Heidi Jacobe

University of Texas Southwestern Medical Center, Dallas, Texas, United States

Are you Heidi Jacobe?

Claim your profile

Publications (35)124.9 Total impact

  • Daniel Condie, Daniel Grabell, Heidi Jacobe
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective Few studies have looked at outcomes of adults with pediatric-onset morphea. The objective of the present study was to compare clinical outcomes and health-related quality of life in adults with pediatric-onset morphea to those of patients with adult-onset morphea.Methods Participants in the study were drawn from the Morphea in Adults and Children Cohort and included 68 adults with pediatric-onset morphea and 234 patients with adult-onset morphea. Outcome measures included the Localized Scleroderma Cutaneous Assessment Tool (LoSCAT), physical exam findings, and quality of life questionnaires.ResultsAdults with pediatric-onset morphea were younger, had longer disease duration, and were more likely to have the linear subtype of morphea. Patients with pediatric-onset disease were less likely to have active disease. Among patients with active disease, those with pediatric-onset morphea had less disease activity as measured by the LoSCAT. Patients with pediatric-onset disease had higher disease damage as measured by the Physician Global Assessment of Damage, but similar disease damage as measured by the Localized Scleroderma Skin Damage Index. Patients with pediatric-onset disease had more favorable quality of life scores for all measures that reached statistical significance.Conclusion Adults with pediatric-onset morphea differ from patients with adult-onset disease with respect to subtype, disease activity, disease damage, and health-related quality of life. © 2014 American College of Rheumatology.
    Arthritis & Rheumatology. 08/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To determine human leukocyte antigen class I (HLA-class I) and II (HLA-class II) alleles associated with morphea (localized scleroderma) in the Morphea in Adults and Children (MAC) cohort by a nested case–control association study.Methods: Morphea patients were included from MAC cohort and matched controls from the NIH/NIAMS Scleroderma Family Registry and DNA Repository and Division of Rheumatology at the University of Texas Health Science Center at Houston. HLA- Class II genotyping and SSCP typing was performed of HLA-A, -B, -C alleles. Associations between HLA-Class I and II alleles and morphea as well as its subphenotypes were determined.Results: There were 211 cases available for HLA-class I typing with 726 matched controls and 158 cases available for HLA Class-II typing with 1108 matched controls. The strongest associations were found with DRB1*04:04 (OR 2.3, 95% CI 1.4-4.0 P=0.002) and HLA-B*37 conferred the highest OR among Class I alleles (3.3, 95% CI 1.6-6.9, P= 0.0016). Comparison with risk alleles in systemic sclerosis determined using the same methods and control population revealed one common allele (DRB*04:04).Conclusion: Results of the present study demonstrate specific HLA Class I and II alleles are associated with morphea and likely generalized and linear subtypes. The associated morphea alleles are different than in scleroderma, implicating morphea is also immunogenetically distinct. Risk alleles in morphea are also associated with conditions such as rheumatoid arthritis (RA) and other autoimmune conditions. Population based studies indicate patients with RA have increased risk of morphea, implicating a common susceptibility allele. © 2014 American College of Rheumatology.
    Arthritis & Rheumatology. 08/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Skin trauma may play a role in the development of morphea lesions. The association between trauma and the distribution of cutaneous lesions has never been examined to our knowledge.
    Journal of the American Academy of Dermatology 05/2014; · 4.91 Impact Factor
  • Shinjita Das, Ira Bernstein, Heidi Jacobe
    [Show abstract] [Hide abstract]
    ABSTRACT: Determining a disease's impact on life quality is important in clinical decision making, research, and resource allocation. Determinants of quality of life (QOL) in morphea are poorly understood. We sought to ascertain demographic and clinical variables correlated with negative impact on self-reported QOL in morphea. We conducted a cross-sectional survey of the Morphea in Adults and Children cohort. Symptoms (pruritus and pain) and functional impairment were correlated with decreased QOL in children and adults. This was true in both sexes and was independent of subtype and age. Patient-reported QOL correlated with physician-based measures of disease severity in adults, but not in children. Patients with linear and generalized morphea had the greatest impact on QOL. Small sample size is a limitation. Symptoms and functional impairment were determinants of impaired life quality in both children and adults independent of morphea subtype. These results suggest that clinicians should consider suppressing the accumulation of new lesions (when rapidly accumulating) and symptoms (pain and pruritus) in the treatment of patients with morphea.
    Journal of the American Academy of Dermatology 02/2014; · 4.91 Impact Factor
  • Rebecca Vasquez, Heidi Jacobe
    [Show abstract] [Hide abstract]
    ABSTRACT: Phototherapy is efficacious for a variety of sclerosing skin conditions. It is particularly attractive because many of these disorders are considered unresponsive to other therapies. Furthermore, phototherapy offers an alternative to systemic immunosuppressives for patients who cannot tolerate these medications. There are a number of phototherapeutic modalities used for the treatment of sclerosing skin conditions; here, we review the current evidence for the use of UVA1, broadband UVA1, psoralen plus UVA and narrowband UVB phototherapy.
    Expert Review of Dermatology 01/2014; 6(6).
  • [Show abstract] [Hide abstract]
    ABSTRACT: Studies support efficacy of ultraviolet (UV)A1 phototherapy, but little is known about recurrence after successful UVA1 treatment. We sought to determine the frequency of recurrent activity after UVA1 phototherapy and variables associated with recurrence. This was a case series and prospective cohort study of patients treated with UVA1 phototherapy with minimum 6 months of follow-up. Demographics, clinical features, and cumulative UVA1 dose were analyzed for association with recurrence. Of 37 patients, 46% (n = 17) had recurrence of active morphea lesions after successful UVA1 phototherapy. Two-year and 3-year (after the last UVA1 phototherapy treatment) recurrence rates were 44.5% (95% confidence interval 30.1%-62.2%) and 48.4% (95% confidence interval 33.2%-66.1%), respectively. The only variable associated with recurrence was duration of morphea before UVA1 (P value = .02, hazard ratio 1.15, 95% confidence interval 1.06-1.27). The sample size limits conclusions. With the exception of increased duration of morphea, risk of recurrence is no different in adults and children, or between morphea subtypes, skin types, and medium- to high-dose regimens. This indicates treatment doses in the medium-high UVA1 range are adequate with respect to frequency of recurrence.
    Journal of the American Academy of Dermatology 12/2013; · 4.91 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Pansclerotic morphea is a poorly described form of morphea with little information on prevalence, demographics, and clinical features. Classification criteria for this subtype varies and the distinction from other forms of morphea, such as extensive generalized morphea and pansclerotic morphea, is not always clear. The purpose of our study was to clarify classification criteria for pansclerotic morphea by identifying its prevalence in the morphea in adults and children (MAC) cohort and describing its demographic and clinical features as compared with generalized morphea. Patients who met predefined criteria for generalized and pansclerotic morphea were identified using a modified Laxer and Zulian classification system. Baseline demographic and clinical features of the patients were compiled and then analyzed for traits characteristic of pansclerotic morphea versus those of generalized morphea. One hundred and thirteen patients met the criteria for inclusion: pansclerotic (n = 13) and generalized morphea type (n = 100). Patients with pansclerotic morphea were more frequently male (46.2% vs 6%; p < 0.0001); had a shorter time to diagnosis (mean difference of 10.4 mos; 95% CI: 0.8-19.9 mos; p = 0.0332); higher rates of functional impairment (61.5% vs 16%; p = 0.0046); higher rates of deep involvement (61.5% vs 17%; p = 0.004); and higher average Rodnan Skin Score (mean difference of 10.8 points; 95% CI: 5-16.6; p = 0.0017), Localized Scleroderma Skin Damage Index (mean difference 28.3; 95% CI: 9-47.6; p = 0.009), and Physician Global Assessment of Disease Damage scores (mean difference 25.1; 95% CI: 0.3-50; p = 0.048). Our results suggest demographic and clinical features are sufficient to define the pansclerotic subtype as they represent a distinct clinical phenotype with a more rapidly progressive and severe course commonly accompanied by disability. Presence of features of the pansclerotic phenotype should alert practitioners to the possibility of significant morbidity and the need for early aggressive treatment.
    The Journal of Rheumatology 12/2013; · 3.26 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: IMPORTANCE Small studies have implicated the association of specific autoantibodies with morphea subtype or severity, but no large-scale studies have been conducted. This prospective case-control study confirmed the presence of antinuclear antibodies (ANAs) and other autoantibodies in morphea but found they are of limited significance. OBJECTIVE To determine the prevalence of ANAs, extractable nuclear antigens such as antihistone antibodies (AHAs), and anti-single-stranded DNA antibodies (ssDNA abs) in patients with morphea vs a healthy control population and their association with clinical measures of morphea severity. DESIGN, SETTING, AND PARTICIPANTS Nested case-control study, conducted at the University of Texas Southwestern Medical Center, Dallas, and University of Texas Health Science Center, Houston. Study participants included individuals enrolled in the Morphea in Adults and Children (MAC) cohort and Scleroderma Family Registry and DNA Repository. MAIN OUTCOMES AND MEASURES Prevalence of ANAs, AHAs, ssDNA abs in patients with morphea vs matched controls and association of the presence of autoantibodies with clinical indicators of morphea severity. RESULTS The prevalence of ANAs, AHAs, and ssDNA abs in patients with morphea was 34%, 12%, and 8%, respectively. Antinuclear antibodies and AHAs, but not ssDNA abs, were present more frequently in cases than in controls. There was no difference in ANA prevalence among morphea subtypes. Among patients with linear morphea, the presence of autoantibodies was associated with clinical indicators of severe morphea including functional limitation (ssDNA ab, P = .005; and AHA, P = .006), extensive body surface area involvement (ssDNA ab, P = .01; and ANA, P = .005), and higher skin scores (ANA, P = .004). The presence of autoantibodies was not associated with clinical measures of morphea activity. CONCLUSIONS AND RELEVANCE Our results demonstrate that ANAs and AHAs are more prevalent among patients with morphea but are of limited clinical utility except in linear morphea, where their presence, although infrequent, is associated with greater lesion burden and functional impairment.
    JAMA dermatology (Chicago, Ill.). 08/2013;
  • Sarah Nouri, Heidi Jacobe
    [Show abstract] [Hide abstract]
    ABSTRACT: There is huge variation in the evaluation, diagnosis, and treatment of patients with morphea (localized scleroderma). In part, this variability results from the lack of validated methods to assess severity and outcomes with a consequent lack of adequate therapeutic trials. Evaluation is also hindered by lack of information regarding the impact of morphea on patients. Recent studies are addressing this gap in knowledge and include: development of clinical outcome measures, validation of imaging studies, publication of consensus treatment plans, and increased understanding of the impact of morphea on patients and parents. The purpose of this review is to summarize the results of these studies and to synthesize the information into a rational approach to the diagnosis and assessment of patients with morphea.
    Current Rheumatology Reports 02/2013; 15(2):308.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Morphea, also known as localized scleroderma, is a disorder of excessive collagen deposition leading to thickening of the dermis and/or subcutaneous tissues and may cause significant morbidity. This review will describe new developments in the evaluation and management of morphea as well as its pathophysiology. The reader will be able to apply these findings to patient management. The recent development of validated outcome measures (i.e. the localized scleroderma cutaneous assessment tool) as well as consensus treatment recommendations provide a platform for collaboration among specialties to develop both standardized assessment tools and therapeutic trials. New studies have also begun to investigate the immunological underpinnings of morphea. The promise of evidence-based treatments for morphea in the near future will provide better care for patients with morphea and understanding its pathophysiology will lay groundwork for the development of new treatments.
    Current opinion in rheumatology 11/2012; 24(6):685-93. · 4.60 Impact Factor
  • Source
    Pediatric Rheumatology 07/2012; 10(1). · 1.47 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine whether there is an association between sex and academic rank and track, leadership, productivity, income, and career satisfaction. National cross-sectional survey. Academic dermatologists across the United States. A total of 1263 full-time academic dermatologists. The association of sex with the following predictive variables: rank, promotion, academic productivity, leadership, salary, and career satisfaction. Of the 343 respondents (27.2% response rate), 259 were full-time academic dermatologists, of whom 159 (61.4%) were men. Men held more senior positions (P < .001) even after adjustment for age (P < .02) and number of years since completion of residency (P < .05). Men were also more likely to occupy investigative career tracks (26.5% vs 11.1%), whereas women predominantly occupied clinical educator tracks (81.5% vs 50.0%) (P = .03). There was no significant difference in the hours worked between men and women (P = .052), and after controlling for academic rank, there was no difference in number of publications (P = .06) or grants received (P = .19). Difference in yearly salary became insignificant when adjusted for rank and other variables ($20 000 decrement for women; P = .12). Although most men (90.3%) and women (82.8%) were satisfied with their career, women were 24.6% more likely than men to consider leaving academia (P < .001). Sex-based differences in academic dermatology, including career track, academic rank distribution, leadership, and career satisfaction, persist. Measures that enhance the subjective rewards (eg, influence, collegiality, and mentorship) of academics and increased family-friendly measures for early-career academicians are important to close these gaps.
    Archives of dermatology 07/2012; 148(7):809-14. · 4.76 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Acne is a common skin condition often requiring complex therapeutic regimens. Patient nonadherence to prescribed medication regimens is a factor in treatment failure. OBJECTIVE: The goal of this study was to determine if daily automated text messages would result in increased adherence to recommended use of topical acne medication and consequently greater improvement in acne. METHODS: Forty patients with mild to moderate acne were prescribed clindamycin/benzoyl peroxide 1%/5% gel in the mornings and adapalene 0.3% gel in the evenings for 12 weeks. Each medication tube was fitted with an electronic Medication Event Monitoring System cap (MEMS, Aardex Group, Sion, Switzerland) (to record the date and time of every opening/closing of the tube). Twenty patients were randomly assigned to receive customized twice-daily text messages instructing them to apply their morning and evening medication. The remainder of patients (N = 20), who did not receive text messages, served as control subjects. RESULTS: Mean adherence rates for the correct application of both medications on a daily basis over 12 weeks was 33.9% for patients in the reminder group and 36.5% for patients in the control group (P = .75). Patients in both groups had similar clinical improvement of their acne. LIMITATIONS: The small sample size may limit the ability to detect differences between the study groups. CONCLUSIONS: Electronic reminders in the form of daily, customized text messages were not associated with significant differences in adherence to topical medications in patients with mild to moderate acne and had no significant effect on therapeutic response.
    Journal of the American Academy of Dermatology 04/2012; · 4.91 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Juvenile localized scleroderma (LS) is a chronic inflammatory skin disorder associated with substantial morbidity and disability. Although a wide range of therapeutic strategies has been reported in the literature, a lack of agreement on treatment specifics and accepted methods for clinical assessment has made it difficult to compare approaches and identify optimal therapy. Our objective was to develop standardized treatment plans, clinical assessments, and response criteria for active, moderate to high severity juvenile LS. A core group of pediatric rheumatologists, dermatologists, and a lay advisor was engaged by the Childhood Arthritis and Rheumatology Research Alliance (CARRA) to develop standardized treatment plans and assessment parameters for juvenile LS using consensus methods/nominal group techniques. Recommendations were validated in 2 face-to-face conferences with a larger group of practitioners with expertise in juvenile LS and with the full membership of CARRA, which encompasses the majority of pediatric rheumatologists in the US and Canada. Consensus was achieved on standardized treatment plans that reflect the prevailing treatment practices of CARRA members. Standardized clinical assessment methods and provisional treatment response criteria were also developed. Greater than 90% of pediatric rheumatologists responding to a survey (66% of CARRA membership) affirmed the final recommendations and agreed to utilize these consensus plans to treat patients with juvenile LS. Using consensus methodology, we have developed standardized treatment plans and assessment methods for juvenile LS. The high level of support among pediatric rheumatologists will support future comparative effectiveness studies and enable the development of evidence-based guidelines for the treatment of juvenile LS.
    Arthritis care & research. 04/2012; 64(8):1175-85.
  • Weilan Johnson, Heidi Jacobe
    [Show abstract] [Hide abstract]
    ABSTRACT: Little is known about the diagnosis, evaluation, and therapy of morphea (localized scleroderma) in the United States. Delays in diagnosis and initiation of appropriate therapy, if present, may negatively affect patient care. Further, this gap in knowledge hinders planning for clinical trials and therapeutic guidelines. The morphea in adults and children (MAC) cohort is designed to address this gap. We sought to determine the duration between morphea onset and diagnosis, specialty of the diagnosing provider, and initial evaluation and therapy in the MAC cohort. This was a cross-sectional survey of the inception cohort of the MAC study. In all, 63% (n = 141 of 224) of patients were given the diagnosis more than 6 months after onset. Dermatologists diagnosed and treated the majority of patients (83.5%, n = 187). Rheumatologists diagnosed and treated the more severe forms of morphea (linear and generalized). The most commonly prescribed therapy was topical corticosteroids (63%). Dermatologists predominantly prescribed topical treatments or phototherapy (P < .0001, P = .0018, respectively), even to patients with linear and generalized morphea. In contrast, rheumatologists predominantly prescribed systemic immunosuppressives and physical therapy (P < .0001, P = .0021, respectively). Referral bias and recall bias may affect patterns of evaluation/therapy and ascertainment of disease duration before diagnosis. Patients with morphea experience delay in diagnosis, which likely impacts outcome. Therapeutic decision making is largely determined by the specialty of the provider rather than disease characteristics and many treatments with little or no proven efficacy are used, whereas others with proven efficacy are underused. This underscores the need for a collaborative, multispecialty approach in designing therapeutic trials and guidelines.
    Journal of the American Academy of Dermatology 02/2012; 67(5):881-9. · 4.91 Impact Factor
  • Daniel Walker, Heidi Jacobe
    [Show abstract] [Hide abstract]
    ABSTRACT: Dermatologists are presented with a diversity of therapeutic modalities for the treatment of inflammatory, sclerosing, and neoplastic conditions, but with the development of various new irradiation devices that utilize specific parts of the electromagnetic spectrum, phototherapy has become a more viable, accessible, and efficacious option in the treatment of these conditions. The ultraviolet (UV) range (10-400 nm) is further subdivided into UVA and UVB, each of which has been particularly useful in a number of skin conditions. The most commonly used forms of UV irradiation are UVA1, psoralen plus UVA (PUVA), and narrowband (NB) UVB. Each of these modalities differ in their mechanism of action, indications, and side effect profiles, and it is important that clinicians be familiar with these differences. Today, phototherapy is a valuable option in the treatment of many nonpsoriatic conditions including atopic dermatitis, sclerosing skin conditions such as morphea, vitiligo, and mycosis fungoides. Due to its relative safety, phototherapy may be used in most populations, including children and pregnant women. However, contraindications and side effects are known and should be considered before patients begin a phototherapeutic regimen.
    Seminars in cutaneous medicine and surgery 12/2011; 30(4):190-8. · 1.81 Impact Factor
  • Archives of dermatology 09/2011; 147(9):1112-5. · 4.76 Impact Factor
  • Brittany A Zwischenberger, Heidi T Jacobe
    [Show abstract] [Hide abstract]
    ABSTRACT: Morphea (localized scleroderma) is a skin disorder with significant morbidity. No consistent recommendations exist for therapy, impeding patient care. We sought to create an evidence-based therapeutic algorithm. We reviewed English-language literature using search engines and hand searches for therapeutic interventions in morphea. Results were summarized. Narrowband ultraviolet B is appropriate for progressive or widespread superficial dermal lesions; broadband ultraviolet A/ultraviolet A-1 is appropriate for widespread or progressive deeper dermal lesions. Systemic treatment with methotrexate, corticosteroids, or both is indicated for deep or function-impairing lesions and rapidly progressive or widespread (severe) disease. Topical treatment with calcipotriene or tacrolimus is supported for limited, superficial, inflammatory lesions. Use of oral calcipotriol, D-penicillamine, interferon gamma, and antimalarials is not supported. Limitations are publication bias; lack of adequately powered, controlled trials; and no validated outcome measures. Phototherapy, methotrexate/systemic corticosteroids, calcipotriene, and topical tacrolimus have the most evidence for efficacy in morphea. Treatment works best in inflammatory disease. Disease activity, severity, progression, and depth should play a role in therapeutic decision making.
    Journal of the American Academy of Dermatology 06/2011; 65(5):925-41. · 4.91 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Frequent and excessive tanning persists despite a growing understanding of its associated morbidity and mortality, suggesting that ultraviolet radiation may impart rewarding effects beyond the assumed cosmetic benefits. To empirically measure putative centrally rewarding properties of ultraviolet radiation (UVR), we assessed the effects of a commercially available tanning bed upon regional cerebral blood flow (rCBF), a measure of brain activity, using single-photon emission computed tomography (SPECT). Seven frequent salon bed tanners were placed under a UVA/UVB tanning light during two sessions; one session with UVR and the other with filtered UVR (sham UVR). Session order was randomized and subjects were blinded to study order. During the UVR session, relative to sham UVR session, subjects demonstrated a relative increase in rCBF of the dorsal striatum, anterior insula and medial orbitofrontal cortex, brain regions associated with the experience of reward. These changes were accompanied by a decrease in the subjective desire to tan. These findings suggest that UVR may have centrally rewarding properties that encourage excessive tanning.
    Addiction Biology 04/2011; 17(3):680-6. · 5.91 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Frequent, purposeful exposure to ultraviolet (UV) light may induce a compulsive desire to tan despite the negative consequences being known, suggesting a behavioural complex similar to addictive disorders. To assess the presence of addictive-like behaviours in subjects using indoor tanning salons. Subjects (n = 100) were surveyed by two questionnaires: a modified CAGE questionnaire to assess behaviours consistent with problem tanning and a modified Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) ('substance dependence' criteria) to assess behaviours consistent with a dependence-like disorder. In total, 41% of subjects met criteria consistent with a 'tanning addictive disorder', and an additional 33% met criteria for problematic tanning behaviour based on the modified CAGE criteria or subthreshold criteria on the modified DSM-IV criteria. Female gender and early age of onset were associated with meeting tanning addiction criteria. A high percentage of subjects who tan frequently in indoor salons experience behaviours and consequences to their tanning consistent with other identified addictive disorders.
    Clinical and Experimental Dermatology 01/2011; 36(1):33-8. · 1.33 Impact Factor