6897 Impact of brodalumab on work productivity in patients with mod- erate-to-severe plaque psoriasis: Analysis of two phase 3 studies April Armstrong, MD, MPH, University of Southern California; Boni Elewski, MD, University of Alabama, Birmingham; Shipra Rastogi, PhD, MBA, Ortho Dermatologics; Robert J. Israel, MD, Valeant Pharmaceuticals North America Introduction: Psoriasis is a debilitating disease with major social implications, including work limitations. The Work Limitations Questionnaire (WLQ) is a reliable self-report instrument for measuring the effect of health problems on job perfor- mance and productivity. This analysis assessed the effect of brodalumab, a fully human antieinterleukin-17 receptor A monoclonal antibody, on work productivity and work limitations in patients with moderate-to-severe psoriasis during the first 12 weeks of two 52-week, randomized, placebo- and active comparatorecontrolled, phase 3 studies (AMAGINE-2, -3). Methods: During the 12-week induction phase of each trial (AMAGINE-2, -3), patients were randomized 2:2:1:1 to receive brodalumab 210 mg (n ¼ 612, 624) or 140 mg (n ¼ 610, 629) every 2 weeks (q2w), ustekinumab (n ¼ 300, 313), or placebo (n ¼ 309, 315). At baseline and week 12, patients completed the 25-item WLQ, which categorizes work limitations into 4 domains: time management scale (TMS), physical demands scale (PDS), mental/interpersonal demands scale (MDS), and output demands scale (ODS). WLQ scores were converted into an estimate of productivity loss. Improvement in produc- tivity loss was represented as a negative change from baseline. Results: Work productivity at baseline was similar across treatment groups in both studies. At week 12, brodalumab 210 mg q2w was associated with statistically significant improvement in productivity loss vs. placebo in both studies (least square [LS] mean difference from placebo [95% confidence interval (CI)], AMAGINE-2: À3.66 [À4.31 to À3.01], P \.001; AMAGINE-3: À3.16 [À3.77 to À2.55], P \.001). Treatment difference (LS mean [95% CI]) vs. placebo at week 12 was observed for TMS (AMAGINE-2: 19.14 [15.94-22.35], P \.001; AMAGINE-3: 17.26 [14.29-20.23], P \.001), PDS (AMAGINE-2: 5.00 [À0.43 to 10.43], P ¼ .071; AMAGINE-3: 8.94 [3.63-14.24], P \.001), MDS (AMAGINE-2: 14.96 [12.41-17.51], P \.001; AMAGINE- 3: 12.74 [10.34-15.14], P \.001), and ODS (AMAGINE-2: 12.02 [9.43-14.60], P \ .001; AMAGINE-3: 10.11 [7.50-12.72], P \.001). The days of work missed (mean [95% CI]) in the 2 weeks before the week 12 assessment was lower with brodalumab (AMAGINE-2: 0.70 days [0.55-0.86]; AMAGINE-3: 0.87 days [0.68-1.06]) than placebo (AMAGINE-2: 1.31 days [0.95-1.68]; AMAGINE-3: 1.27 days [0.94-1.60]). Conclusion: Brodalumab significantly improved work limitations and increased work productivity compared with placebo in patients with moderate-to-severe psoriasis. Commercial support: Amgen, Inc. Medical writing support provided by MedThink SciCom and funded by Valeant Pharmaceuticals North America, LLC. 6302 Impact of dermatology intervention on cellulitis management: A prospective study David Li, BS, Department of Dermatology, Brigham and Women’s Hospital; Fandi Xia, BA, Brigham and Women’s Hospital and Harvard Medical School, Hasan Khosravi, MD, Brigham and Women’s Hospital and Harvard Medical School, Anna Dewan, MD, Department of Medicine, Vanderbilt University Medical Center; Daniel Pallin, MD, MPH, Department of Emergency Medicine, Brigham and Women’s Hospital; Christopher Baugh, MD, MBA, BDepartment of Emergency Medicine, righam and Women’s Hospital; Karl Laskowski, MD, MBA, Department of Internal Medicine, Brigham and Women’s Hospital; Arash Mostaghimi, MD, MPA, Department of Dermatology, Brigham and Women’s Hospital Background: Many inflammatory dermatoses of the skin clinically mimic cellulitis (termed pseudocellulitis), leading to misdiagnosis rates of 30%-90%. Inappropriate treatment for misdiagnosed patients may result in[9,000 nosocomial infections, 1,000- 5,000 Clostridium difficile infections, and 2-6 cases of anaphylaxis annually, in addition to substantial costs. In this study, we evaluate the impact of dermatology intervention on the management and disposition status of patients with presumed cellulitis. Methods: We prospectively enrolled patients who were in the emergency department, emergency department observation unit, or within 24 hours of admission to an inpatient unit with presumed diagnosis of cellulitis. We excluded patients who required antibiotics for an alternative indication, such as patients with known soft tissue abscess, osteomyelitis, deep penetrating wound, animal bite, or diabetic foot infection. Eligible patients were subsequently examined by a board- certified dermatologist, who provided the primary treatment team with recom- mendations on diagnosis, management, and disposition. Results: We recruited 107 patients into the study, 35 (32.7%) of whom were diagnosed with pseudocellulitis by dermatology. Of these, 26 (74.3%) had been started on antibiotics for presumed cellulitis by the primary team at the time of enrollment. Dermatology recommended antibiotic discontinuation in 21 of 26 patients (80.8%), and antibiotics were stopped in 20 of 21 (95.2%) cases. Dermatology also recommended discharge from planned observation or inpatient admission in 17 of 35 (48.6%) pseudocellulitis patients, and the primary team acted on this recommendation in 15 of 17 (88.2%) cases. In the remaining 18 patients, 4 were discharged by the emergency department and 14 had another medical condition requiring in-hospital level of care. Notably, no patients diagnosed with pseudocellulitis complained of worsening condition after discharge based on phone and clinic follow-up (77.1% response rate). Discussion: Our findings suggest dermatology intervention to be beneficial for patients presumed to have cellulitis, because misdiagnosis rates remain high. Collaboration between the primary team and dermatology to improve diagnostic accuracy may optimize health-related outcomes for patients through the reduction of unnecessary antibiotic use and hospitalizations. Commercial support: None identified. 6973 Impact of genital lichen sclerosus treatments on occurrence of vulvar neoplasms in 275 adult women Emily Dell, MD, Mayo Clinic; Rachel Miest, MD, Mayo Clinic; Christine Lohse, MS, Mayo Clinic; Rochelle Torgerson, MD, PhD, Mayo Clinic Background: Lichen sclerosus (LS) is a chronic inflammatory disease most commonly affecting the genital area of women. LS-associated vulvar neoplasms are known to occur. Treatment of LS is thought to reduce malignancy risk. A recent report showed reduction in vulvar neoplasms in those compliant with maintenance therapy. We performed a single-institution, retrospective chart review to identify vulvar neoplasm occurrence in women with biopsy-proven genital LS and to determine whether a correlation exists between LS treatments and vulvar neoplasm occurrence. Methods: A key word search of the electronic medical record was performed to identify women with biopsy-proven genital LS diagnosed from January 1, 2004, through December 31, 2013. Manual chart review confirmed adherence to inclusion criteria. A diagnoses of vulvar neoplasm, either vulvar intraepithelial neoplasia (VIN) or squamous cell carcinoma (SCC), and LS treatments were recorded. Results: A total of 275 women with biopsy-proven genital LS met search criteria. Twenty-three patients (8.4%) had a vulvar neoplasm including VIN (n ¼ 8), SCC (n ¼ 10), and metastatic SCC (n ¼ 5). Vulvar neoplasm recurrence or second genital neoplasm arose in 57% (13/23) including all those who developed metastatic SCC. Of 275 patients, 7 were excluded from treatment analysis due to no treatment or treatment with topical hormone preparations, analgesics, or emollients alone. Of the remaining 268 patients, many used [1 treatment, including superpotent topical corticosteroids (n ¼ 256), potent topical corticosteroids (n ¼ 10), medium-potency corticosteroids (n ¼ 24), low-potency corticosteroids (n ¼ 31), calcineurin inhibitors (n ¼ 22), and systemic therapy (n ¼ 5). There was no statistically significant difference between any treatment category and the occurrence of differentiated VIN and SCC either when considered together or independently (P [ .05). Conclusions: In our study population, treatment of lichen sclerosus did not impact malignancy risk. The nature of the study did not allow assessment of compliance nor maintenance regimens, factors recently shown to reduce vulvar neoplasms risk. Larger studies that include these factors may be needed to detect treatment effect on the development of LS-associated vulvar neoplasms. Limitations: As a retrospective review, data are dependent on medical record information. In addition, cases were limited to biopsy-proven LS at a quaternary institution which likely created bias. Commercial support: None identified. 7624 Impact of graft-versus-host disease on incidence of secondary skin cancers in allogeneic bone marrow transplant recipients Pooja Rambhia, BA, Case Western Reserve University School of Medicine; Ruzica Conic, MD, Case Western Reserve University School of Medicine; Natasha Atanaskova-Mesinkovska, MD, PhD, University of California, Irvine; Melissa Piliang, MD, Cleveland Clinic Foundation; Wilma Bergfeld, MD, Cleveland Clinic Foundation Introduction: Hematopoietic stem cell transplant (HSCT) patients are at an increased risk of secondary skin cancers. Impact of acute and chronic graft-versus- host disease (GVHD) on development of cutaneous neoplasms remains uncertain. The aim of this retrospective review was to examine association between acute and chronic GVHD, and secondary skin cancer incidence, as well as other transplant risk factors. Methods: Allogeneic HSCT recipients were reviewed who received transplants from 2009 to 2015 (n ¼ 207). Data were collected on gender, age at transplant, primary disease, hematologic disease status, conditioning regimen, GVHD prophylaxis, donor-recipient demographics, GVHD status, time to GVHD, and skin cancer incidence. Histopathology reports were reviewed to confirm diagnosis of GVHD and secondary skin cancers. Comparison of demographic and clinical variables was performed by t test, chi-square test, and Fisher exact test. Results: In total, 207 HSCT allogeneic transplant patients were identified, of which 58.0% were male and 42.0% were female, with a mean age of 50.19 6 15.77. GVHD was present in 33.81%. There was no difference between GVHD and no GVHD groups with regards to age (P ¼.3), gender (P ¼.98), primary disease (P ¼.37), graft type (P ¼.52), hematologic disease status (P ¼.27), donor-recipient relationship (P ¼ .81), GVHD prophylaxis (P ¼ .31), total transplants performed per patient (P ¼ .94), and skin cancer incidence (P ¼.13). Thirty skin cancers were identified among 12 patients, 3 of which were malignant melanomas, 17 squamous cell carcinomas, and 10 basal cell carcinomas. When comparing patients with skin cancers to those without, no differences were noted with age (P ¼ .15), primary disease (P ¼ .25), graft type (P ¼.87), GVHD prophylaxis (P ¼.64), and donor-recipient relationship (P ¼ .86). Skin cancer patients were more likely to have been treated with non- myeloablative conditioning regimens rather than myeloablative conditioning, (P ¼ .001). Among patients who had GVHD, those with acute that proceeded to chronic GVHD were more likely to develop skin cancers (P ¼.006). Conclusions: The data suggest that patients with acute GVHD who proceed to chronic GVHD may be more likely to develop skin cancers. This risk may be due to specific conditioning regimens and longer duration of post-transplantation immu- nosuppression. Larger studies involving long term surveillance of this population are needed to further establish their skin cancer risk. Commercial support: None identified. AB158 JAM ACAD DERMATOL SEPTEMBER 2018