Plain Language Summaries
Herpes simplex virus reactivation as a trigger of mucous lesions in pemphigus vulgaris
M. Kurata, Y. Mizukawa, Y. Aoyama, T. Shiohara
This summary relates to DOI: 10.1111/bjd.12961
British Journal of Dermatology, 171, 554–560, September 2014
Summary
Pemphigus vulgaris (PV) is a rare disease that causes severe blistering of the skin and of the mucous membranes lining the mouth, nose, throat and genitals. In PV the immune system, which normally fights off infection, sees the cells in our skin as ‘invaders’ and makes antibodies (which normally help the immune system) to damage them. Herpes simplex is an infection of the skin with the herpes simplex virus (HSV) and previous studies have indicated that HSV may play a part in the development of PV. Therefore, in this study, researchers in Japan tested the saliva of 16 newly-diagnosed PV patients for the presence of HSV DNA, and at various times thereafter. The results were compared with 66 ‘controls’ with skin diseases caused by HSV (herpes labialis and eczema herpeticum) and other skin diseases suggestive of HSV involvement (oral lichen planus, Stevens-Johnson syndrome and bullous pemphigoid). The prevalence of HSV DNA in the PV patients (37.5%) was lower than that of eczema herpeticum patients (56.5%), but comparable to that of herpes labialis patients (30.0%). However, ‘copy numbers’ of the HSV DNA (which indicate levels of the DNA) were higher in PV patients. No HSV DNA was found in saliva from any of the patients with other skin diseases suggestive of the involvement of HSV. The researchers then carried out blood tests and found that levels of HSV antibodies were higher in patients with PV than those with visible herpes lesions, such as herpes labialis and eczema herpeticum. Furthermore, none of the PV patients who had tested positive for HSV DNA responded to their initial treatment using a drug called prednisone, and all required additional treatment, while most HSV DNA-negative PV patients were successfully treated with prednisone alone.
Actinic damage on the back is significantly determined by MC1R variants and previous sun exposure compared with other body sites in a multivariate analysis
J. Wendt, S. Rauscher, S. Burgstaller-Mühlbacher, F. Roka, I. Fae, G. Fischer, H. Pehamberger, I. Okamoto
This summary relates to DOI: 10.1111/bjd.12994
British Journal of Dermatology, 171, 622–630, September 2014
Summary
Exposure to ultraviolet (UV) light from the sun is known to contribute to skin cancer. Signs of sun damage on the skin, called ‘actinic’ damage, can therefore be helpful in assessing a person's risk of developing skin cancer, because they show whether the person's skin type is susceptible to damage and also if they have a history of sun exposure. MC1R is a gene which influences the skin's pigment called melanin and determines what colour a person's skin will be. Variants of this gene cause the body to produce pigment called pheomelanin, leading to red hair, fair skin and less protection from the sun. This Austrian study looked at the different types of, and risk factors for, actinic damage on the face, hands and back, and how MC1R is linked to the different types and locations of sun damage. The researchers recorded the skin phototype (colour), hair colour, number of sunburns and history of sun exposure for 2112 people of central European origin. Actinic damage, including wrinkling and freckling, was also measured. The study revealed that actinic damage on different body sites has different causes: damage on the back is mainly caused by intense bursts of sun exposure and sunburns, e.g. during holidays, and is associated with MC1R variants found in fair skinned people. In contrast, actinic damage on the face depends mainly on age and cumulative sun exposure, such as general exposure to the sun over the years, and is not linked to MC1R variants. Therefore, while skin damage on the face is highly visible, it is not as informative about a person's sensitivity to the sun as the back.
Influence of smoking on disease severity and antimalarial therapy in cutaneous lupus erythematosus: analysis of 1002 patients from the EUSCLE database
A. Kuhn, J. Sigges, C. Biazar, V. Ruland, N. Patsinakidis, A. Landmann, S. Amler, G. Bonsmann, the EUSCLE coauthors
This summary relates to DOI: 10.1111/bjd.13006
British Journal of Dermatology, 171, 571–579, September 2014
Summary
‘Cutaneous lupus erythematosus’ (CLE) covers a group of lupus-specific manifestations, all of which can affect the skin. This study, of 1002 patients in 14 different countries, relates to the types that chiefly affect the skin. Some patients will be treated using drugs that were traditionally intended to prevent and treat malaria (antimalarials) but that have been found to be highly effective for lupus also. In recent years, it has been suggested that smoking may worsen CLE and stop antimalarial drugs working so well. The researchers therefore looked at data of patients with various subtypes of CLE, from a database called EUSCLE Core Set Questionnaire, involving 13 countries in Europe and one in South America. For each patient, doctors recorded: the activity and damage of the disease using the CLASI scoring system, any treatment with antimalarials and if this was successful, and the patient's smoking behaviour (if the person had ever smoked, and if they were a smoker at the date of the first diagnosis). The authors found that a high number of CLE patients had ever smoked (59.5%) and, of these, 87.2% were smokers at the date of their first diagnosis, confirming the idea that smoking may induce and/or aggravate the disease. The results also suggested that smoking worsens symptoms and prevents antimalarials from working as effectively. The authors conclude that patients with CLE should be motivated to completely stop smoking, and even a reduction in smoking can improve their disease.
Comparison of anatomical locations of cutaneous melanoma in men and women: a population-based study in France
V. Chevalier, C. Barbe, A. Le Clainche, G. Arnoult, P. Bernard, E. Hibon, F. Grange
This summary relates to DOI: 10.1111/bjd.13052
British Journal of Dermatology, 171, 595–601, September 2014
Summary
Melanoma is a type of skin cancer, with excess sun exposure being a major cause. This study, of 1542 melanomas diagnosed between 2004 and 2011 in one region of France, looked at the different parts of the body the cancers occur on in men and women. 44.4% occurred in men and 55.6% in women, at a mean age of 61.4 years. Major differences between the genders were seen for the locations of the melanomas on the body. The trunk was the most frequent body site for melanomas in men (41.8% of cases compared to 14.9% in women), while the legs were the most frequent site in women (32.2% vs 9.3% in men). Women had higher numbers of melanomas on the hand and foot (10.3% in women vs 6.3% in men). The proportion of melanomas on the arms and head/neck were similar in both genders. The precise location within the head and neck, however, differed greatly according to gender. In women, 75.1% of melanomas were located on the neck or in the ‘central area’ of the head, which included the eyelids, nose, cheeks and around the mouth and chin. 24.9% of melanomas on the head in women occurred in the ‘peripheral’ areas, meaning the scalp, forehead, temples or ears. In contrast, these proportions in men were 46.3% and 53.7%, respectively. Head/neck melanomas were more frequently right-sided in women and left-sided in men. The authors conclude that gender differences in occupational and leisure-time UV-exposure, clothing (including shoes), hairstyle, and left or right side exposure to the sun in cars could explain these results.
Risk factors for facial melasma in women: a case-control study
A.C. Handel, P.B. Lima, V.M. Tonolli, L.D.B. Miot, H.A. Miot
This summary relates to DOI: 10.1111/bjd.13059
British Journal of Dermatology, 171, 588–594, September 2014
Summary
Melasma is a common skin condition in adults, in which patches of light to dark brown or greyish pigmentation (colouring) develop, mainly on the face. It is more common in women and people with darker skin-types who live in sunny climates. The exact cause is not known, but several factors contribute. These include pregnancy, hormonal drugs such as the contraceptive pill, and very occasionally medical conditions affecting hormone levels. There is research to suggest that it can be triggered by stress. Sunshine and the use of sun beds usually worsen any tendency to melasma. This study, from Brazil, compared 207 people with melasma to the same number of controls (without melasma) to see if factors including phototype (skin colour), time exposed to sun at work or in leisure activities, antidepressant use, menstrual irregularity, pregnancy, oral contraceptive use and anxiety contribute to a person's risk of developing melasma. The research showed that sun exposure, sexual hormones, darker skin types and a family history of melasma are risk factors. Interestingly, the study showed that melasma patients had a higher level of anxiety and psychological stress, as well as increased use of antidepressants and anxiolytics (anti-anxiety drugs) compared to the controls. Stress is associated with higher levels in the body of chemicals called cortisol and melanocortin, which may affect the skin's pigment, and therefore trigger melasma. Amerindian ancestry was also found to increase the risk of the disorder.
Safety of biological therapies for psoriasis: effects on reproductive potential and outcomes in male and female patients
Z.Z.N. Yiu, C.E.M. Griffiths, R.B. Warren
This summary relates to DOI: 10.1111/bjd.13060
British Journal of Dermatology, 171, 485–491, September 2014
Summary
Psoriasis is a skin disorder which causes lesions or ‘plaques’ on the skin. For more severe psoriasis, doctors may prescribe powerful injections called ‘biological’ drugs (or ‘biologics’) which are designed to mimic normal human molecules and alter the body's immune system, to reduce the impact of psoriasis. These biologics include adalimumab, ustekinumab, etanercept and infliximab. This review of a number of different studies, looked at the effect of biologics on pregnancy, fertility and breastfeeding, which are common concerns but for which there is relatively little evidence to guide clinicians and patients. According to the authors, based in the UK, studies on animals have shown that etanercept, infliximab and adalimumab do not cause miscarriage or birth defects, and initial case reports in humans suggest the same. Large scale drug safety registries have also shown that these drugs are not associated with miscarriage or birth defects. These drugs could, however, alter the immune system of the baby in the womb, and therefore they should be stopped before the third trimester to minimise transfer of the drug to the baby. The effects of biologics on breast-feeding babies are unclear as it is not fully understood if the drugs are absorbed by the baby's gastrointestinal tract (gut). No negative effects on babies have been shown, but there are very few case reports on the subject so it may be prudent to advise against breast-feeding while on biologics until further evidence is available. There is no evidence that etanercept, infliximab and adalimumab taken by men fathering children cause harm to the foetus, however there are limited studies available. There are no studies regarding the safety of ustekinumab in men who are reproducing, so it is not recommended in male patients intending to start a family. Ustekinumab has the least evidence to guide its use in pregnancy, breast-feeding mothers and reproductive males and therefore is not recommended for any individuals wishing to start a family.
Increased prevalence of psoriasis in patients with coronary artery disease: results from a case-control study
D. Picard, J. Benichou, C. Sin, C. Abasq, E. Houivet, R. Koning, A. Cribier, B. Veber, F. Dujardin, H. Eltchaninoff, P. Joly
This summary relates to DOI: 10.1111/bjd.13155
British Journal of Dermatology, 171, 580–587, September 2014
Summary
Psoriasis is a skin disorder that affects about 2% of the population and causes lesions or ‘plaques’ on the skin. Coronary artery disease (CAD) is the most common type of heart disease and cause of heart attacks. Recent studies have shown that the risk of heart attack is increased in psoriasis patients. However, it is still unknown if psoriasis itself directly increases the risk of CAD, or if it is other risk factors that are linked to psoriasis – such as increased body mass index (BMI), hypertension or smoking – which in turn increase the CAD risk. This French study compared the prevalence of psoriasis between 500 patients with a diagnosis of CAD, and 500 patients with no CAD (‘control’ patients). Both groups were examined for the presence of psoriasis by two dermatologists. Additionally, information on the presence of the following heart disease risk factors was recorded: high blood pressure, elevated cholesterol levels, diabetes, smoking, being overweight, obesity and family history of heart disease. The prevalence of psoriasis was higher in CAD patients (8%) than in control patients (3.4%) overall, and even when all the above risk factors were taken into account, the CAD risk was still slightly higher in people with psoriasis. Neither the severity of the psoriasis nor the duration of the disease were found to increase the CAD risk. However, the study suggests that psoriasis might be associated with a more severe form of CAD. Severity of CAD is measured according to how many of the three vessels that supply blood to the heart are affected. In this study, patients for whom all three vessels were affected were more likely to have psoriasis than those for whom just one or two vessels were involved.
