BHNS Journal Club June 2021
Sonia Sharma
CED
Original article
Comorbidities of alopecia areata: a population-based cohort study
Egeberg, S. Anderson, E. Edson-Heredia, R. Burge
https://doi.org/10.1111/ced.14507
What?
Population based cohort study – nationwide register in Denmark
Why?
Previous studies have associated alopecia areata (AA) with a number of comorbidities. However, the timing between AA and the development of such comorbidities remains poorly understood.
Methods
A Danish nationwide register-based cohort study was performed on all individuals diagnosed with AA between 2007 and 2016 (n = 1843), and each patient was matched for age and sex with 10 healthy controls (HCs). Time between AA and comorbidity development was assessed, and incidence rate ratios (IRRs) were calculated to assess risk of comorbidity following initial AA diagnosis.
Results
Participant data from Jan 2007 – December 2016
Each of the 1843 participants matched with 10 healthy controls
Use of antidepressant and anxiolytic drugs were mostly started prior to AA diagnosis, and these drugs were used more frequently before than after diagnosis with AA. Additional frequent comorbidities included thyroid disease, hyperlipidaemia, type 2 diabetes and asthma. Most comorbidities occurred prior to AA diagnosis; however, among those that occurred after AA diagnosis, antidepressants (IRR = 1.26, 95% CI 1.01–1.56), anxiolytics (IRR = 1.55, 95% CI 1.17–2.05), atopic dermatitis (AD; IRR = 9.41, 95% CI 4.00–22.16), asthma (IRR = 2.17, 95% CI 1.46–3.21), vitiligo (IRR = 30.35, 95% CI 6.13–150.39), Crohn disease (CD; IRR = 3.04; 95% CI 1.22–7.56) and thyroid disease (IRR = 2.38; 95% CI 1.72–3.29) occurred more frequently among patients with AA compared with controls.
Author conclusions:
AA was significantly associated with risk of several comorbidities, most notably vitiligo, atopic dermatitis and Crohn’s disease.
Majority of patients appeared to have developed these co-morbidities prior to AA diagnosis, suggesting that a thorough medical history screening by dermatologists at the initial visit may be appropriate.
Thoughts:
1) This study highlights the importance of other conditions and AA
2) In children, vitiligo, atopic dermatitis, Crohn’s disease and ulcerative colitis as well as use of antidepressant medications occur AFTER AA diagnosis, whereas in adults, other co-morbidities occur BEFORE AA diagnosis
3) We could utilise screening questions in our clinic patients presenting with AA for these conditions
CED
Original article
Molecular epidemiology of pachyonychia congenita in the Israeli population
M. Pavlovsky, A. Peled, L. Samuelov, L. Malki, K. Malovitski, S. Assaf, J. Mohamad, O. Meijers, M. Eskin-Schwartz, O. Sarig, E. Sprecher
First published: 15 November 2020
https://doi.org/10.1111/ced.14509
What?
Cohort of Israeli families diagnosed with PC
Most patients were Ashkenazi Jews and had a family history of PC
Why?
To delineate the clinical and genetic features of PC in a series of Israeli patients
Methods
Collection of clinical and molecular data
Use of direct sequencing of genomic DNA and cDNA sequencing
Results
N = 16
Most common clinical findings were painful focal plantar keratoderma (94%) accompanied by nail dystrophy (81%), pilosebaceous cysts (31%) and prenatal/natal teeth (13%).
KRT16 mutations were the most common type among Israeli patients with PC (56%) and KRT17 (26%) followed by KRT6A mutations (which is the most common PC-associated gene worldwide).
Most (77%) of the Israeli patients with PC with KRT16 mutation carried the same variant (c.380G>A; p.R127H) and shared the same haplotype around the KRT16 locus
Spontaneous mutations documented in 3 patients (20%).
Author conclusions
The data gleaned from this study emphasizes the importance of population-specific tailored diagnostic strategies.
Thoughts on this:
IPCRR (as of Jan 2021) holds information on 1083 patients with PC in 53 countries – mainly focussed on USA, so interesting study looking at a specific population in Israel to evaluate gene mutations and clinical findings in this small group.
CED
Therapeutic vignette
Recalcitrant psoriatic onycho-pachydermo-periostitis successfully treated with guselkumab
A. M. G. Brunasso, S. Sola, C. Massone
First published: 22 February 2021
https://doi.org/10.1111/ced.14459
What?
Case report
Why?
To gain up-to-date knowledge regarding treatment of psoriatic onycho-pachydermo-periostitis (POPP).
Reported current treatments have shown variable and inconsistent results
Case
80 year old lady with 18 month history of nail changes, painful swelling of the fingers and toes and severe functional impairment (DLQI 22) was diagnosed with POPP. She had a background of Crohn’s disease in complete remission for the last 20 years. Had tried standard treatment regimens of ciclosporin, acitretin, methotrexate which were ineffective. Started on adalimumab – at week 16 partial response seen. However week 2 of adalimumab developed atopic dermatitis, which was unresponsive to topical treatments; therefore stopped. Ustekinumab then commenced with the later addition of MTX due to increased CRP and joint pains – still ineffective. Guselkumab then commenced with rapid resolution and DLQI of 2 at week 12. Almost complete resolution at week 28
Author conclusions
AD like eruptions have rarely been described with anti-TNF alpha therapy
Anti IL-17A not administered due to previous history of Crohn’s disease
First case of anti IL-23 therapy (particularly guselkumab) in POPP
Thoughts
Interesting finding of AD like eruption with anti-TNF alpha therapy – important to keep this in mind with patients on these agents