Psoriasis and risk of type 2 diabetes among women and men in the United States: a population-based cohort study

Type 2 diabetes (T2D) shares some common risk factors with psoriasis. We evaluated the association between psoriasis and the risk of incident T2D among women and men in the United States in a mixed retrospective-prospective cohort study. A total of 184,395 participants were included from an older cohort of women (the Nurses' Health Study (NHS); 1996-2008), a younger cohort of women (NHS II; 1991-2007), and an older cohort of men (Health Professionals' Follow-Up Study (HPFS); 1986-2006). During 2,700,958 person-years of follow-up, 9,938 incident T2D cases were confirmed. We found a significantly increased risk of T2D associated with psoriasis only among younger women (NHS II; multivariate-adjusted relative risk (RR)=1.25, 95% confidence interval (CI): 1.05-1.49). When only including those younger than 60 years during follow-up (NHS and HPFS), we observed a nonsignificant trend toward increased risk for T2D. In a pooled analysis of the three cohorts, psoriatics younger than 60 years were at a higher risk of T2D (RR 1.26, 95% CI: 1.08-1.48 for women and RR 1.26, 95% CI: 1.08-1.46 for both sexes combined). In addition, the risk of T2D was much higher for those developing psoriasis at an early age. In conclusion, we found an association between psoriasis and the risk of T2D among individuals younger than 60 years.     

Narrow band ultraviolet B irradiations cause alteration in interleukin-31 serum level in psoriatic patients

Scientific communications indicate the disturbed expression of neuropeptides in the skin and serum in psoriasis vulgaris (PsV) patients. Narrow-band ultraviolet radiation (NB-UVB) is one of the systemic therapies of PsV. The aim of the study was to evaluate the influence of NB-UVB therapy on substance P (SP), calcitonin gene-related peptide (CGRP), brain-derived neurotrophic factor (BDNF), corticotropin-releasing factor (CRF) and interleukin-31 (IL-31) serum concentrations in PsV patients. 59 psoriatic patients with mean PASI (psoriasis area and severity index) 14.3 were treated with NB-UVB (20 exposures). The control group consisted of 50 healthy subjects, whose age and sex matched. In all patients, serum concentration of BDNF, CRF, IL-31 substance P and CGRP was analyzed by ELISA before the treatment and in psoriatic group the analysis was also done after 10 and 20 irradiations. In patients there was found a significantly higher concentration of IL-31 (215.3 vs. 748.6 ng/ml; p < 0.0001), SP (25.7 vs. 67.2 pg/ml; p < 0.01), CGRP (31.4 vs. 44.15 pg/ml; p < 0.01) and a lower concentration of CRF (0.89 vs. 0.426 ng/ml; p < 0.0001) and BDNF (16.39 vs. 14.15 ng/ml; p = 0.1216) in comparison with the controls. 20 NB-UVB exposures caused a significant decrease in IL-31 level (748.6 vs. 631.7 ng/ml; p < 0.0001). The NB-UVB therapy had no major effect on neuropeptides serum levels regardless of a number of irradiations. On the basis of our study it can be suggested that IL-31 is involved in pathogenesis of psoriasis and the NB-UVB therapy causes alterations in its level.     

The −1154 G/A VEGF gene polymorphism is associated with the incidence of basal cell carcinoma in patients from northern Poland

Vascular endothelial growth factor (VEGF) is believed to play a crucial role in neoplastic angiogenesis. Although the genetic background of basal cell carcinoma (BCC) has been analyzed in some papers, the mechanism of BCC pathogenesis is not fully understood. To the best of our knowledge, VEGF gene polymorphisms have not yet been explored. The aim of the study was to asses the frequency of three polymorphisms in the VEGF gene (?1154 G/A, ?460 T/C and +405 G/C) in patients of Polish origin with BCC and control group. In addition, VEGF serum levels of patients with BCC and controls were measured. The study involved 180 patients (96 women, 84 men) with BCC and a mean age of 68.9 ± 11.8, and 215 healthy age- and sex-matched volunteers. The VEGF polymorphisms at positions ?1154 and +405 were analyzed using the amplification refractory mutation system polymerase chain reaction method. To assess the VEGF gene polymorphism at position ?460, we used the polymerase chain reaction restriction fragment length polymorphism method. Serum levels of VEGF protein were measured using the ELISA test. The presence of the G allele (GA or GG) in the ?1154 VEGF polymorphism was associated with an increased risk of BCC development (OR = 7.28, p < 0.0001). Furthermore, the carriers of the AA genotype in ?1154 VEGF polymorphism showed significantly reduced risks of BCC (OR = 0.14, p < 0.0001). It was also shown that the GTC haplotype of VEGF predisposes to BCC development (OR = 1.69, p = 0.013), while the presence of the ATG haplotype significantly reduces this risk (OR = 0.17, p = 0.00001). We have found significantly increased VEGF serum levels among BCC patients, in comparison with the healthy controls (mean 596.7 ± 393.5 pg/ml; range 60.1–931.4 vs. 255.9 ± 174.6 pg/ml; range 42.2–553.0 pg/ml; p < 0.0004). The serum levels of VEGF significantly correlated with tumor size: r = 0.41, p < 0.0001. Our results testify to the importance of ?1154 G/A VEGF gene polymorphisms in altering the risk of BCC among the population from northern Poland.     

Interactions between adiposity and genetic polymorphisms on the risk of psoriasis

Background Adiposity is a known risk factor for psoriasis. Genome‐wide association studies (GWAS) have identified a number of genes associated with risk of psoriasis while the evidence on gene–environment interactions in psoriasis is very sparse. Objectives To investigate the effect modification by adiposity measures on the association between single‐nucleotide polymorphisms (SNPs) from published GWAS and risk of psoriasis. Methods Our psoriasis GWAS dataset comprised 9194 participants, including 337 individuals with psoriasis and 8857 controls from six GWAS, nested within the Nurses’ Health Study (NHS), NHS II, and Health Professionals’ Follow‐up Study. Clinician‐diagnosed psoriasis was ascertained with high validity. For stratified analyses, body mass index (BMI) was dichotomized at 25, and waist circumference was dichotomized at 30 (women) and 36 inches (men), while waist–hip ratio (WHR) was dichotomized at 0·8 (women) and 1·0 (men). Results Forty‐one out of 44 previously reported psoriasis‐related SNPs were included in our GWAS datasets. After excluding those with high linkage disequilibrium, 33 remained in the analysis. There were significant interactions between BMI and two SNPs in the IL12B (rs3212227) and IL23R (rs7530511) genes. Further analysis of these two SNPs indicated interactions between rs3212227 and waist circumference or WHR [P for interaction (P_int) < 0·05], but not for rs7530511. These observations were confirmed among participants without type 2 diabetes or coronary heart disease. The interactions remained after simultaneously adjusting for BMI as a continuous variable. In addition, we did not observe a significant main effect for rs7530511. Conclusions The association between a polymorphism in IL12B and psoriasis risk may be modified by measures of overall and central adiposity.     

Effects of interleukin (IL)-6 gene polymorphisms on recurrent aphthous stomatitis

Recurrent aphthous stomatitis (RAS) is a common disease with oral ulceration in which cytokines are thought to play an important role. High levels of interleukin (IL)-6, a pro-inflammatory cytokine have been detected in the circulation of ulcer tissue. The purpose of the present study was to investigate if the IL-6 gene polymorphisms are associated with RAS or clinical characteristics of RAS in a cohort of Turkish population. 184 RAS patients and 150 healthy controls were included in the study. The genotypes of IL-6 gene ?572G>C and ?174G>C polymorphisms were determined using polymerase chain reaction based restriction fragment length polymorphism analysis. The genotype frequencies of ?572G>C polymorphism showed statistically significant differences between RAS patients and controls (p = 0.01). Frequencies of GG + GC genotypes and G allele of ?572G>C polymorphism were found higher in RAS patients (p = 0.0001, OR 10.8, 95 % CI 2.79–70.5; p = 0.0008, OR 2.06, 95 % CI 1.35–3.17, respectively). The genotype frequencies of ?174G>C polymorphism also showed statistically significant differences between RAS patients and controls (p < 0.0001). Frequencies of GG genotype and G allele of ?174G>C polymorphism were found higher in RAS patients (p < 0.0001, OR 4.87, 95 % CI 3.06–7.85; p < 0.0001, OR 3.82, 95 % CI 2.64–5.59, respectively). GG–GG combined genotype and G–G haplotype of ?174G>C to ?572G>C loci were also significantly higher in RAS patients (p < 0.0001 and p = 1.5 × 10^?8, respectively). After stratifying clinical and demographical characteristics of RAS patients according to IL-6 gene polymorphisms, an association was observed between family history of RAS and ?174G>C polymorphism (p = 0.011). Susceptibility effects of both IL-6 gene ?572G>C and ?174G>C polymorphisms for RAS were observed. Further studies are necessary to prove the association of IL-6 gene polymorphisms with RAS.     

No association between vitamin D intake and incident psoriasis among US women

We investigated the association between dietary, supplementary and total vitamin D intake and incident psoriasis in women. A prospective study was performed of 70,437 US female nurses aged 47–74 enrolled in the Nurses’ Health Study who did not have psoriasis at baseline in 1994 and who completed semi-quantitative food frequency questionnaires in 1994, 1998, 2002 and 2006. The incidence of clinician-diagnosed psoriasis was ascertained and validated by self-reported questionnaires. 502 confirmed incident psoriasis cases were documented during 973,057 person-years of follow-up from 1994 June to 2008 June. Association between vitamin D intake and incident psoriasis was assessed using multivariable-adjusted cox regression analysis. After adjusting for age, smoking, body mass index, calorie intake, UV flux, exercise and alcohol use, there was no significant association between vitamin D intake (dietary, supplementary and total vitamin D) and the risk of incident psoriasis. Compared with women whose dietary vitamin D intake was <100 IU/day, multivariate relative risks for psoriasis was 1.13 (95 % CI 0.66–1.92) for ≥400 IU/day (P trend = 0.88). The multivariate relative risk for women who took supplementary vitamin D ≥400 IU/day was 1.18 (95 % CI 0.88–1.58) compared with women who did not take supplementary vitamin D. The multivariate risk for women who had total vitamin D intake of 300–399 IU/day was no different than at higher and lower doses of vitamin D intake. Our study does not support preventive roles of dietary or supplemental vitamin D intake for incident psoriasis.     

Body Region Involvement and Quality of Life in Psoriasis: Analysis of a Randomized Controlled Trial of Adalimumab

Background

Psoriasis severity and treatment responsiveness vary by body region, which differentially impacts quality of life (QoL).

Objective

The objective of the study was to examine adalimumab efficacy by body region and regional response and QoL relationship.

Methods

Patients (n = 1212) with moderate-to-severe psoriasis were randomized 2:1 to 80 mg at week 0, followed by adalimumab 40 mg or placebo every other week for 16 weeks in the double-blind REVEAL study. Psoriasis Area and Severity Index (PASI) responses and Dermatology Life Quality Index outcomes were analyzed.

Results

Week 16 regional mean PASI improvements were significantly greater with adalimumab (83.1 ± 1.57, 81.3 ± 1.58, 75.7 ± 1.34, and 73.9 ± 1.26% in the trunk, head, upper extremities, and lower extremities, respectively; all p < 0.001 vs. placebo). Likewise, percentages of patients with regional PASI ≥75/≥90/100% reduction from baseline were significantly higher with adalimumab (all p < 0.001); adalimumab responses were greater for the trunk (77.9/65.0/59.1%) and head (74.6/66.1/62.8%; all p ≤ 0.0001 vs. lower) than upper (67.7/45.1/39.6%; p = 0.4, p = 0.04, p = 0.0005, respectively, vs. lower) and lower extremities (65.7/40.0/31.3%). Adalimumab significantly improved Dermatology Life Quality Index scores vs. placebo (8.2- vs 1.7-point decrease from baseline; p < 0.001).

Limitations

The study was a post hoc analysis.

Conclusions

Adalimumab treatment resulted in statistically significant and clinically meaningful improvements in disease severity and QoL. QoL improvements were associated with PASI responses in all body regions.

Trial Registration

ClinicalTrials.gov identifier NCT00237887.

     

Expression of GLTSCR2/Pict-1 in squamous cell carcinomas of the skin

The most important cause of cutaneous squamous cell carcinomas (SCC) is DNA damage induced by exposure to solar UV irradiation. DNA damage induced by UV irradiation is sensed by early DNA damage response (DDR) proteins. Recently, GLTSCR2 has been suggested to play a role in UV light-induced DDR. To explore the role of GLTSCR2 in the development of cutaneous SCC, we investigated the molecular mechanism underlying GLTSCR2 inactivation in response to UV irradiation. We analyzed cutaneous SCC (n = 42), basal cell carcinomas (BCC; n = 26), and normal skin tissue samples (n = 36) and compared GLTSCR2 expression between tumor and normal tissues, using immunohistochemistry. Next, to investigate the effects of UV irradiation on GLTSCR2, we performed immunocytochemistry, RT-PCR, immunoblotting, half-life assay for GLTSCR2, and comet assay after UV irradiation in primary keratinocytes. GLTSCR2 expression in SCC was significantly lower than that of normal skin tissue (p < 0.05), but not different between BCC and normal skin. In cultured primary keratinocytes, GLTSCR2 expression was decreased and translocated after UV irradiation. UV irradiation accelerated degradation of GLTSCR2 through proteasomal pathway. Knockdown of GLTSCR2 resulted in marked decrease in γH2AX foci after UV exposure. Furthermore, comet assay showed that DNA damage after UV exposure persists longer in GLTSCR2 knocked-down cells. Our data show that GLTSCR2 is downregulated in SCC of the skin and that UV light exposure decreases the stability of GLTSCR2 and sensitizes keratinocytes to DNA damage. Therefore, our data suggest that GLTSCR2 might be involved in the development and/or progression of SCC of the skin.     

Study of MDM2 and SUMO-1 expression in actinic cheilitis and lip cancer

Actinic cheilitis exhibits a potential of malignant transformation in 10–20 % of cases. The objective of this study was to compare the expression of MDM2 and SUMO-1 proteins between actinic cheilitis (AC) and squamous cell carcinoma (SCC) of the lip. The sample consisted of lower lip mucosa specimens obtained from cases with a clinical and histopathological diagnosis of AC (n = 26) and SCC (n = 25) and specimens of labial semi-mucosa (n = 15) without clinical alterations or inflammation. The tissue samples were stained with hematoxylin-eosin and anti-MDM2 and anti-SUMO-1 antibodies. Data were analyzed by the Kruskal–Wallis and Dunn’s tests (5 %). The median expression of MDM2 (kW = 36.8565; df = 3?1 = 2; p = 0.0001) and SUMO-1 (kW = 32.7080; df = 3?1 = 2; p = 0.0001) was similar in cases of AC and SCC of the lip, but differed significantly from that observed for normal labial semi-mucosa. Despite the limitations of the present study, immunohistochemistry demonstrated the overexpression of important proteins (MDM2 and SUMO-1) related to regulatory mechanisms of apoptosis in AC and SCC of the lip, but further studies are needed.     

X-rays and photocarcinogenesis in hairless mice

It is well known that excessive X-ray radiation can cause non-melanoma skin cancers. With the increased incidence of sun-related skin cancer there is a need to investigate the combination of sunlight and X-rays. Immunocompetent C3.Cg/TifBomTac mice (n = 298) were divided into 12 groups. Mice were irradiated with 12, 29 or 50 kV X-rays. The mice received a total dose of 45 Gy. They were irradiated with 3 SED simulated solar radiation (SSR) either before or after irradiation with X-rays. The groups irradiated with X-rays alone, 0, 3, 9 and 10 mice (0, 12, 29 and 50 kV, respectively) developed squamous cell carcinoma. In the groups irradiated with SSR after X-rays the development of tumours was significantly faster in the 50 kV group than in the corresponding control group (175 vs. 194 days, p < 0.001). In the groups irradiated with SSR prior to the X-ray radiation the development of tumours was significantly faster in the 29 and the 50 kV groups than in the corresponding control group (175 vs. 202 days, p < 0.001 and 158 vs. 202 days, p < 0.001, respectively). In conclusion, X-ray radiation alone is a weak carcinogen in hairless mice. There is an added carcinogenic effect if X-ray radiation is given on prior sun-exposed skin or if the skin is sun-exposed after X-rays. We still believe that X-ray radiation is a safe and effective therapy for various dermatological diseases but caution should be observed if a patient has severely sun-damaged skin or has a high-risk sun behaviour.     

Assessment of hydro-saline retention in bullous pemphigoid patients treated with super-potent topical corticosteroids

IntroductionSuper-potent topical corticosteroids (CS) are the mainstay of treatment for bullous pemphigoid. Since super-potent topical CS have systemic effects due to their transcutaneous absorption, we assessed whether super-potent CS were responsible for hydro-saline retention (HSR) in bullous pemphigoid patients.Patients and MethodsFrom 2015 to 2017, patients with newly-diagnosed bullous pemphigoid treated using clobetasol propionate cream at a starting daily dose of 20 to 40 g were subsequently included in a prospective study. HSR was assessed by longitudinally measuring extracellular water (ECW) volume using bioimpedance analysis (BodyStat QuadScan 4000®) from Day 0 to Day 30 after the initiation of topical CS. Other parameters related to HSR such as weight, blood pressure, natriuresis and proteinuria, were also recorded.ResultsTwenty-nine patients (14 men and 15 women) of mean age 81.8 ± 9.3 years were included and analysed. The mean ECW volume decreased from Day 0 to Day 7 (18.1 ± 4.2 vs 16.7 ± 2.7, p = 0.0094) and was maintained from Day 7 to Day 30 (16.8 ± 2.8 vs 17.0 ± 3.4 L; p = 0.8040). Patient weight loss at Day 30 (69.9 ± 13.6 vs 72.5 ± 14.2 kg, p = 0.0085) was closely correlated with the decrease in ECW volume (r = 0.6740, p < 0.0001). No significant changes in natriuresis, 24-hour proteinuria or blood pressure were observed from Day 0 to Day 30.ConclusionWe found no evidence of HSR in bullous pemphigoid patients treated with super-potent topical CS. Conversely, ECW volume decreased from Day 0 to Day 30, which was correlated with patient weight loss.     

Treatment of palmar hyperhidrosis with botulinum toxin type A: results of a pilot study based on a novel injective approach

Botulinum toxin type A (BoNT/A) improves symptoms of palmar hyperhidrosis, but some drawbacks related to its injection in the hands still persist (e.g., muscle weakness caused by drug diffusion, pain during injections, or delayed functional recovery of the hand when using wrist block). In this open, controlled, non-randomized, intra-individual clinical trial, 50 patients with severe palmar hyperhidrosis received in the same session intradermal injections of BoNT/A through a new injection technique (NA/BoNT/A) based on the use of a specific adapter for needles (PCT/IT2011/000299) in one hand, and BoNT/A injection following the anaesthetic block of the wrist (WB/BoNT/A) in the other. Several measures of efficacy and safety were evaluated both before (T0) and four weeks after the treatment (T4): disease severity improvement, sweat reduction, handgrip strength decrease, pain/discomfort during the treatment, and patient’s global satisfaction. All patients were also re-evaluated through the gravimetric assessment of sweat production in both hands at T12 and T24 to compare the long-term efficacy of the two treatments. All patients were responsive to the treatments, and disease severity was significantly decreased at T4 compared to baseline (p < 0.0001). Both procedures were equally effective in reducing sweat production in the short term (p = 0.08 at T4), but WB/BoNT/A caused a higher decrease of handgrip strength compared with WB/BoNT/A at T4 (p < 0.0001). Finally, patients reported that NA/BoNT/A and WB/BoNT/A procedures were comparable for pain/discomfort (p = 0.204); however, they were globally more satisfied with the NA/BoNT/A rather than WB/BoNT/A method (p < 0.0001). No significant difference in percentage of clinical relapse at T12 and T24 was detected between hands treated via WB/BoNT/A or NA/BoNT/A (p = 0.70). The use of the described adapter to inject BoNT/A in the hands seems to lead the clinicians to obtain same therapeutic results of conventional method based on the use of anaesthetic block of the wrist. Moreover, this new injective approach seems to increase the safety of the treatment by reducing the extent of muscle weakness and is preferred by patients mostly because it makes the functional recovery of the hand faster.     

Estimates of primary and secondary syphilis rates in persons with HIV in the United States, 2002

BACKGROUND: In the United States, there is a high rate of HIV coinfection in persons with syphilis. GOAL: The goal of this study was to estimate the rate of primary and secondary (P&S) syphilis in persons living with HIV in the United States in 2002. STUDY: We approximated the number of new cases of P&S syphilis in HIV-infected persons and divided this by the estimated number of persons living with HIV. Values for the calculations were obtained from national syphilis and HIV/AIDS surveillance reports and other published sources. RESULTS: We estimated the rate of new cases of P&S syphilis at 186 per 100,000 persons living with HIV in 2002, 25 per 100,000 HIV-infected women, 60 per 100,000 HIV-infected men who have sex with women only, and 336 per 100,000 HIV-infected men who have sex with men. Of the 6862 reported cases of P&S syphilis in 2002, an estimated 1718 (25%) occurred in persons coinfected with HIV. CONCLUSIONS: The estimated rate of P&S syphilis in persons with HIV is considerably higher than that of the general population. These findings highlight the importance of providing sexually transmitted disease prevention and control services to HIV-infected persons.     

Evaluation of Oxidant–Antioxidant Balance in Children with Atopic Dermatitis: A Case–Control Study

Background

Increased reactive oxygen species (ROS) and oxidative stress (OS) has been reported in many allergic and inflammatory skin diseases, including urticaria, psoriasis, and atopic dermatitis (AD). Melatonin is a hormone secreted from the pineal gland and is a potent antioxidant.

Objective

The aim of the study was to measure serum antioxidant melatonin, oxidants of nitric oxide (NO), and malondialdehyde levels to calculate the serum oxidant–antioxidant balance based on the NO/melatonin and malondialdehyde/melatonin ratios and to determine the correlation with the disease severity in children with AD.

Methods

Seventy-three children with AD and 67 healthy controls were included in the study. The clinical diagnosis of AD was based on the diagnostic criteria of Hanifin-Rajka. The severity of AD was evaluated by the scoring AD (SCORAD) index, and atopy was determined by skin prick tests (SPTs) with commercial extracts. The OS-related parameters of serum melatonin, NO, malondialdehyde, and the NO/melatonin and malondialdehyde/melatonin ratios were calculated and compared with the results of healthy controls.

Results

Serum melatonin levels were higher (p < 0.0001) and serum NO levels and the NO/melatonin and malondialdehyde/melatonin ratios were lower in children with AD than in healthy controls (p = 0.045, p < 0.0001, p < 0.0001, respectively). There was no difference between children with AD and healthy controls in terms of serum malondialdehyde levels (p = 0.119). Serum melatonin levels were significantly lower in severe AD than in mild AD (p = 0.012). However, in terms of serum melatonin levels, there was no difference between mild and moderate AD (p = 0.742) and moderate to severe AD (p = 0.301). There was no significant difference in serum NO and malondialdehyde levels and NO/melatonin and malondialdehyde/melatonin ratios among children with mild, moderate, and severe AD (p > 0.05). A negative correlation was found between serum melatonin levels and the SCORAD index (r = ?0.252, p = 0.031), and a positive correlation was found between NO/melatonin and malondialdehyde/melatonin ratios (r = 0.511, p < 0.0001). There was no statistically significant relationship between age (≤24 or >24 months), disease duration (≤6 or >6 months), and sex for the OS-related parameters (p > 0.05).

Conclusion

The serum oxidant–antioxidant balance was impaired in children with AD. Serum melatonin levels were higher in children with AD; however, this was negatively correlated with disease severity. Serum NO levels and NO/melatonin and malondialdehyde/melatonin ratios were lower in children with AD than in healthy controls. Melatonin might be used as a promising antioxidant to evaluate disease severity in children with AD. Thus, further studies are needed to clarify the role of melatonin in AD pathogenesis.

     

Health Status, Coping Strategies, and Alexithymia in Subjects with Androgenetic Alopecia

Background

Androgenic alopecia (AGA) is viewed as a relatively mild dermatologic condition; however, affected individuals feel that alopecia is a serious condition with major consequences in their life.

Objective

The objective of this study was to assess the health status, the risk of anxiety/depression, the coping strategies, and alexithymia in subjects with AGA.

Methods

Consecutive subjects referred to the outpatients department of the Istituto Dermopatico dell’Immacolata, Istituto di Ricovero e Cura a Carattere Scientifico (IDI IRCCS) dermatologic hospital with a diagnosis of AGA were enrolled. AGA was assessed using the Ludwig scale in female subjects and following Hamilton–Norwood’s classification in male subjects. The questionnaires provided to the patient and collected before the visit were the Medical Outcomes Study Short Form-12 (SF-12), the 12-item General Health Questionnaire (GHQ-12), the Coping Orientations to Problems Experienced (COPE), and the Toronto Alexithymia Scale-20 (TAS-20). Multiple logistic regressions were performed to examine the relationship of sociodemographic variables and clinical characteristics with coping.

Results

351 subjects were enrolled during the study period. Sixty percent of female subjects with AGA were GHQ-12 positive (values ≥4) compared with 32 % of male subjects with AGA. AGA male and AGA female subjects had a statistically worse score than non-AGA male subjects for the physical component summary (PCS) and the mental component summary (MCS) of the SF-12, and for the GHQ-12. Compared with male subjects, AGA female subjects were more likely to adopt an ‘active emotional coping’ strategy according to COPE scores, and less likely to have ‘externally oriented thinking,’ and more ‘difficulty identifying feelings’ according to the TAS-20 scores. In a logistic regression model, including sex, MCS, total TAS-20, and the COPE scores as independent variables and the AGA severity as a dependent variable, only sex had a significant odds ratio (OR) [13.32; 95 % CI 4.77–38.58, p < 0.001]. Female subjects were almost 13 times more likely to have more severe AGA than male subjects. In three other models (i.e., one for each coping category) which included sex, AGA severity, MCS, and TAS-20, the ‘problem-focused coping’ strategy was negatively associated with alexithymia (OR 0.48; 95 % CI 0.27–0.86, p = 0.01), the ‘active emotional coping’ strategy was associated with gender (women had an OR of 2.69; 95 % CI 1.5–4.8, p = 0.001), and the ‘avoidant coping’ strategy was associated with alexithymia (OR 4.12; 95 % CI 2.23–7.58, p < 0.001) and with lower MCS values (OR 0.37; 95 % CI 0.22–0.64, p < 0.001).

Conclusion

The study confirmed the high prevalence of depression/anxiety in AGA subjects, with a significantly higher prevalence in AGA female than male subjects. It is interesting to observe that patients reactions to their AGA related more to the emotional and psychological states deriving from their alopecia than to the objective clinical rating. Avoidant coping strategies were selected more frequently by AGA subjects if they were GHQ-12 positive and had alexithymia. To have alexithymia modified all coping strategies in AGA female subjects but not in AGA male subjects. Physicians should be aware that the impact of AGA is not limited to symptoms, and should help people to deal with their emotional responses to alopecia, such as anger and worry, and their beliefs about the consequences of their condition, and how it will impact on their daily life.     

Skin rash during erlotinib for advanced non-small cell lung cancer: is age a clinical predictor?

The aim of this study was to evaluate the intensity and the duration of acneiform skin rash in young and elderly patients, to define a possible relationship between age and skin rash. We retrospectively analyzed all consecutive patients with advanced NSCLC who developed acneiform skin rash during erlotinib treatment at our Clinical Oncology Unit from June 2006 to May 2011. We divided the general case study into two subgroups: young and elderly patients (≥65 years) and we compared clinical, pathological and therapeutical characteristics of both subgroups. Among 25 patients affected by advanced NSCLC treated with erlotinib during the reference period, 19 patients (76.0 %) developed acneiform skin rash. Fourteen (73.7 %) of 19 patients were elderly. The majority of elderly patients has developed acneiform skin rash (82.4 vs 62.5 %). In addition, in elderly patients, acneiform skin rash has a higher intensity (for mild rash 7.1 vs 20.0 %, for moderate rash 57.1 vs 60.0 %, for severe rash 35.7 vs 20.0 %) and longer duration, especially for mild and moderate rash (for mild rash 154 vs 40 days, for moderate rash 120 vs 76 days, for severe rash 31 vs 85 days). The univariate analysis showed no statistical significant difference in OS between young and elderly patients (p = 0.191), such as age, does not seem to influence the appearance (p = 0.386), duration (p = 0.455) and grade of acneiform skin rash (p = 0.765). In conclusion, we can affirm that age is an insufficient predictor of acneiform skin rash during erlotinib treatment in advanced NSCLC and does not seem to statistically influence the appearance, duration and grade of skin rash.     

Malignant melanoma and nonmelanoma skin cancers in Northrhine-Westphalia, Germany: a patient- vs. diagnosis-based incidence approach

BACKGROUND: Dermatologists have repeatedly criticized that the public health importance of nonmelanoma skin cancers is not appropriately reflected by the patient-based cancer incidence rates of population-based cancer registries. The aims of this study were to estimate the patient incidence rates of squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and skin melanoma, and to study the effect of multiple primary skin tumors on the incidence rates. METHODS: We used a network of physicians covering a population of about 75,000 individuals to register all newly diagnosed invasive skin cancers (996 diagnoses in 796 patients), including BCC, SCC, and skin melanoma, from July 1998 to June 2003. We calculated age-standardized (world standard population) incidence rates (cases per 100,000 person-years) for the first diagnoses (called "patient incidence") and for any diagnoses of BCC, SCC, and skin melanoma (called "case incidence"). RESULTS: The patient incidence rates of BCC were 63.6 in men and 54.0 in women, and the case incidence rates of BCC were 82.7 and 71.1, respectively. The patient incidence rates of SCC were 17.4 in men and 9.7 in women, and the case incidence rates were 20.4 and 10.2, respectively. The patient and case incidence rates of skin melanoma were about the same at 13.6 in men and 18.5 in women. Twenty-five per cent of the BCC patients and 14% of the SCC patients suffered from more than one BCC and SCC, respectively, during the 5-year period. CONCLUSIONS: Patient incidence rates of BCC and SCC substantially underestimate the burden of nonmelanoma skin cancer in the population.     

Age distribution of patients with advanced non-melanoma skin cancer in the United States

The epidemiology of non-melanoma skin cancer (NMSC) is not well understood due to exclusion from most US cancer registries. Patients with at least two claims with a NMSC diagnosis (ICD-9-CM 173.xx) at least 60 days apart, or at least one claim for a NMSC-specific treatment from 1/2010 to 12/2010, were identified from a large US commercial insurance claims database and grouped into one of three cohorts: metastatic (MET), locally advanced (LA), or “all other”. MET patients had at least two claims with a metastasis code at least 30 days apart. LA patients had at least two visits to a medical oncologist, one diagnostic imaging service, two radiation therapy services, or one visit to two or more physician specialties. Remaining patients were “all other”. Incidence and prevalence of NMSC were calculated from among the total number of persons continuously enrolled in the plan during the study period and standardized to the 2010 US population. From among 6,610,256 patients, there were 47,451 incident cases of NMSC (MET n = 16, LA n = 387, all other n = 47,048). The age-adjusted incidence rate of 693 per 100,000 persons (2010 population) approximates to 2,139,535 total NMSC cases in the US (0.7 % of population). 671 prevalent cases had advanced disease (MET n = 43, LA n = 628); an age-adjusted rate of 0.6 and 10 per 100,000 US persons equivalent to 1,993 and 29,841 MET and LA cases, respectively. Although NMSCs rarely progress, the number of patients with advanced disease is significant. Further studies to determine proportions of advanced NMSC by subtype are needed.