Risk of Bullous Pemphigoid and Pemphigus in Patients on Chronic Dialysis

Abstract

Bullous pemphigoid has a high incidence among dialysis patients. However, whether or not chronic dialysis is an independent risk factor of bullous pemphigoid remains unclear. We aimed to investigate the effect of chronic dialysis on the development of bullous pemphigoid and pemphigus. We performed a retrospective cohort study using records from Taiwan's National Health Insurance Research Database between 2008 and 2019. We identified a dialysis cohort that included patients on chronic hemodialysis and peritoneal dialysis, and the hazard ratios (HRs) for bullous pemphigoid and pemphigus were compared with those of a sex-, age-, and index-matched cohort, then the results were adjusted for various confounding factors. Among 93 538 patients on chronic dialysis and 93 538 patients in the control group, 287 and 139 developed incident bullous pemphigoid, and 45 and 35 developed incident pemphigus after a median follow-up of 3.7 and 5.6 years, respectively. The incidence rates of bullous pemphigoid in the dialysis patients and the control group were 74.2 and 25.2 per 100 000 person-years, respectively (difference between groups, P < 0.0001). The incidence rates of pemphigus in the dialysis patients and the control group were 11.6 and 6.3 per 100 000 person-years, respectively (difference between groups, P < 0.01). Cox proportional hazard adjustment showed the HR for bullous pemphigoid in dialysis patients was 2.12 (95% confidence interval [CI] 1.64-2.74, P < 0.0001) compared with the control group. Dialysis patients aged <75 years had an even higher risk of bullous pemphigoid development (5- to 8-fold) than the control group. The adjusted HR for pemphigus was not elevated in dialysis patients (adjusted HR 1.52, 95% CI 0.87-2.67, P = 0.14). Chronic dialysis is an independent risk factor for developing bullous pemphigoid, but not a risk factor for pemphigus. Physicians should be aware of the predisposition of chronic dialysis patients to bullous pemphigoid.

TAKE-HOME MESSAGE

• This retrospective cohort study from Taiwan found that the incidence rate of bullous pemphigoid per 100,000 person-years was 74.2 among patients undergoing chronic dialysis compared with 25.2 among those in the control group. Patients younger than 75 years undergoing dialysis were at five to eight times higher risk of developing bullous pemphigoid compared with those in the control group. The adjusted hazard ratio for pemphigus was not significantly higher in patients undergoing dialysis.
• Chronic dialysis is an independent risk factor for developing bullous pemphigoid.

–  Katherine M. Stiff, MD

The Journal of Dermatology

Risk of bullous pemphigoid and pemphigus in patients on chronic dialysis: A nationwide population-based cohort study

J Dermatol 2023 Sep 04;[EPub Ahead of Print], CH Tang, YM Sue, CL Chang, CC Wang 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
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Characteristics and Clinical Relevance of Sulfites: The Allergen of the Year 2024 | PracticeUpdate



https://www.practiceupdate.com/content/characteristics-and-clinical-relevance-of-sulfites-the-allergen-of-the-year-2024/156954

Characteristics and Clinical Relevance of Sulfites: The Allergen of the Year 2024

TAKE-HOME MESSAGE

• Sulfites are used in industrial processes, are found in mineral formations, and are in food/beverages and personal care products. These are commonly added as preservatives and/or antioxidants and are found in topical antifungals, topical steroids, local anesthetics, and prescription eye drops. Sulfite allergy most often presents as a facial or hand dermatitis. Sulfites are not included in many patch test series, despite their allergen prevalence ranging from 1.4% to 7.0% in recent reports.
• Sulfites are the American Contact Dermatitis Society Allergen of the Year for 2024. They are under-recognized. The authors recommend the inclusion of sulfites in the next American Contact Dermatitis Society Core Allergen Series.

–  Katherine M. Stiff, MD

Abstract 

Sodium disulfite, also known as sodium metabisulfite or sodium pyrosulfite, is an inorganic compound, which may cause allergic contact dermatitis. Sulfites act as antioxidants and preservatives; common sources include food/beverages, pharmaceuticals, and personal care products. Importantly, sulfites are not included in most screening patch test series and thus may be missed as a relevant contact allergen. The American Contact Dermatitis Society chose sulfites as the Allergen of the Year for 2024 to raise awareness about this significant allergen.

Dermatitis

Sulfites: Allergen of the Year 2024

Dermatitis 2023 Aug 17;[EPub Ahead of Print], SF Ekstein, EM Warshaw 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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Coronary Microvascular Dysfunction ID'd in 31.5 Percent With Psoriasis | PracticeUpdate

https://www.practiceupdate.com/c/157087/2/4/?elsca1=emc_enews_daily-digest&elsca2=email&elsca3=practiceupdate_derma&elsca4=dermatology&elsca5=newsletter&rid=NjA4ODYxMjU4ODkS1&lid=20845206

Coronary Microvascular Dysfunction ID'd in 31.5 Percent With Psoriasis

WEDNESDAY, Sept. 20, 2023 (HealthDay News) -- Coronary microvascular dysfunction (CMD) occurs in 31.5 percent of patients with psoriasis, with disease severity and duration associated with increased risk, according to a study published in the October issue of the Journal of Investigative Dermatology.

Stefano Piaserico, M.D., Ph.D., from the University of Padova in Italy, and colleagues examined the prevalence and predictors of CMD in a cohort of 448 patients with psoriasis without clinical cardiovascular disease. The participants underwent assessment of coronary microcirculation by transthoracic Doppler echocardiography.

The researchers found that 31.5 percent of the patients had CMD. Independent associations with CMD were seen for higher Psoriasis Area and Severity Index (PASI), longer disease duration, presence of psoriatic arthritis, and hypertension. The risk for CMD was increased 5.8 and 4.6 percent in association with an increase of 1 point of PASI and one year of psoriasis duration, respectively.

"Our findings extend the observations of earlier small studies by showing a high prevalence of coronary microvascular dysfunction in asymptomatic patients with severe psoriasis and by showing that the excess microvascular dysfunction is independently associated with the severity and duration of psoriasis," the authors write.

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Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
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Study Looks at Treatment Patterns for Alopecia Areata | PracticeUpdate

https://www.practiceupdate.com/c/157088/2/4/?elsca1=emc_enews_daily-digest&elsca2=email&elsca3=practiceupdate_derma&elsca4=dermatology&elsca5=newsletter&rid=NjA4ODYxMjU4ODkS1&lid=20845206

Study Looks at Treatment Patterns for Alopecia Areata

WEDNESDAY, Sept. 20, 2023 (HealthDay News) -- For patients with alopecia areata (AA), corticosteroids are the most commonly used treatment, and by one year, 71.8 percent are receiving no treatment, according to a study published online Sept. 20 in JAMA Dermatology.

Hemin Lee, M.D., M.P.H., from Brigham and Women's Hospital in Boston, and colleagues conducted a retrospective cohort study involving 45,483 individuals to review treatment patterns for adults newly treated for AA between Oct. 15, 2015, and Feb. 28, 2020.

The researchers found that 66.4 percent of the participants received at least one AA treatment during the year of follow-up. The most common treatments were intralesional, topical, intramuscular, and oral corticosteroids (41.8, 40.9, 38.1, and 20.6 percent, respectively). Patients with versus those without alopecia totalis and alopecia universalis had a lower frequency of intralesional steroid use (11.1 versus 44.1 percent) and higher frequency of topical corticosteroid use (25.4 versus 42.1 percent). On the day of diagnosis, 47.2 percent of patients received no treatment. Overall, 71.8 percent of patients were not receiving any treatment by 12 months.

"The most common treatments in this cohort were intralesional or topical corticosteroids, and there was a dynamic change in treatment over the course of a year, culminating with no prescription therapy for most patients," the authors write. "Additional studies are needed to understand the reasons for treatment absence after one year of follow-up."

Two authors disclosed ties to the biopharmaceutical industry.

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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Comorbilidades en Alopecia Areata

1. American Journal of Clinical Dermatology  
2. Article

• Systematic Review 
• Published: 18 July 2023

Comorbid Conditions Associated with Alopecia Areata: A Systematic Review and Meta-analysis

• Sophia Ly, 
• Priya Manjaly, 
• …
• Arash Mostaghimi 

American Journal of Clinical Dermatology(2023)Cite this article

• 182 Accesses

• 15 Altmetric

• Metrics details

Abstract

Background

Alopecia areata (AA) is a complex autoimmune condition resulting in nonscarring hair loss. In recent years, many studies have provided new evidence on comorbid diseases present in patients with AA. However, some studies have conflicting results, and analyses conducting a comprehensive approach are lacking.

Objective

The aim of our study was to provide an updated systematic review and meta-analysis of medical comorbidities associated with AA.

Methods

We searched PubMed, Embase, and Web of Science for case-control, cross-sectional, and cohort studies investigating medical comorbidities in AA published from inception through 1 February 2023.

Results

We screened 3428 abstracts and titles and reviewed 345 full text articles for eligibility. Ultimately, 102 studies were analyzed, comprising 680,823 patients with AA and 72,011,041 healthy controls. Almost all included studies (100 of 102 studies) were of satisfactory to high quality (Newcastle–Ottawa scale score ≥ 4). Among patients with AA, comorbidities with the highest odds ratios (OR) compared with healthy controls and data available from more than one study included vitamin D deficiency (OR 10.13, 95% CI 4.24–24.20), systemic lupus erythematous (OR 5.53, 95% CI 3.31–9.23), vitiligo (OR 5.30, 95% CI 1.86–15.10), metabolic syndrome (OR 5.03, 95% CI 4.18–6.06), and Hashimoto's thyroiditis (OR 4.31, 95% CI 2.51–7.40). AA may be a protective factor for certain disorders, for which the AA group had lower odds compared with healthy controls, such as irritable bowel syndrome (OR 0.38, 95% CI 0.14–0.99) and colorectal cancer (OR 0.61, 95% CI 0.42–0.89).

Conclusion

These findings corroborate and contextualize the risks across comorbidities for patients with AA. Further work should be done to identify the underlying pathophysiology and understand appropriate screening criteria.

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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