Editor’s Choice December 2012

Course of ICD related to filaggrin and atopy

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This prospective cohort study included 327 (71·2%) atopic individuals and 132 nonatopic individuals. Sixty-eight patients showed a mutation in the filaggrin gene (FLG) alleles R501X, R2447X, S3247X and 2282del4 (60 atopic and eight nonatopic). Nonatopic patients with irritant contact dermatitis (ICD) responded well to therapeutic approaches, while atopy status made subjects more resistant to therapy, resulting in lower rates of recovery and job continuation, and higher use of topical corticosteroids. Carriage of FLG loss-of-function mutations in combination with atopy worsened the course. The risk of abandoning one’s profession in this group was significantly increased when compared with ‘pure’ ICD (odds ratio 3·1) after 3 years. It is concluded that in the presence of atopic dermatitis, FLG mutations seem to be a modifier of the severity of the clinical course in ICD.

Landeck L, Visser M, Skudlik C et al. Clinical course of occupational irritant contact eczema of the hands in relation to filaggrin genotype status and atopy. Br J Dermatol 2012; 167: 302–09.

doi: 10.1111/bjd.12035

Psoriasis, stroke and myocardial infarction

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Seven cohort studies were included in the meta-analysis, five considered good quality and two fair. The overall combined relative risk for psoriasis and composite vascular endpoint was 1·2 (95% confidence interval 1·1–1·31). Subgroup analysis maintained this significance with respect to stroke and myocardial infarction (MI) individually. Sensitivity analysis and the ‘trim and fill’ method yielded similar results. No evidence of publication bias was observed. Results suggest that psoriasis significantly increases the risk of stroke and MI. The increase is probably independent of conventional cardiovascular risk factors.

Xu T, Zhang Y-H. Association of psoriasis with stroke and myocardial infarction: meta-analysis of cohort studies. Br J Dermatol 2012; 167: 1345–50.

doi: 10.1111/bjd.12002

Risk of second primary ­melanoma, ­Netherlands Cancer Registry, 1989–2008

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This is the first large, European, population-based study that has observed long-term increased risks of a second primary invasive melanoma after a first in situ (20-year cumulative risk = 6·2%) and invasive melanoma (20-year cumulative risk = 5·0%). A total of 10 765 patients with in situ melanoma and 46 700 with invasive melanoma were included in this study. The relative risk of developing any melanoma (in situ or invasive) after any first melanoma (measured as standardized incidence ratio, SIR) varied from 12·4-fold to 26·4-fold increase compared with the general population. SIRs and absolute excess risk remained elevated up to 20 years after the first melanoma.

van der Leest RJT, Liu L, Coebergh JWW et al. Risk of second primary in situ and invasive melanoma in a Dutch population-based cohort: 1989–2008. Br J Dermatol 2012; 167: 1321–30.

doi: 10.1111/j.1365-2133.2012.11123.x

IL2RA and TNF/LTA ­associated with alopecia areata

Redler et al. investigated the association between alopecia areata (AA) and selected cytokine genes using a sample of 768 patients with AA and 658 controls of Central European origin. Significant association was found for two variants within both IL2RA and TNF/LTA. In the overall sample, the most significant results were obtained for the IL2RA variant rs706778 and the TNF/LTA locus variant rs1800629. In subgroup analyses, according to severity, age at onset and family history these effects were stronger in the severely affected patients, with the lowest P-values being obtained for rs706778 (= 3·8 × 10−6). Results support the hypothesis that the cytokine gene IL2RA and the TNF/LTA region influence susceptibility to AA and determine a severe disease course, and that AA is an autoimmune disease.

Redler S, Albert F, Brockschmidt FF et al. Investigation of selected cytokine genes suggests that IL2RA and the TNF/LTA locus are risk factors for severe alopecia areata. Br J Dermatol 2012; 167: 1360–65.

doi: 10.1111/bjd.12004