuction that presented active morphea lesions in the same surgery regions and were confirmed by ultrasound and histology. A retrospective descriptive analysis of the clinical, ultrasonographic, and pathology database took place (2014-2020). Eleven patients met the criteria. Ultrasound supported the diagnosis, and the ultrasonographic signs of activity in these cases matched the features described in the literature in 100% of cases. In summary, morphea may appear after liposuction and ultrasound can support its early detection.
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    Sun Sign in the Ultrasound Diagnosis and Activity Assessment of Morphea
    (2022) Salgueiro, Catalina; Baeza, Javiera; Moll, Catherina; Alfaro-Sepulveda, Daniela; Mellado, Gonzalo; Villaseca-Hernandez, Miguel; Vera-Kellet, Cristian; Wortsman, Ximena
    Morphea, a localized form of scleroderma, is a chronic inflammatory autoimmune disease of the skin. Color Doppler Ultrasound has been reported as a reliable tool to assess the activity of the disease. With histologically confirmed cases, this case series describes a new ultrasound sign consisting of a hyperechoic halo surrounding superficial subcutaneous veins of the extremities in transverse view, named the sun sign. This sign can help diagnose morphea in the inflammatory phase and correlate in pathology with perivascular infiltrates surrounding superficial subcutaneous veins.
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    Ultrasonographic subclinical signs of inflammation of the lacrimal, parotid, and submandibular glands in users of cosmetic fillers
    (2021) Wortsman, Ximena; Moll-Manzur, Catherina; Ramirez-Cornejo, Cristian; Alfaro-Sepulveda, Daniela; Mellado-Francisco, Gonzalo; Rezende, Juliana; Vera-Kellet, Cristian
    Objectives To detect ultrasonographic inflammatory signs in the lacrimal, parotid, and submandibular glands in cosmetic fillers (CFs) users.
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    Very High- and High-Frequency Ultrasound Features of Cutaneous Larva Migrans
    (2019) Ogueta, Isabel; Navajas-Galimany, Lucas; Concha-Rogazy, Marcela; Alvarez-Veliz, Sergio; Vera-Kellet, Cristian; Gonzalez-Bombardiere, Sergio; Wortsman, Ximena
    Cutaneous larva migrans is a common infestation among travelers. Although the diagnosis may be suspected clinically, cases can show atypical presentations. We present the ultrasound features of 4 cases at 18 and 70 MHz. Small linear hyperechoic and hyper-refringent subepidermal and intrafollicular structures suggestive of fragments of larvae, hypoechoic dermal and hypodermal tunnels that match with dilatation of lymphatic ducts, and inflammatory dermal and hypodermal ultrasound signs can support the diagnosis. This work suggests that larvae can penetrate the cutaneous basement membrane through the ostia of the hair follicles and potentially disseminate through the dermal and hypodermal lymphatic network.