Is Eczema Associated With Celiac Disease?
A recent study showed a significant association between atopic dermatitis (AD) and celiac disease.
The cross-sectional, observational study included 116,816 patients enrolled in a large health management organization who were diagnosed with AD from 2002 to 2017. Among these patients, 45,157 were adults, and 1909 adult patients had moderate to severe AD. The presence of celiac disease and celiac disease-related morbidities were identified among all patients with AD, adults with AD, and adults with moderate to severe AD and compared with controls without AD.
The prevalence rate of celiac disease among all patients with AD was 0.6% vs 0.4% among controls; 0.6% among adults with AD vs 0.3% among matched controls; and 0.8% among adults with moderate to severe AD vs 0.3% among matched controls.
In multivariate analysis, researchers found AD was associated with significantly higher prevalence of celiac disease (odds ratio, 1.609; 95% CI, 1.42-1.82) in the entire study population and each subgroup.
“This association emphasizes the need for timely screening of gastrointestinal morbidities in individuals with [AD] to prevent long-term complications,” the researchers concluded.
Reference
Shalom G, Kridin K, Raviv KO, et al. Atopic dermatitis and celiac disease: a cross-sectional study of 116,816 patients [published online November 2, 2019]. Am J Clin Dermatol. doi:10.1007/s40257-019-00474-2
Over 70% of Patients With HS Make Dietary Changes
Nearly 75% of patients with hidradenitis suppurativa (HS) report changing their diet to help manage their disease, according to the findings of a recent study.
“People with HS are interested in dietary alterations to manage the condition. However, there are few data on the prevalence of this or the impact on HS activity,” the researchers concluded.
In the cross-sectional survey, researchers investigated the prevalence and impact of dietary alterations among 242 participants with HS. On the survey, participants reported food alterations in the prior 6 months.
A total of 182 participants (75.8%) reported altering at least one food from their diet, the researchers said, and 154 participants in this group (84.6%) made changes to multiple food groups. Overall, 30.9% of participants reported these changes made their HS “much better,” the researchers added.
The five food groups that were altered were gluten (48.8%), dairy (44.2%), refined sugars (40%), tomatoes (36.7%), and alcohol (3.1%). In addition, 27.5% of participants eliminated smoking.
“Dietary alteration to manage HS was common among participants in this study. Some people reported improvement in HS activity, but some noted worsening,” the researchers said. “Additional research is needed to evaluate the efficacy of dietary alteration to manage HS and to better understand the underlying pathomechanisms.”
Reference
Dempsey A, Butt M, Kirby JS. Prevalence and impact of dietary avoidance among individuals with hidradenitis suppurativa [published online November 1, 2019]. Dermatology. doi:10.1159/000503063
Patients With Psoriasis Have Over Two-fold Odds of HS
Hidradenitis suppurativa (HS) was strongly associated with psoriasis, according to the findings of a recent study.
“HS and psoriasis appear to share important pathogenic elements,” the researchers said. “In spite of this, the co-occurrence of the [two] has been widely unexplored.”
In the study, the researchers assessed the co-occurrence of psoriasis and HS among patients who attended an outpatient clinic at Zealand University Hospital in Roskilde, Denmark. They compared data with previously reported Danish national prevalence rates for HS and psoriasis.
A total of 1036 patients were included, 440 with HS, 624 with psoriasis, and 28 with both.
Overall, 6.4% of patients with HS had psoriasis, and 4.5% of patients with psoriasis had HS, the researchers said. Compared with the background population, patients with HS had an odds ratio (OR) for psoriasis of 2.99 (95% CI, 2.04-4.38) and patients with psoriasis had an OR for HS of 2.56 (95% CI, 1.74-3.77).
“We found a strong association between HS and psoriasis, which implies a possible comorbidity between psoriasis and HS that has not previously been properly elucidated,” the researchers concluded. “Such a connection could be a common inflammatory pathway driven by the increased secretion of IL-12/23 and tumor necrosis factor-α that is a hallmark of both diseases.” n
Reference
Andersen RK, Saunte SK, Jemec GBE, Saunte DM. Psoriasis as a comorbidity of hidradenitis suppurativa [published online Oct 8, 2019]. Int J Dermatol. doi:10.1111/ijd.14651
Recommendations for Opioid Use in Dermatology
Most pain following dermatologic procedures can be managed with acetaminophen and ibuprofen, said the authors of a recently published consensus on opioid use in dermatologic surgery.
“Opioid overprescribing is a major contribute to the opioid crisis,” the authors said. One contributing factor to overprescribing is the lack of procedure-specific guidelines, they added.
To create opioid-prescribing consensus guidelines, the authors conducted a systematic discussion among a panel of providers in general dermatology, dermatologic surgery, and cosmetics and phlebology using a four-step modified Delphi method. They developed guidelines for common dermatologic procedural scenarios for opioid-naïve patients and defined opioid tablets as oxycodone 5-mg oral equivalents.
Acetaminophen and/or ibuprofen can adequately manage postoperative pain after most uncomplicated procedures, the authors said. The consensus group also found no specific dermatological scenario that required more than 15 oxycodone 5-mg oral equivalents to manage pain after procedures. In addition, 23% of procedural scenarios were found to routinely require 1 to 10 opioid tablets but only one scenario routinely required 1 to 15 opioid tablets, they added.
“Procedure-specific opioid-prescribing guidelines may serve as a foundation to produce effective and responsible postoperative pain management strategies after dermatologic interventions,” the authors concluded.
“These recommendations are based on expert consensus in lieu of quality evidence-based outcomes research,” they added, and should be individualized based on patient factors, including comorbidities.
Reference
McLawhorn JM, Stephany MP, Bruhn WE, et al. An expert panel consensus on opioid-prescribing guidelines for dermatologic procedures [published online November 12, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.09.080
Does Body Weight Affect Psoriasis Risk?
High body weight variability appeared to be associated with an increased risk for developing psoriasis, according to the findings of a recent study in Journal of the European Academy of Dermatology and Venereology.
“Body weight variability has been suggested to exacerbate chronic inflammation and increase the risk of adverse cardiovascular events,” the researchers said. They investigated the association between weight variability and psoriasis risk using data from a representative cohort enrolled in the national health examination program conducted by the Korean National Health Insurance Service. A total of 8,016,907 individuals free of psoriasis at baseline and who underwent at least three health examinations between 2010 and 2015 were included in the study and followed until the end of 2017.
Participants were classified numerically based on variability indices and stratified into quartiles. Cox proportional hazard regression models were used to determine the risk of psoriasis based on quartile groups of body weight variability.
During the median 3.4 years of follow up, 187,128 participants developed psoriasis (2.33%), the researchers said. They found an association between baseline body mass and the risk of psoriasis.
After adjusting for confounding variables, the researchers observed an incrementally increased risk of psoriasis for higher quartiles compared with the lowest quartile group, with a hazard ratio of 1.06 (95% CI, 1.05-1.07).
“High body weight variability was significantly associated with an increased risk of psoriasis,” the researchers concluded. “These findings imply that clinicians should encourage patients to maintain proper body weight to help prevent psoriasis.”
Reference
Kim M, Han KD, Lee JH. Body weight variability and the risk of psoriasis: a nationwide population-based cohort study [published online November 20, 2019]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.16099
