Copy number variations of the human histamine H4 receptor gene are associated with systemic lupus erythematosus

Background Systemic lupus erythematosus (SLE) is a complex genetic disease; the histamine H4 receptor (HRH4) has been shown to be related to different kinds of autoimmune disorders; and copy number variations (CNVs) have been found to be associated with various types of diseases. Objectives To explore a possible association between HRH4 (formerly H4R) CNVs and the risk of SLE. Methods Genomic DNA and RNA from 340 patients with SLE and 392 healthy controls were extracted, and CNVs and mRNA levels of HRH4 were examined. Results The expression of HRH4 mRNA was significantly increased in patients with SLE compared with controls. Amplification of HRH4 copy numbers significantly increased the risk of SLE [P < 0·001, odds ratio (OR) 2·26, 95% confidence interval (CI) 1·50–3·40]. HRH4 amplifications also positively correlated with the incidence of arthritis (P = 0·019, OR 1·96, 95% CI 1·11–3·47), and proteinuria (P < 0·001, OR 2·95, 95% CI 1·73–5·00) and antinuclear antibody abnormalities (P < 0·001, OR 2·97, 95% CI 1·66–5·33). Deletions of HRH4 copy numbers were protective against proteinuria (P = 0·03, OR 0·50, 95% CI 0·26–0·94). Conclusion CNVs of the HRH4 gene are associated with SLE.     

Tyrosine kinase 2 and interferon regulatory factor 5 polymorphisms are associated with discoid and subacute cutaneous lupus erythematosus

Please cite this paper as: Tyrosine kinase 2 and interferon regulatory factor 5 polymorphisms are associated with discoid and subacute cutaneous lupus erythematosus. Experimental Dermatology 2010; 19: 123–131. Abstract: Lupus erythematosus (LE) is a heterogeneous disease ranging from skin‐restricted manifestations to a progressive multisystem disease. The specific skin lesions include chronic cutaneous, subacute cutaneous and acute cutaneous LE. Both genetic and environmental factors are involved in the development of LE. However, reports on the genetic background of cutaneous lupus erythematosus (CLE) forms, namely discoid (DLE) and subacute cutaneous lupus erythematosus (SCLE), are sparse. We investigated whether the known systemic LE (SLE) susceptibility genes also predispose to CLE. Altogether, 219 Finnish patients with DLE or SCLE and 356 healthy controls were recruited. Single nucleotide polymorphisms tagging reported risk genes were genotyped. Tyrosine kinase 2 (TYK2) rs2304256 was associated with increased risk of DLE (P = 0.012, OR = 1.47, 95% CI = 1.01–1.98). Expression of TYK2 was demonstrated by immunohistochemistry in macrophage‐like cells and neutrophils and interferon regulatory factor 5 (IRF5) in macrophage‐ and fibroblast‐like cells of DLE, SCLE and SLE skin. IRF5 rs10954213 showed association with DLE (P = 0.017, OR = 1.40, 95% CI = 1.06–1.86) and SCLE (P = 0.022, OR = 1.87, 95% CI = 1.09–3.21). A haplotype of cytotoxic T‐lymphocyte‐associated protein 4 (CTLA4) showed association with DLE (P = 0.0065, OR = 2.51, 95% CI = 1.25–5.04). Our results show that the TYK2, IRF5 and CTLA4 genes previously associated with SLE also confer risk for DLE and SCLE, suggesting that different LE subphenotypes may share pathogenetic pathways.     

Acridone acetic acid,sodium salt,as an agent to stop vitiligo progression: a pilot study

Vitiligo progression is attributed to immune system malfunctioning, thus immunomodulating compounds might be beneficial in stopping vitiligo progression which is a prerequisite for successful repigmentation. The goal of this study was to assess efficacy of acridone acetic acid, sodium salt (Na‐AAA), an immunomodulating compound with favorable safety profile, in stabilizing active vitiligo, and to reveal prognostic factors of treatment outcome. Sixty consecutive patients with progressing nonsegmental vitiligo were treated with 10 i.m. injections of Na‐AAA every other day. Disease stability was assessed in 1, 3, 6, and 12 months post‐treatment. Statistical analysis was applied to correlate treatment outcome and available clinical parameters. Of the 60 patients treated, vitiligo stopped progression in 44 patients (73.3%). Older age (p = 0.0219), age of 35 and older (p = 0.0189, odds ratio (OR) = 5.2, 95% confidence interval (CI) 1.30–20.84) or age of 40 and older (p = 0.0039, OR = 6.48, 95% CI 1.86–22.61), longer disease duration (p = 0.0234), pre‐treatment interleukin‐6 level over 2 pg/mL (p = 0.0005, OR = 13.7, 95% CI 2.97–63), and over the reference threshold value 5.9 pg/mL (p = 0.0009, OR = 25.8, 95% CI 2.8–239) as well as presence of other autoimmune diseases (p = 0.038, OR = 7.0, 95% CI 1.14–42.97) were negative prognostic factors of treatment success. In conclusion, acridone acetic acid, sodium salt, emerges as an efficient option for stopping vitiligo progression.     

Association of TNF‐α polymorphisms with adult dermatomyositis and systemic lupus erythematosus in Bulgarian patients

Background Single‐nucleotide polymorphisms (SNPs) of tumor necrosis factor‐alpha (TNF‐α) have been implicated in various autoimmune diseases; however, the results are quite controversial, and there is still no widely accepted opinion about their role in the pathology of the autoimmune diseases. This is a pilot study to investigate the association of six SNPs of the TNF‐α gene with the risk of adult dermatomyositis (DM) and systemic lupus erythematosus (SLE) in Bulgarian patients. Materials and methods Twenty‐seven patients with DM and 27 with SLE were included in this study. Genomic DNA was extracted from the peripheral blood, and six SNPs (?1031T/C, ?863C/A, ?857C/T, ?308G/A, ?238G/A, +489G/A) were selected for investigation by polymerase chain reaction‐restriction fragment length polymorphism analysis. Results We found association between the TNF‐α?1031CC genotype and SLE (P = 0.025) and tendency for association with DM (P = 0.0876). The association appeared even stronger in the female patients with SLE (P = 0.024) and DM (P = 0.067). The TNF‐α?857GG genotype shows weak association with SLE (P = 0.097, OR 2.06, 95% CI 0.81–5.29) when analyzed for the whole group, but it appeared significantly associated with SLE in women (P = 0.048, OR 3.23, 95% CI 0.93–11.14). The ?863C allele showed association with arthritis in patients with SLE (P = 0.008). The haplotype analysis revealed a significant association between TNF ?1031C/?863C/?857C/?308G/+489G haplotype with both DM (P = 0.022) and SLE (P = 0.007) in women. Conclusions The TNF‐α polymorphisms are associated with increased relative risk mainly for SLE, particularly in women, while their role for DM is less evident and needs further analysis in an enlarged sample cohort.     

Association of FCGR2A-R/H131 polymorphism with susceptibility to systemic lupus erythematosus among Asian population: a meta-analysis of 20 studies

The results of studies on association between FCGR2A-R/H131 polymorphism and susceptibility to systemic lupus erythematosus (SLE) in the Asian population are controversial. To derive a more precise estimation on the genetic risk of FCGR2A-R/H131 variant for SLE in Asians, a meta-analysis was performed for genotypes R/R + R/H (dominant effect), R/R (recessive effect), and R allele in fixed/random effects models. Twenty studies involving 4,832 SLE patients and 6,190 controls were included. The meta-analysis showed that FCGR2A-R/H131 variant was associated with development of SLE in overall Asians both at allele or genotype level (R vs H, OR 1.201, 95 % CI 1.098–1.315; RR + RH vs HH, OR 1.369, 95 % CI 1.115–1.682; RR vs RH + HH, OR 1.305, 95 % CI 1.029–1.654). After stratification by ethnic, a significant association of R allele with susceptibility to SLE was observed in the Chinese population (R vs H, OR 1.104, 95 % CI 1.030–1.183). Evidence from subgroup analyses in non-Chinese populations (all Asians excluding Chinese population) also showed a significant association (R vs H, OR 1.354, 95 % CI 1.207–1.519; RR + RH vs HH, OR 1.705, 95 % CI 1.234–2.355). In addition, FCGR2A-R131 allele was associated with a 1.186-fold (95 % CI 1.043–1.349) greater risk for the occurrence of nephritis in the Asians population with SLE. After stratification by ethnic, this significant association was only consistently identified in non-Chinese populations (R vs H, OR 1.220, 95 % CI 1.002–1.486). In summary, FCGR2A-R/H131 polymorphism is associated with SLE and lupus nephritis in Asians.     

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.     

Cardiovascular disease risk factors in patients with hidradenitis suppurativa: a systematic review and meta‐analysis of observational studies

Hidradenitis suppurativa (HS) is a chronic, inflammatory, debilitating skin disease. The aim of the study was to systematically review the literature and critically answer the question: In patients with HS, do cardiovascular risk factors appear at a significantly higher rate compared with controls? The main search was conducted in Medline, Embase and the Cochrane Central Register. Studies eligible for inclusion were of case–control, cross‐sectional and cohort design, and included comparison of any cardiovascular risk factor(s) in patients with HS with those of control groups. An I² value > 50% was considered to show substantial heterogeneity. In this case, DerSimonian and Laird random‐effect models were considered to compute pooled odds ratios (OR). Otherwise, a fixed‐effects model was suitable. Nine studies, with 6174 patients with HS and 24 993 controls, were included. Significant association of HS with obesity [OR 3·45, 95% confidence interval (CI) 2·20–5·38, P < 0·001], central obesity (OR 2·97, 95% CI 1·41–6·25, P = 0·004), active smoking (OR 4·34, 95% CI 2·48–7·60, P < 0·001), history of smoking (OR 6·34, 95% CI 2·41–16·68, P < 0·001), hypertriglyceridemia (OR 1·67, 95% CI 1·14–2·47, P = 0·009), low high‐density lipoprotein (HDL) (OR 2·48, 95% CI 1·49–4·16, P < 0·001), diabetes (OR 2·85, 95% CI 1·34–6·08, P = 0·007) and metabolic syndrome (OR 2·22, 95% CI 1·62–3·06, P < 0·001) was detected. Associations were significant both in population and hospital patients with HS, with hospital HS groups having uniformly higher ORs than the population HS groups. Causality could not be assessed. Heterogeneity was substantial in all analyses. This systematic review indicated that cardiovascular risk factors appear at a significantly higher rate in patients with HS compared with controls. The need for screening of patients with HS for modifiable cardiovascular risks is emphasized.     

Factores de riesgo de carcinoma espinocelular,un estudio del Centro Nacional de Dermatología de Colombia

IntroductionNonmelanoma skin cancer is the most common malignancy in white individuals. The risk factors for squamous cell carcinoma, which belongs to the family of nonmelanoma skin cancers, have not been studied in Colombia.ObjectiveTo determine the risk factors for squamous cell carcinoma in patients at a national referral center for skin diseases in Colombia.Material and methodsWe conducted a case-control study that evaluated sociodemographic, epidemiological, and clinical factors among 332 individuals. Risk was calculated as odds ratio (ORs) using the multivariate conditional logistic regression analysis method.ResultsThe following risk factors were identified: family history of skin cancer (OR, 6.55; 95% CI, 1.4-28.9), living in a rural area after the age of 30 years (OR, 3.13; 95% CI, 1.3-7.2), a lifetime working outdoors (OR, 2.98; 95% CI, 1.5-5.7), smoking more than 10 cigarettes a day (OR, 2.96; 95% CI, 1.3-6.5), actinic conjunctivitis (OR, 2.68; 95% CI, 1.2-5.9), poikiloderma of Civatte (OR, 3.29; 95% CI, 1.7-6.1), numerous facial actinic keratoses (OR, 9.23; 95% CI, 4.9-17.1), and numerous freckles (OR, 3.68; 95% CI, 1.3-10.1).ConclusionsWe have documented clinical characteristics and personal history factors that should guide the physician in making decisions on the preventive and follow-up measures to be adopted for individuals at risk of squamous cell carcinoma. These findings may help guide policy for controlling the disease using local information.     

A cross-sectional epidemiological study conducted in Argentina to evaluate the impact of the exposome on skin aging

Background

Skin aging is a gradual cumulative process that may be accelerated by various exposome factors.

Aims

To investigate associations between exposome factors and facial skin aging in 11 locations in Argentina.

Patients/Methods

An observational, cross-sectional study with assessments by exposome questionnaire, Glogau photoaging classification from I to IV, AI-based algorithm analysis of 7 skin aging signs, and SCINEXA score.

Results

Of 1346 participants, most were women (82%), aged 31–50 years (62%), of skin phototype III (52%), and living in urban areas (94%). The Glogau skin age was higher than the chronological age for 28% of overall participants, 36% of men, and 45% of participants from Ciudad de Buenos Aires versus 12% from Jujuy (p < 0.001). Being male (OR = 1.59; 95% CI 1.18–2.13), exposed to agrochemicals (OR = 1.59: 95% CI 1.01–2.51), of lower socioeconomic levels (OR = 2.06; 95% CI 1.32–3.21) and doing outdoor physical activity (OR = 1.33; 95% CI 1.00–1.76) increased the risk for premature aging. Odds decreased with high daily intake of water (OR = 0.76; 95% CI 0.59–0.97), daily dermocosmetic use (moisturizers [OR = 0.72; 95% CI 0.55–0.94], cleansers [OR = 0.53; CI 95% 0.42–0.67], retinoids [OR = 0.61; 95% CI 0.39–0.95]), and antiaging treatments (OR = 0.74; 95% CI 0.57–0.97).

Conclusions

Some exposome factors increased the risk for premature skin aging (physical outdoor activity, exposure to agrochemicals), while others were protective factors (high water intake, antiaging treatments, use of dermocosmetics). Locations with higher pollution levels had more premature skin aging.     

Androgen receptor gene polymorphisms and risk for androgenetic alopecia: a meta-analysis

Background. Numerous studies have shown an association between polymorphisms in the androgen receptor gene (AR) and the risk for androgenetic alopecia (AGA), but the overall results are still controversial. Aim. To determine, by conducting a meta‐analysis, whether the common AR gene polymorphisms confer susceptibility to AGA. Methods. Publications addressing the association between AR gene polymorphisms and risk for AGA were selected from the PubMed, EMBASE and CBMdisc databases. Data were extracted from the studies by two independent reviewers. The meta‐analysis was performed using the software programs RevMan (version 5.0.25) and STATA (version 9.2). From these data, odds ratio (OR) with 95% confidence interval (CI) was calculated. Results. Only eight studies were found, reporting a total of 2074 patients with AGA and 1115 healthy controls. Three common polymorphisms of the AR gene were addressed: a StuI restriction‐site polymorphism (rs6152, G>A), and CAG and GGC triplet‐repeat polymorphisms. Meta‐analysis results identified a significant association between the G allele of the AR StuI polymorphism and the risk for AGA (OR = 2.68, 95% CI 1.71–4.19, P < 0.01), especially in white populations (OR = 2.76, 95% CI 1.71–4.45, P < 0.01). No association was found between the CAG or GGC polymorphism and the risk for AGA (OR = 0.81, 95% CI 0.49–1.34, P = 0.41; OR = 1.01, 95% CI 0.47–2.14, P = 0.99, respectively). Conclusion. Our meta‐analysis suggests that the G allele of AR StuI polymorphism might be a potential risk factor for AGA, especially in white populations. However, we did not find any obvious association of the CAG and GGC triplet‐repeat polymorphisms of the AR gene with risk for AGA.     

Relationship between smoking and the clinical severity of psoriasis

OBJECTIVE: To evaluate the association between different components of smoking history and the clinical severity of psoriasis. DESIGN: A hospital-based cross-sectional study. SETTING: Inpatient wards of a hospital for skin diseases in Rome, Italy. PATIENTS: A total of 818 adults with psoriasis. MAIN OUTCOME MEASURE: The Psoriasis Area and Severity Index was used to assess the clinical severity of psoriasis between February 21, 2000, and February 19, 2002. RESULTS: After adjustment for potential confounders (sex, age, body mass index, psychological distress, family history of psoriasis, duration of psoriasis disease, and alcohol consumption), high intensity of smoking (>20 cigarettes daily) vs a lower level of consumption (< or =10 cigarettes daily) was associated with a more than 2-fold increased risk of clinically more severe psoriasis (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.2-4.1). Cigarette-years, measured as the product of the intensity and duration (years) of smoking, significantly increased the risk of clinically more severe psoriasis after adjustment for confounding factors (OR,1.3; 95% CI, 1.0-1.6, for a 600-U increase in cigarette-years). Separate analyses for men and women showed that the effect of cigarette-years was stronger for women (OR, 1.8; 95% CI, 1.2-2.6, for a 400-U increase in cigarette-years) than for men (OR, 1.2; 95% CI, 0.9-1.6, for a 700-U increase in cigarette-years). CONCLUSION: Smoking is associated with the clinical severity of psoriasis and highlights the importance of smoking cessation in patients with psoriasis.     

Factors affecting vaginal pH levels among female adolescents attending genitourinary medicine clinics

OBJECTIVES: Vaginal pH is related to hormonal status, and adolescents experience disturbed hormonal patterns following menarche. We assessed hormonal factors and risk of abnormal vaginal pH and bacterial vaginosis (BV) among adolescents attending genitourinary medicine (GUM) clinics. METHODS: In a cross sectional study adolescents within 5 years of menarche, < or =17 years, or with oligo-amenorrhoea were recruited. Vaginal pH and BV were assessed and among those not using hormonal contraceptives, estrone-3-glucuronide (E3G) and pregnanediol-3alpha-glucuronide (P3G) concentrations were measured. RESULTS: Among 102 adolescents, 59.8% (61) had a high vaginal pH (>4.5), which was higher than the prevalence of BV, detected in 33% (34). No association was found between presence of sexually transmitted infections (STI) and vaginal pH. In logistic regression, after controlling for BV and condom use, vaginal pH was positively associated with cervical ectopy (OR = 2.5; 95% CI 1.0 to 6.6, p = 0.05) and STI treatment history (OR = 2.5; 95% CI 0.9 to 6.5, p = 0.07), and negatively associated with use of Depo-Provera (OR = 0.1; 95% CI 0.03 to 0.6, p = 0.003) and recent onset (<12 months) of sexual activity (OR = 0.2; 95% CI 0.1 to 0.7, p = 0.004). Among 23 adolescents not using hormonal contraceptives, a high pH occurred more often in abnormal compared to normal menstrual cycles (OR = 10.8; 95% CI 1.4 to 85.4; p = 0.026). E3G concentrations were inversely correlated with vaginal pH in the follicular phase (Spearman: r = 0.51; p = 0.024). CONCLUSIONS: Ectopy and abnormal menstrual cycles are common features of adolescence. Their presence is associated with increased risk of abnormal pH, and may also predispose to BV.     

Lack of evidence for a protective effect of prolonged breastfeeding on childhood eczema: lessons from the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Two

Summary Background Exclusive breastfeeding for at least 4 months is recommended by many governments and allergy organizations to prevent allergic disease. Objectives To investigate whether exclusive breastfeeding protects against childhood eczema. Methods Study subjects comprised 51 119 randomly selected 8‐ to 12‐year‐old schoolchildren in 21 countries. Information on eczema and breastfeeding was gathered by parental questionnaire. Children were also examined for flexural eczema and underwent skin prick testing. Odds ratios (ORs) were calculated for each study centre and then pooled across populations. Results There was a small increase in the risk of reported ‘eczema ever’ in association with ‘breastfeeding ever’ and breastfeeding < 6 months [pooled adjusted OR 1·11, 95% confidence interval (CI) 1·00–1·22 and OR 1·10, 95% CI 1·02–1·20, respectively]. There was no significant association between reported ‘eczema ever’ and breastfeeding > 6 months (pooled adjusted OR 1·09, 95% CI 0·94–1·26). Risk estimates were very similar for exclusive breastfeeding < 2 months, 2–4 months and > 4 months and for eczema symptoms in the past 12 months and eczema on skin examination. As for more severe eczema, breastfeeding per se conveyed a risk reduction on sleep disturbed eczema (pooled adjusted OR 0·71, 95% CI 0·53–0·96), but this effect was lost where children had been exclusively breastfed for > 4 months (pooled adjusted OR 1·02, 95% CI 0·67–1·54). Allergic sensitization and a history of maternal allergic disease did not modify any of these findings. Conclusions Although there was a protective effect of ever having been breastfed on more severe disease, we found no evidence that exclusive breastfeeding for 4 months or longer protects against eczema. Our results are consistent with findings from a recent systematic review of prospective studies. The U.K. breastfeeding guidelines with regard to eczema should be reviewed. Intervention studies are now required to explore how and when solids should be introduced alongside breastfeeding to aid protection against eczema and other allergic diseases.     

Risk factors associated with having psoriatic arthritis in patients with cutaneous psoriasis

The aim of this study was to determine if the following characteristics were associated with the presence of psoriatic arthritis in a sample of psoriasis patients: race, family history of psoriasis and psoriatic arthritis, age of onset of psoriasis, smoking, alcohol consumption and the maximum body surface area (BSA) affected by psoriasis. This was a case–control study involving 400 psoriasis patients who attended the Psoriasis and Photo‐medicine clinic in the National Skin Center of Singapore over a 1‐year period. Cases were psoriasis patients with psoriatic arthritis while controls were psoriasis patients without psoriatic arthritis. The diagnosis of psoriatic arthritis was made by rheumatologists and participants completed a self‐administered standardized questionnaire. The maximum BSA involved was determined from the case notes. Psoriatic arthritis was not significantly associated with sex, race, age of onset of psoriasis, a family history of psoriasis, smoking and alcohol consumption but was significantly associated with a family history of psoriatic arthritis (P < 0.001) and the maximum body surface involved (P = 0.05). Using multivariate analysis to control for variables, the presence of psoriatic arthritis was significantly associated with a family history of psoriatic arthritis (odds ratio [OR] = 20.5; 95% confidence interval [CI] = 2.49–169.10) and the maximum BSA involved (OR = 2.52; 95% CI = 1.33–4.75). Indian psoriatic patients were more likely to have psoriatic arthritis compared to the other races. A family history of psoriatic arthritis and a greater maximum body surface involved may be associated with having psoriatic arthritis in this study population of psoriasis patients.     

Prevalence of myocardial infarction in patients with psoriasis in central China

Objective To explore whether the prevalence of myocardial infarction (MI) was higher in psoriatics than in patients without psoriasis, and whether major cardiovascular risk factors were associated with psoriasis in central China. Methods Data were collected at Medical Records Section of Affiliated Union Hospital, Tongji Hospital, Wuhan Iron and Steel Company General Hospital and No. 1 Hospital of Wuhan between 1999 and 2007. Patients with psoriasis were classified as severe if they ever received a systemic therapy. And patients were classified as having risk factors if they received codes for diabetes, hypertension, hyperlipidemia, or smoking. Controls without psoriasis were randomly selected from the Physical Examination Centre in the Affiliated Union Hospital. Analysis was performed by using conditional logistic regression, and adjustments were made for age and sex. Results There were 45 MIs (2.96%) within the control population and 97 (6.00%) and 118 (8.01%) MIs within the mild and severe psoriasis groups, respectively. Respective odds ratio (OR) and 95% confidence interval (95% CI) of cardiovascular risk factors in those with mild psoriasis than controls were as follows: obesity (OR, 1.41; 95% CI, 1.08–1.85), diabetes (OR, 1.45; 95% CI, 1.11–1.91), hypertension (OR, 1.39; 95% CI, 1.04–1.85), hyperlipidemia (OR, 1.37; 95% CI, 1.06–1.78) and smoking (OR, 1.35; 95% CI, 1.01–1.80). Patients with severe psoriasis had higher adjusted odds of obesity (OR, 1.51; 95% CI, 1.15–1.98), diabetes (OR, 1.69; 95% CI, 1.32–2.17), hypertension (OR, 1.41; 95% CI, 1.06–1.88), hyperlipidemia (OR, 1.43; 95% CI, 1.11–1.84), and smoking (OR, 1.57; 95% CI, 1.20–2.05) than patients with mild psoriasis and controls. After adjusting for systemic therapies and cardiovascular risk factors (obesity, diabetes, hypertension, hyperlipidemia and smoking) in addition to age and sex, for patients with mild or severe psoriasis, the OR of having an MI was 1.72 (95% CI, 1.29–2.30) and 2.01 (95% CI, 1.45–2.79), respectively. Conclusions The prevalence of MI is higher in mild andsevere psoriasis than in patients without psoriasis in central China. In addition, MI and major cardiovascular risk factors (e.g. diabetes, hypertension, hyperlipidemia and smoking) are associated with psoriasis in central China.     

Risk factors associated with rosacea

Background Although rosacea is a common disease, the cause of disease is still a mystery –Helicobacter pylori infection, genetic predisposition, climatic factors, and detrimental habits are implicated as triggers of rosacea. Objective The aim of current study is to evaluate several suspected risk factors coincidently. Methods Patients with rosacea from a dermatology clinic and skin‐healthy controls from an randomly selected employees' population enrolled the study. Skin status were evaluated by one and same dermatologist. Participants were queried for age, gender, sun‐reactive skin type, and detrimental habits using a questionnaire; blood samples for detecting Helicobacter pylori serostatus were collected. Results Totally 145 skin‐healthy controls and 172 subjects either with flushing episodes or established rosacea included the study. In multivariate analysis, rosacea patients had significantly higher chance to have photosensitive skin types (OR 1.75; 95% CI 1.01–3.04; P < 0.05), positive family history to rosacea (OR 4.31; 95% CI 2.34–7.92; P < 0.0001) or previous smoking status (OR 2.01; 95% CI 1.07–3.80; P < 0.05) comparing with skin‐healthy controls. There were no statistically significant differences either in gender, Helicobacter pylori serostatus, caffeine intake, alcohol consumption, occupational environment, or education level between rosacea patients and controls. Conclusion Rosacea is foremost associated with familial predisposition. There is no association between Helicobacter pylori infection and rosacea in current study.     

Sex partner concurrency: measurement, prevalence, and correlates among urban 18-39-year-olds

BACKGROUND: Sex partner concurrency probably accelerates the spread of sexually transmitted disease (STD) and HIV, yet few data exist on population prevalence or correlates. GOAL: The goal of the study was to compare definitions and estimate the frequency of concurrent partnerships and to identify individual and partnership correlates of con-currency. STUDY DESIGN: A random-digit-dialing survey (n = 637) was performed to collect demographic information, sexual history and history of STD, and partnership characteristics. RESULTS: Men reported concurrency more frequently than women. For men, lifetime partners (odds ratio [OR], 1.15 per partner; 95% CI, 1.07-1.23), a night in jail (OR, 1.99; 95% CI, 1.03-3.82), and same sex partners (OR, 1.88; 95% CI, 0.92-3.84) were associated with concurrency. Important factors for women were first coitus before age 16 (OR, 2.90; 95% CI, 1.38-6.10), lifetime partners (OR, 1.09 per partner; 95% CI, 1.01-1.16), and STD diagnoses during relationship (OR, 3.53; 95% CI, 1.55-8.05). Partnership characteristics associated with concurrency included lifetime partners (OR, 1.09; 95% CI, 1.05-1.14), race discordance (OR, 1.72; 95% CI, 1.14-2.59), married/living together (OR, 0.60; 95% CI, 0.36-0.98), night in jail (OR, 2.04; 95% CI, 1.32-3.17), partnership duration of >6 months (OR, 2.43; 95% CI, 1.41-4.19), and STD diagnoses during relationship (OR, 2.68; 95% CI, 1.42-5.07). CONCLUSIONS: Concurrency was independently associated with individual STD risk. Sex differences may reflect true behavioral differences or differential reporting.     

Substantial skin disorders in psychiatric illness coincide with diabetes and addiction

Background Dermatological diseases in psychiatric patients are common; however, epidemiological data on this subject are scarce and to our knowledge integral studies of dermatological disease in psychiatric inpatients are not available yet. Aim The aim of this study was to describe the incidence of dermatological problems in psychiatric inpatients. Method This study evaluates the consultations for new dermatological problems by inpatients of a general psychiatric hospital of over 700 beds during a 6‐month period. Results A total of 255 patients consulted their physician because of a new dermatological problem. Diagnoses (n = 360) included skin infections (32%), accidents (7%), decubitus ulcers (7%), complications of medical treatment (3%), auto mutilation (1%) and neoplasms of the skin (1%). Patients with skin infections were likely to have diabetes [odds ratio (OR) = 3.6; 95% confidence interval (CI): 1.56–8.40]. Patients with decubitus ulcers were likely to have an addiction problem (OR = 6.4; 95% CI: 1.46–28.00). Dermatitis was associated with affective disorder (OR = 2.5; 95% CI: 1.12–5.43) but not with psychosis (OR = 0.5; 95% CI: 0.23–0.90). Only a poor correlation existed between the length of hospital stay and skin problems. Conclusions Dermatological problems are common in hospitalized psychiatric patients. Patients with diabetes mellitus are at high risk for skin infections. There are significant relationships between the psychiatric and the dermatological diagnoses. The length of the admission to a psychiatric hospital does not seem to play a major role in skin diseases.     

Tumor necrosis factor alpha promoter-308G/A polymorphism in Mexican patients with patchy alopecia areata

Background Alopecia areata (AA) is a chronic inflammatory condition characterized by hair loss, most frequently from the scalp. Its etiopathogenesis is currently unknown, but inflammatory traits and associations with autoimmune diseases suggest that AA shares a similar origin. The tumor necrosis factor alpha (TNFα) gene, located on chromosome 6 within the major histocompatibility complex class III gene, may carry previously described polymorphisms – particularly in the promoter region, such as TNFα‐308G/A – known to be risk factors in a wide variety of inflammatory pathologies. In Mexican populations, this polymorphism has been associated with augmented TNFα production and, thus, renders carriers more susceptible to developing autoimmune diseases; however, as yet it has not been associated with AA. Objectives To assess a possible association between the presence of TNFα‐308G/A and patchy AA. Materials and methods Blood samples were taken from 59 patients affected by patchy AA and 103 control subjects without AA, all from the northeastern Mexican population. Genomic DNA was isolated using the phenol‐chloroform method and samples subjected to polymerase chain reaction‐restriction fragment length polymorphism in order to detect the TNFα‐308G/A polymorphism. Results TNFα‐308G/A (TNF2) allele [odds ratio (OR) = 3.22, P = 0.026, 95% confidence interval (CI) = 0.99–11.61], when segregated in the heterozygous (TNF1/TNF2) genotype (OR = 3.53, P = 0.023, 95% CI = 1.01–12.89) confers a significant risk for developing AA, compared with the genotype TNF1/TNF1 observed in controls (OR = 0.28, P = 0.023, 95% CI = 0.08–0.99). Conclusions Our data suggest that there is a plausible association between the presence of the TNFα‐308G/A polymorphism and a higher susceptibility for developing patchy AA. This risk might be due to overproduction of TNFα, which would facilitate an autoimmune response against the hair follicle.     

Risk factors for nonpurulent leg cellulitis: a systematic review and meta‐analysis

Nonpurulent cellulitis is an acute bacterial infection of the dermal and subdermal tissues that is not associated with purulent drainage, discharge or abscess. The objectives of this systematic review and meta‐analysis were to identify and appraise all controlled observational studies that have examined risk factors for the development of nonpurulent cellulitis of the leg (NPLC). A systematic literature search of electronic databases and grey literature sources was performed in July 2015. The Newcastle–Ottawa Scale (NOS) was used to assess methodological quality of included studies. Of 3059 potentially eligible studies retrieved and screened, six case–control studies were included. An increased risk of developing NPLC was associated with previous cellulitis [odds ratio (OR) 40·3, 95% confidence interval (CI) 22·6–72·0], wound (OR 19·1, 95% CI 9·1–40·0), current leg ulcers (OR 13·7, 95% CI 7·9–23·6), lymphoedema/chronic leg oedema (OR 6·8, 95% CI 3·5–13·3), excoriating skin diseases (OR 4·4, 95% CI 2·7–7·1), tinea pedis (OR 3·2, 95% CI 1·9–5·3) and body mass index > 30 kg m⁻² (OR 2·4, 95% CI 1·4–4·0). Diabetes, smoking and alcohol consumption were not associated with NPLC. Although diabetics may have been underrepresented in the included studies, local risk factors appear to play a more significant role in the development of NPLC than do systemic risk factors. Clinicians should consider the treatment of modifiable risk factors including leg oedema, wounds, ulcers, areas of skin breakdown and toe‐web intertrigo while administering antibiotic treatment for NPLC.