Lichen planus and dyslipidaemia: a case–control study

Background  Previous reports have demonstrated an association between psoriasis and dyslipidaemia.
Objectives  As lichen planus (LP) is also a chronic inflammatory disorder, we investigated the association between LP and dyslipidaemia in Israel.
Methods  A case–control study was performed utilizing the database of Clalit Health Services, a large healthcare provider organization in Israel. Patients aged 20–79 years who were diagnosed as having LP were compared with a sample of enrollees without LP regarding the prevalence of dyslipidaemia. Data on other health-related lifestyle factors and comorbidities were collected.
Results  The study included 1477 patients with LP and 2856 controls without LP. The prevalence of dyslipidaemia was significantly higher in patients with LP (42·5% vs. 37·8%, P  =   0·003; odds ratio, OR 1·21, 95% confidence interval, [CI]: 1·06–1·38). A multivariate logistic regression model demonstrated that LP was significantly associated with dyslipidaemia even after controlling for confounders, including age, sex, smoking, hypothyroidism, diabetes, hypertension, socioeconomic status and obesity (multivariate OR 1·34, 95% CI: 1·14–1·57, P  <   0·001).
Conclusions  In the present study, LP was found to be associated with dyslipidaemia.     

Inverse relationship between contact allergy and psoriasis: results from a patient- and a population-based study

Background  An inverse association between contact allergy and autoimmune diseases has been suggested. Psoriasis is an autoimmune disease and it has been debated whether contact allergy is less prevalent among patients with psoriasis. Previous studies have shown conflicting results.
Objectives  To examine a possible association between contact allergy and psoriasis in two conceptually different epidemiological studies.
Patients and methods  Two study populations were included: (i) a clinic-based register linkage study population, achieved by record linking information from the Danish National Hospital Registry identifying patients with psoriasis with information on contact allergy from a comprehensive patch test database of 15 641 patients; and (ii) a population-based cross-sectional study population organized in 1990, 1998 and 2006 and obtained by random samples from the Danish Central Personal Register. Information was obtained by questionnaire and patch testing of 4989 subjects.
Results  An inverse association was found between a psoriasis diagnosis and a positive patch test in both studies. The odds ratio for a person with a psoriasis diagnosis of having a positive patch test was, adjusted for sex and age, 0·58 [95% confidence interval (CI) 0·49–0·68] and 0·64 (95% CI 0·42–0·98), respectively, in the two studies.
Conclusions  The finding of an inverse association between psoriasis and contact allergy may express opposite immunological mechanisms and calls for additional research in this field.     

Psoriasis and inflammatory bowel diseases

Psoriasis and inflammatory bowel diseases (Crohn's disease and ulcerative colitis) are among the immune-mediated inflammatory diseases. This group includes approximately 80 disorders, some of which can at times be associated in a single patient. In psoriasis, Crohn's disease may be observed slightly more frequently, but ulcerative colitis and celiac disease are also an issue. The underlying relations between these disorders comprise: i) genetic data obtained by genome-wide association studies that show the involvement of shared predisposing loci and/or genes, for example, in innate immunity; ii) immunological data: these disorders share inflammation effector mechanisms, particularly the activation pathway of Th17 lymphocytes, which explains the efficacy of anti-TNF antibodies and anti-IL-12/23; and iii) environmental co-factors such as smoking, possibly certain food proteins (gliadin, etc.), and bacterial infections that are probably decisive elements in the genesis of these diseases.     

Further evidence for an association between psoriasis, Crohn's disease and ulcerative colitis

To test the hypothesis that psoriasis is associated with Crohn's disease and ulcerative colitis, 204 patients with inflammatory bowel disease (116 with Crohn's disease and 88 with ulcerative colitis) and 204 age and sex matched controls were interviewed and examined. The prevalence of psoriasis in Crohn's disease (11.2%) and in ulcerative colitis (5.7%), was significantly greater than in the control group (1.5%). The prevalence of psoriasis in first degree relatives of patients with inflammatory bowel disease was also increased. It is suggested that there is a relationship between psoriasis, ankylosing spondylitis, sacroiliitis, peripheral arthropathy and inflammatory bowel disease, which may be explained by common genetic factors.     

银屑病和银屑病关节炎与溃疡性结肠炎相关性Meta分析

目的:有研究报道银屑病或银屑病关节炎患者溃疡性结肠炎发生率明显高于正常人,本文目的在于进一步明确银屑病、银屑病关节炎与溃疡性结肠炎的相关性。方法:通过Pubmed、Cochrane Library、Embase、知网、万方等数据库检索银屑病、银屑病关节炎并溃疡性结肠炎相关文献,采用Review Manager 5.3软件进行Meta分析。结果:共纳入13篇文献,横断面研究3篇、病例对照研究2篇、队列研究8篇,包含银屑病723 402例,银屑病关节炎37 059例,Meta分析结果显示银屑病与溃疡性结肠炎[RR=1.65(95%CI 1.55～1.76),OR=1.76(95%CI 1.43～2.17)],差异具有统计学意义,银屑病关节炎与溃疡性结肠[RR=2.14 (95%CI 1.72～2.66),OR=2.05 (95%CI 1.50～2.80)],差异具有统计学意义。结论:银屑病、银屑病关节炎可能增加溃疡性结肠炎的发生率。     

Hand eczema in geriatric nurses in Germany – prevalence and risk factors

Background and objectives:  The aim of this cross-sectional study was to collect data on the prevalence of hand eczema and relevant risk factors in geriatric nurses in Germany.
Methods:  1375 geriatric nurses from 86 nursing homes were investigated by 41 occupational physicians.
Results:  Hand eczema was diagnosed in 243 nurses, corresponding to a point prevalence of 18% [95% confidence interval (CI) 16–20%]. In most cases (71%), the skin changes were only mild. Two thirds of the geriatric nurses who reported skin changes stated that they had developed hand eczema after starting this profession. In most cases (85%), the clinical course was described as chronic. Risk factors associated with hand eczema were a lifelong tendency for dry skin [odds ratios (OR) 2.76; 95% CI 2.02–3.76] and a history of allergic rhinoconjunctivitis (OR 1.50; 95% CI 1.03–2.18). There was no association between the amount of wet work and hand eczema (OR 1.18; 95% CI 0.76–1.86).
Conclusions:  Our study indicates that it is necessary to provide geriatric nurses with specific skin care advice as part of their training. This might help to identify trainees at increased risk of developing eczema, encouraging the initiation of appropriate skin protection measures, thus preventing chronic disease.     

Psoriasis and smoking: a systematic review and meta‐analysis

Psoriasis is an inflammatory skin disease associated with increased cardiovascular comorbidity. Smoking is associated with an increased risk of cardiovascular disease, and prior studies have suggested that patients with psoriasis are more likely to be active smokers. Smoking may also be a risk factor in the development of psoriasis. We conducted a systematic review and meta‐analysis to assess the prevalence of smoking among patients with psoriasis, and we reviewed the contribution of smoking to the incidence of psoriasis. A total of 25 prevalence and three incidence studies were identified. The meta‐analysis of prevalence studies included a total of 146 934 patients with psoriasis and 529 111 patients without psoriasis. Random effects meta‐analysis found an association between psoriasis and current smoking [pooled odds ratio (OR) 1·78, 95% confidence interval (CI) 1·52–2·06], as well as between psoriasis and former smoking (pooled OR 1·62, 95% CI 1·33–1·99). Meta‐regression analysis did not reveal any sources of study heterogeneity, but a funnel plot suggested possible publication bias. A subset of studies also examined the association between moderate‐to‐severe psoriasis and smoking, with a pooled OR of 1·72 (95% CI 1·33–2·22) for prevalent smoking. The three incidence studies found an association between smoking and incidence of psoriasis, with a possible dose‐effect of smoking intensity and duration on psoriasis incidence. These findings suggest that smoking is an independent risk factor for the development of psoriasis, and that patients with established psoriasis continue to smoke more than patients without psoriasis.     

Coeliac disease associated with psoriasis

Background Psoriasis is a chronic inflammatory disorder of the skin reported to be associated with systemic comorbidities. Objectives To investigate the association between psoriasis and coeliac disease (CD). Methods Patients with psoriasis were compared with age‐ and sex‐matched controls regarding the prevalence of CD in a case–control study. χ² and t‐tests were used for univariate analysis and a logistic regression model was used for multivariate analysis. The study was performed utilizing the medical database of Clalit Health Services. Results The study included 12 502 patients with psoriasis aged > 20 years and 24 285 age‐ and sex‐matched controls. The prevalence of CD in patients with psoriasis was increased compared with the prevalence in controls (0·29% and 0·11%, respectively, P < 0·001). In a multivariate analysis psoriasis was associated with CD (odds ratio 2·73, 95% confidence interval 1·65–4·53). Conclusions Patients with psoriasis have a greater prevalence of CD than matched controls. Recent studies showed a possibility of undiagnosed CD among patients with psoriasis. Therefore, physicians treating patients with psoriasis should be aware of this possible association.     

A case of linear IgA disease occurring in a patient with colonic Crohn's disease

Linear IgA disease has been reported in association with inflammatory bowel disease, in particular ulcerative colitis. We experienced a case of linear IgA disease that occurred simultaneously with colonic Crohn's disease in a 55-year-old woman and rather unusually both skin and bowel disease improved in tandem. We report the presentation, investigations and subsequent improvement of our patient and speculate on possible causes.     

Atopic dermatitis and risk factors in poor children from Great Buenos Aires, Argentina

Background.  In recent decades, the prevalence of atopic dermatitis (AD) has risen steadily, and risk factors for AD are currently being investigated worldwide. In Argentina, there are no available data on risk factors of AD.
Aim.  To determine the prevalence of and any gender predilection for AD, and to identify familial and environmental factors that are associated with increased AD risk.
Methods.  In this case–control cross sectional study, 603 children aged 12–60 months old from a poor urban community in Buenos Aires were recruited. AD was defined following UK Working Party Diagnostic Criteria. We evaluated the relationship between AD and the presence of family history of atopy, > 5 family members, wearing synthetic clothes, having a carpeted room, eating ≥ 3 eggs/week, tobacco smoking indoors by family members, and living< 300 m from a main road, polluted stream or industry.
Results.  The prevalence of AD was 41.1% (95% CI 37.2–45.2%). Logistic regression analysis showed that AD was significantly associated only with a family history of atopy (OR = 5.7; 95% CI 3.7–8.8%; P  = 0.0000), wearing synthetic clothes (OR = 2.2; 95% CI 1.4–3.5; P  = 0.0009), having a carpeted room OR = 1.9; 95% CI 1.2–3.0%; P  = 0.009) and living < 300 m from an industry (OR = 1.93; 95% CI 1.2–3.1%; P  = 0.0051).
Conclusion.  We found a high prevalence of AD in our study population. Not all the investigated risk factors for AD had a significant association with the disease.     

Hidradenitis suppurativa and inflammatory bowel disease: are they associated? Results of a pilot study

Background  The co-occurrence of hidradenitis suppurativa (HS) and Crohn disease (CD) published in a few case reports resulted in the wide acceptance of an association between these two diseases. However, the combined prevalence of these diseases is currently unknown; furthermore, it is unknown whether this co-occurrence also applies for ulcerative colitis (UC).
Objectives  To estimate the prevalence of HS in patients with inflammatory bowel disease (IBD) living in the Southwest of the Netherlands.
Methods  During an IBD patient information meeting, randomly, 158 patients with IBD were interviewed about recurrent painful boils in the axillae and/or groin and were shown illustrative clinical pictures of the appearance of HS.
Results  Of the 158 patients interviewed, 102 (65%) had CD and 56 (35%) had UC. Twenty-five people (16%) responded that they had had or still experienced painful boils in the axillae and/or groin, of whom 17 were patients with CD (17%) and eight had UC (14%).
Conclusions  This pilot study shows for the first time that HS occurs in patients with CD or UC. More prospective studies are warranted to establish the association between HS and IBD and its underlying pathogenesis.     

A randomized controlled trial to evaluate short-term treatment with eosin vs. topical steroids in psoriasis

Background.  The therapeutic effects of some histological staining agents on psoriasis have been reported in the past. One of these agents is eosin, which is still currently used in routine treatment, although it has never been formally tested in a randomized controlled trial.
Aim.  To compare treatment with eosin in patients with moderate to severe psoriasis vs. short-course topical steroid, a well-defined, evidence-based treatment.
Methods.  A randomized trial was designed and conducted. The Skindex-29 and General Health Questionnaire (GHQ)-12 questionnaires, and Psoriasis Activity and Disease Index (PASI) were used before treatment in 43 patients. Five days after treatment, PASI was measured again.
Results.  Five days after treatment, a significant mean reduction of PASI was observed in both groups: 6.8 (95% CI 5.5–8) for eosin, and 5.2 (3.2–7.1) for steroids. The difference between the two groups was not significant ( P  = 0.161).
Conclusions.  Eosin has a short-term effect similar to topical steroids. The low cost of eosin treatment and its limited collateral effects suggest that eosin could be an effective steroid-sparing agent in the initial phase of psoriasis treatment.     

银屑病与肾脏疾病风险相关性队列研究的meta分析

目的研究银屑病与肾脏疾病之间的关系。方法通过检索Medline、Pub Med、Embase、Cochrane Library、万方数据库、中国知网,收集银屑病患者肾脏疾病发生风险的队列研究文献。所有的统计学处理均采用Stata 12.0软件。结果 6篇队列研究文献符合入选标准。将各研究调整后的效应值及其95%可信区间合并后发现,纳入的6篇队列研究文献,经异质性检验采用随机效应模型进行meta分析,结果显示与非银屑病患者相比,银屑病患者患肾脏疾病风险增加(OR=1.17,95%CI 1.07~1.29),重度银屑病患慢性肾脏疾病的发病风险更高(OR=2.06,95%CI 1.93~2.2),均具有统计学意义。结论银屑病能显著增加肾脏疾病的发病风险。     

Psoriasis is independently associated with psychiatric morbidity and adverse cardiovascular risk factors,but not with cardiovascular events in a population‐based sample

Background Psoriasis may significantly reduce quality of life. Previous studies reported an association of psoriasis and cardiovascular risk factors and cardiovascular events. The extent to which psoriasis is associated with psychiatric morbidity and the role of psychiatric comorbidity as a potential confounder of the association between psoriasis and cardiovascular morbidity require further investigation. Objectives To study the association between psoriasis, psychiatric morbidity and cardiovascular morbidity. Methods Case–control study utilizing an interdisciplinary administrative outpatient database from Germany. Patients with confirmed diagnosis of prevalent psoriasis within the study period (2003–2004) (n = 3147, mean age 57 years) were individually matched for age and gender with 3147 controls without psoriasis. The relationship of psoriasis with psychiatric morbidities (depression, stress‐related disorders, behaviour disorders and schizophrenic disorders), cardiovascular risk factors (diabetes, hypertension, obesity and dyslipidaemia) and cardiovascular events [myocardial infarction (MI), stroke] was investigated using logistic and linear regression models. Results Crude analyses suggested an association of psoriasis with depression, stress‐related disorders, behaviour disorders and cardiovascular risk factors, but not with MI [odds ratio (OR) 1.14; 95% confidence interval (95% CI) 0.81–1.62] or stroke (OR 0.97; 95% CI 0.61–1.54). Multivariate models controlling for age, gender and consulting behaviour indicated that psoriasis is independently associated with depression (OR 1.49; 95% CI 1.20–1.86), stress‐related disorders (OR 1.41; 95% CI 1.22–1.62), behaviour disorders (OR 1.58; 95% CI 1.05–2.39), diabetes (OR 1.21 95% CI 1.04–1.40), hypertension (OR 1.34; 95% CI 1.18–1.51), dyslipidaemia (OR 1.29; 95% CI 1.07–1.55), and obesity (OR 1.63; 95% CI 1.39–1.90). For each psychiatric condition, the likelihood of being affected significantly increased with each physician visit due to psoriasis, suggesting that the risk of psychiatric comorbidity increases with the severity of psoriasis. Conclusion Psoriasis appears to be independently associated with major psychiatric disorders and with cardiovascular risk factors, but not with cardiovascular events.     

Comorbidity profiles among patients with bullous pemphigoid: a nationwide population-based study

Background Bullous pemphigoid (BP) has been associated with neurological and psychiatric diseases; however, large‐scale population‐based study of different comorbid diseases in patients with BP is quite limited. Objectives We sought to analyse the prevalence of neurological, psychiatric, autoimmune and inflammatory skin diseases prior to the diagnosis of BP and their associations with BP among patients with BP from a nationwide database in Taiwan. Methods A total of 3485 patients with BP and 17 425 matching controls were identified from the National Health Insurance Database in Taiwan from 1997 to 2008. Conditional logistic regression analyses for a nested case–control study were performed to examine the prevalence of comorbidities prior to the diagnosis of BP between these two groups. Results Overall, our results showed that stroke [odds ratio (OR) 3·30; 95% confidence interval (95% CI) 3·03–3·60], dementia (OR 4·81; 95% CI 4·26–5·42), Parkinson disease (OR 3·49; 95% CI 3·05–3·98), epilepsy (OR 3·97; 95% CI 3·28–4·81), schizophrenia (OR 2·56; 95% CI 1·52–4·30) and psoriasis (OR 2·02; 95% CI 1·54–2·66) were significantly associated with BP. Among them, the association with schizophrenia and psoriasis was predominant in female and male patients, respectively, with BP. It remains for all these comorbid diseases to be independently associated with BP by multivariate analysis. Conclusions Patients with BP are more likely to have various neurological diseases, schizophrenia and psoriasis prior to the diagnosis of BP, supporting associations found in other studies. Further research is required to elucidate the tentative causal association with BP.     

Prevalence of psoriasis in patients with alcoholic liver disease

Background.  Excessive alcohol use has been implicated as a risk factor in the development of psoriasis, particularly in men. Despite this, little is known of the incidence or prevalence of psoriasis in patients who misuse alcohol.
Objective.  To assess the prevalence of psoriasis in patients with alcoholic liver disease.
Methods.  In total, 100 patients with proven alcoholic liver disease were surveyed for a history of psoriasis and a full skin examination was performed if relevant.
Results.  Of the 100 patients, 15 reported a history of psoriasis and another 8 had evidence of current activity, suggesting a prevalence (past or present) of 15% in this group of patients.
Conclusion.  It would appear that the prevalence of psoriasis in patients who misuse alcohol is much higher than the 1–3% variously quoted in the general population.     

Desmocollin expression in oral atrophic lichen planus correlates with clinical behavior and DNA content

Background:  Oral lichen planus (OLP) is a chronic mucocutaneous inflammatory disease, with some tendency toward malignant transformation. Markers are needed to identify the lesions at risk.
Methods:  A series of 82 biopsies from 70 patients with atrophic OLP was analyzed for desmocollin-1, E-cadherin, cyclin-dependent kinase 1 (cdk-1) and Rad-51 expression using immunohistochemistry and static DNA cytometry, with particular reference to clinical outcome.
Results:  Desmocollin-1 and E-cadherin expression were each detected in 24.4% (20/82) of the samples. Of the positive samples, only eight specimens expressed both desmocollin-1 and E-cadherin. Strong desmocollin-1 and E-cadherin expression was found in 8.5% and 3.7% of OLP biopsies, respectively. Desmocollin-1 expression increased the risk of dysplasia 31.8-fold (95% confidence intervals (CI) 3.6–280.9; p = 0.0001), while E-cadherin was significantly related to cancer (odds ratio (OR) = 5.13; 95% CI 3.3–8.1; p = 0.001). In univariate survival analysis, desmocollin-1 was a significant predictor of both cancer (log-rank test; p = 0.033) and dysplasia (p = 0.0001), while E-cadherin predicted the development of cancer (p = 0.0001). Neither cdk-1 nor Rad-51 had any predictive value. Importantly, desmocollin-1 retained its value as the only independent predictor of dysplasia in the multivariate (Cox) model (adjusted Hazard Ratio (HR) = 44.13; 95% CI 3.7–525.6).
Conclusions:  In atrophic OLP, desmocollin-1 is a powerful predictor of an important intermediate endpoint marker (dysplasia) in the causal pathway toward oral cancer.     

The prevalence and morbidity of sensitization to fragrance mix I in the general population

Background  The prevalence of sensitization to fragrance mix (FM) I and Myroxylon pereirae (MP, balsam of Peru) has decreased in recent years among Danish women with dermatitis.
Objectives  This study investigated whether the decrease could be confirmed among women in the general population. Furthermore, it addressed the morbidity of FM I sensitization.
Methods  In 1990, 1998 and 2006, 4299 individuals aged 18–69 years (18–41 years only in 1998) completed a premailed questionnaire and were patch tested to FM I and MP. Data were analysed by logistic regression analyses and associations were expressed as odds ratios (ORs) with 95% confidence intervals (CIs).
Results  The prevalence of FM I and MP sensitization followed an inverted V-pattern among women aged 18–41 years (i.e. an increase from 1990 to 1998, followed by a decrease from 1998 to 2006). Logistic regression analyses showed that 'medical consultation due to cosmetic dermatitis' (OR 3·37, 95% CI 1·83–6·20) and 'cosmetic dermatitis within the past 12 months' (OR 3·53, CI 2·02–6·17) were significantly associated with sensitization to FM I.
Conclusions  In line with trends observed in Danish patients with dermatitis, our results supported a recent decrease in the prevalence of FM I and MP sensitization in Denmark. The study also showed that fragrance sensitization was associated with self-reported cosmetic dermatitis and use of health care related to cosmetic dermatitis.     

Psychiatric comorbidity in adult eczema

Background  Atopic eczema (AE) is a common dermatological condition that causes significant problems in everyday life and high levels of illness-related stress in substantial proportions of patients. The extent to which adult AE is associated with clinically relevant psychiatric morbidity is unclear.
Objectives  To investigate the association between adult AE and major psychiatric/psychosomatic disorders.
Methods  Case–control study utilizing the GKV database Saxony, an interdisciplinary administrative outpatient database from Germany. All patients documented as having AE at least twice within the study period (2003–2004) ( n  =   3769, mean age 44 years) were individually matched by age and sex to 3769 controls without AE. Logistic regression models were fitted to investigate the relationship of AE with affective, stress-related, behaviour and schizophrenic disorders, considering sociodemographic characteristics, consulting behaviour and allergic comorbidities as potential confounding factors.
Results  Eczema was independently associated with affective [adjusted odds ratio (OR) 1·42, 95% confidence interval (CI) 1·13–1·79], stress-related (OR 1·55, 95% CI 1·35–1·77), behaviour (OR 1·52, 95% CI 1·03–2·23) and schizophrenic disorders (OR 2·12, 95% CI 1·22–3·71). For each psychiatric condition the likelihood of being affected significantly increased with each physician visit due to AE, suggesting that the risk of psychiatric comorbidity increases with the severity of AE.
Conclusions  This study indicates psychiatric comorbidity of adults with AE. Collaboration between dermatologists and mental health specialists may optimize medical care for a significant subgroup of patients with AE.