Impact of social determinants of health on hospital patient outcomes in cutaneous lupus erythematosus

Abstract

report in conjunction with wound care and oral antibiotics. Suction may represent a less invasive and less painful alternative to surgical debridement. 1 Occlusive agents cause asphyxiation and emergence of maggots, allowing for subsequent mechanical removal. Ether followed by normal saline irrigation was described in one case report; there were no side effects reported and no evidence of local or systemic infection nor recurrence of maggots. 4 Turpentine oil was described in a similar fashion, but this treatment was associated with slower maggot shedding time and incomplete maggot resolution compared with administration of systemic therapy, ivermectin, along with mechanical extraction. 2 Among wound-cleansing agents, the effects of Dakin's solution (0.5% sodium hypochlorite), 70% isopropyl alcohol, povidone-iodine, and 3% hydrogen peroxide on maggot mortality were comparatively evaluated when applied daily to maggots in vitro for a total of 14 days. Maggot mortality among these solutions ranged between 33% and 46%, with Dakin's solution treatment associated with the highest mortality rate, suggesting the need for supplemental treatments to obtain complete clearance of wound myiasis. 5 The evidence to support a single most effective treatment strategy for wound myiasis is inconclusive. This case report presents a combination approach that demonstrated efficacy.There remains a need for additional studies to establish the comparative efficacy of treatment modalities and to develop standard guidelines for the management of wound myiasis.

Influence of Socio-Demographic Factors in Patients With Cutaneous Lupus Erythematosus

“…Finally, socioeconomic factors like reduced income and low educational attainment have been associated with worse outcomes in patients with CLE ( 7 , 15 , 19 , 23 , 26 , 30 , 33 , 35 ). A diagnosis of CLE comes with significant financial burden.…”

“…The exception to this finding comes from a predominately White population study in Minnesota which found the prevalence of CLE to be higher than SLE in men than in women (11). All studies investigating alterations in disease course or severity were predominately female cohorts (16)(17)(18)(19)(20)(21)25). Gender did not play a significant role in predicting progression of disease activity in a multicenter endeavor studying the natural disease course of CLE (21).…”

“…Verma et al found that Black patients develop CLE at an earlier age than non-Black patients and present with greater initial disease damage ( 16 ). Not only are non-White patients younger at initial disease presentation but Black patients may be more likely to hospitalized longer than their White counterparts (14.5 days vs. 6.3 days, respectively, p < 0.02) ( 19 ). When comparing DLE lesion distribution and disease activity and damage scores using the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) between Black vs. non-Black patients, Black patients with DLE (median = 10.0, IQR 6.0–14.5) had higher baseline CLASI damage scores compared with non-Black patients (median = 6.0, IQR 3.0–10.0) ( p < 0.001) ( 20 ).…”

“…Socio-demographic factors including income, education level, and geographic location can affect patients with CLE ( 7 , 19 , 28 , 30 , 33 , 35 ). CLE patients have been shown to experience significantly high healthcare expenditures, particularly if depression is present.…”

“…In CLE patients with depression, inpatient visits ( p < 0.01), prescription drugs ( p < 0.001), and ER visits ( p < 0.05) were identified as the most significant contributors to medical expenses, respectively ( 28 ). Higher levels of poverty were associated with a significantly increased likelihood of rehospitalization within 1 year ( p < 0.0047) and being female ( p < 0.002) ( 19 ). Income level was also shown to have an inverse relationship with CLASI damage scores ( p = 0.006), but no significant relationship to CLASI activity scores ( 35 ).…”