Skin diseases and their association with systemic diseases in the Northern Finland Birth Cohort 1966

Abstract Skin diseases are common: one in every three of all general practice patients have at least one dermatological problem. However, epidemiological studies addressing the overall prevalence of skin diseases are sparse. The skin is the largest organ in the body and it has several vital and immunological functions. Cutaneous signs are often the first manifestation of many systemic diseases. The aim of this study was to determine the overall prevalence, and the distribution according to sex and socioeconomic status, of skin diseases in an adult population. The study particularly focused on multiple melanocytic naevi and their risk factors because multiple melanocytic naevi are the strongest risk factor for melanoma. A further aim was to analyse the association between cutaneous disorders and systemic conditions; specifically to determine whether abnormal skin findings in toe webs have an association with abnormal glucose metabolism and whether skin diseases have a relationship with systemic low-grade inflammation. For these purposes a comprehensive dermatological evaluation was performed as a part of the 46-year follow-up survey of the Northern Finland Birth Cohort 1966. Data on this cohort have been collected since birth. Numerous laboratory tests were also performed cross-sectionally during the 46-year follow-up survey, including an oral glucose tolerance test and the measurement of fasting plasma glucose and glycated haemoglobin fraction. High sensitivity C-reactive protein was measured as a marker of low-grade inflammation. Over half (60%) of the 1 932 individuals examined had at least one skin disorder requiring further treatment. The need for treatment was more common in males and those with lower socioeconomic status. Multiple melanocytic naevi were found in 12% of individuals; high educational level, male sex and fair skin type increased the risk. Abnormal skin findings in toe web spaces was associated with undiagnosed type 2 diabetes. Atopic eczema, rosacea and onychomycosis were associated with low-grade inflammation. This unique study with nearly 2 000 subjects reports for the first time the overall prevalence of skin diseases in an unselected Finnish population. Its findings support the previous postulate that skin diseases are common in adults and suggest that skin evaluation should be an essential part of routine medical examinations in clinical practice.Tiivistelmä Ihotaudit ovat yleisiä, ja jopa 30 %:lla yleislääkärin potilaista on jokin ihoon liittyvä ongelma. Väestötason tutkimuksia ihotaudeista on kuitenkin niukasti. Iho on ihmisen suuri elin, ja sillä on useita tärkeitä tehtäviä, kuten osallistuminen immunologiseen puolustukseen. Monet yleissairaudet voivat näkyä iholla jo ennen taudin puhkeamista ja ihoilmentymät voivat olla varhaisia merkkejä piilevästä sairaudesta. Tämän tutkimuksen tarkoituksena oli määrittää ihotautien esiintyvyys aikuisväestössä sekä ihotautien jakautuminen sukupuolen ja sosiaalisen aseman suhteen. Lisäksi tarkoituksena oli selvittää runsasluomisuuden (yli 50 pigmenttiluomea) esiintyvyyttä ja sen riskitekijöitä, sillä runsasluomisuus on melanooman merkittävin riskitekijä. Tutkimuksen tavoitteena oli myös selvittää ihotautien yhteyttä yleissairauksiin, kuten poikkeavien varvasvälilöydösten yhteyttä häiriintyneeseen sokeriaineenvaihduntaan sekä matala-asteisen tulehduksen ja ihotautien välistä yhteyttä. Osana Pohjois-Suomen syntymäkohortti 1966:n 46-vuotistarkastusta tehtiin kokonaisvaltainen ihon tutkiminen yhteensä 1 932:lle tutkimushenkilölle vuosina 2012–13. Samassa yhteydessä tutkittavilta määritettiin paastoverensokeri ja pitkäaikainen verensokeri sekä tehtiin sokerirasitustesti sokeriaineenvaihdunnan häiriön toteamiseksi. Matala-asteisen tulehduksen arvioimiseksi määritettiin herkkä C-reaktiivinen proteiini. Tutkimusjoukon pitkäaikaiset taustatiedot perustuivat syntymäkohortin aiempiin aineistoihin. Tutkittavista 60 %:lla todettiin jokin hoitoa vaativa ihotauti. Hoidon tarve oli suurempaa miehillä ja matalammissa sosiaaliluokissa. Runsasluomisuutta esiintyi 12 %:lla, ja korkea koulutustaso, miessukupuoli ja vaalea ihotyyppi lisäsivät riskiä. Varvasväleissä esiintyvät muutokset liittyivät diagnosoimattomaan diabetekseen. Atooppinen ihottuma, ruusufinni ja kynsien sieni-infektioon sopivat muutokset olivat yhteydessä matala-asteiseen tulehdukseen. Tämä lähes 2 000 henkilön koko ihon kliiniseen tutkimukseen perustuva työ raportoi ensimmäistä kertaa ihotautien yleistä esiintyvyyttä suomalaisessa, valikoitumattomassa väestössä. Tutkimus tukee aiempaa oletusta, jonka mukaan ihotaudit ovat aikuisväestössä yleisiä; ihon tutkiminen tulisi olla oleellinen osa potilaan kliinistä perustutkimusta

Reply to:Bridging the gap:commentary on “The high prevalence of skin diseases in adults aged 70 and older"

Abstract This letter comments on the letter by Shreya Sreekantaswamy

Pediatric primary synovial chondromatosis of the shoulder, biceps tendon sheath and subcoracoid bursa

Abstract A child with shoulder pain and great palpable mass without any injury history is an emergent case until the diagnosis is confirmed. We report the clinical findings, imaging features, surgery and histological analyses of primary synovial chondromatosis in glenohumeral joint, biceps tendon sheath and subcoracoid bursa in a child, aged 14. Primary synovial chondromatosis is characterised by multiple calcified nodules in joints, tendons or bursa areas. The condition is more usual in large joints, in particular in lower extremities. It may be symptomless until the volume of chondromatosis has increased to such an extent that it results in pain, locking symptom or palpable mass. The treatment is removal of the loose bodies and potentially synovectomy, in means of open or arthroscope-assisted surgery. Postoperative follow-up is recommended due to the risk of recidivism and potential malignant transformation. The disease is more common in older patients and there are only isolated cases in pediatric population

Iän tuomat iho-ongelmat

Tiivistelmä Ikääntyminen aiheuttaa rakenteellisia ja toiminnallisia muutoksia eri elimiin, myös ihoon. Monien ihosairauksien esiintyvyys kasvaa ikääntyessä (1). Nykyiselläänkin ihotaudit aiheuttavat kuolemaan johtamattomista sairauksista neljänneksi eniten tautitaakkaa sairauden vuoksi menetettyinä toimintakykyisinä elinvuosina mitaten (disability adjusted life years, DALY) (2). Väestön vanhetessa tämä taakka lisääntyy. Väestötason tutkimuksia ikäihmisten ihosairauksien yleisyydestä on niukasti. Noin 4 000 potilaan sairaalarekisteristä tehdyn tutkimuksen mukaan yleisimpiä olivat ekseemat, ihoinfektiot, kutina ja ihosyövät (3). Myös hyvänlaatuisten ihokasvainten, kuten seborrooisten keratoosien (rasvaluomien), kirsikkaluomien ja lentigojen, määrä lisääntyy iän karttuessa (4). Tässä katsauksessa käsittelemme tavanomaisia iän tuomia iho-ongelmia. Krooniset alaraajahaavat sekä lääkeaineihottumat on jätetty katsauksesta pois.Abstract Skin problems in the elderly Aging causes many structural changes in the skin and affects its functionality. Therefore, many skin diseases are more common in the older population. Measured on the DALY index (disability adjusted life years), skin diseases are the fourth most common disease group causing disability. The most common skin diseases in older adults are eczemas, skin infections, pruritus and malignant diseases. Skin aging can be divided into chronological aging and photoaging. Smoking, air pollutants and exposure to ultraviolet radiation are the most significant factors in skin aging. Dry skin is the most common cause of pruritus in the elderly but sometimes systemic diseases can be the cause and they must be excluded. Asteatotic eczema is a common skin disease found particularly in the elderly population. It is caused by structural changes in the skin and excessive washing with soap. It can be prevented by applying moisturizing cream daily. Sometimes corticosteroid creams or ultraviolet light treatment are needed. Seborrhoeic dermatitis is most common in older people and possibly caused by a weakened immune system. As many as half of the elderly population are estimated to have dermatitis in skinfolds. The term MASD (moistureassociated skin damage) is used when moisture and chemicals break the skin’s protective barrier. It is treated with washing and careful drying of the skinfolds. Sometimes local antimycotics are needed because of secondary infection. Skin infections caused by bacteria, viruses and fungi are common in the elderly because of their weakened immune system. Malignant and premalignant lesions are becoming more common due to aging of the population. The prevalence of actinic keratosis varies according to age, skin phototype and residence. Some actinic keratoses evolve to Bowen’s disease and eventually to squamous cell carcinoma. Diagnosis is confirmed by biopsy. Actinic keratoses with mild dysplasia can be treated topically. Otherwise treatment by a dermatologist is needed. Patients’ ability to function must be considered when treating older patients

Skin cancers and their risk factors in older persons:a population-based study

Abstract Background: The number of skin cancer is increasing rapidly. However, little is known about the risk factors of skin cancer in older persons. Our objectives were to determine the risk factors for skin cancer or its precursors in an older population. More specifically, to study the association of new skin cancers with previous skin cancer, sex, age, Fitzpatrick’s skin type, history of outdoor work and socioeconomic status (SES). Methods: In this retrospective cross-sectional study of a large, well documented historical cohort data set a total body skin examination (TBSE) was performed for 552 participants aged between 70 and 93 years by dermatologists. The information gathered was augmented with health register data and self-reported data. The associations between skin cancer and its risk factors were studied by using the logistic regression analyses. Results: According to the TBSE skin cancer/precursor was present in 25.5% of participants and was more common in males than in females (34.5% vs 20.2%, p < 0.001). Previous skin cancer increased the risk of subsequent skin cancer 2.6-fold (OR 2.56, 95% CI 1.43–4.55) and male sex nearly 2-fold (1.97, 95% CI 1.26–3.08). Specific risk factors for the first occurrence of skin cancer were male sex and outdoor work. There was also association between skin cancer and age and socioeconomic status. Conclusions: TBSE is recommend for physicians treating older persons to allow early recognition of skin cancers or their precursors. Older males need particularly close attention

Risk factors of hand eczema:a population-based study among 900 subjects

Abstract Background: Many risk factors such as atopic dermatitis (AD) have shown to associate with hand eczema (HE). However, studies concerning other atopic diseases, parental or longitudinal risk factors of HE are scarce. Objectives: To examine the association between HE and atopic diseases, parental factors, environmental factors (keeping animals, exposure to moulds) and lifestyle factors (obesity, tobacco smoking, alcohol consumption and physical activity) at population level. Methods: Subjects belonging to the Northern Finland Birth Cohort 1966 Study (NFBC1966) (n = 6830) answered a comprehensive health questionnaire. The data was completed with parental information. Results: HE was reported in 900 (13.3%) individuals. All atopic diseases, parental allergy, female gender and obesity increased the risk of HE whereas physical activity decreased the risk of HE. A statistically significant association was not found between HE and tobacco smoking or alcohol consumption. Conclusions: All atopic diseases, not only AD, seem to have influence on the presence of HE. In addition, parental and environmental factors associated with HE

Cardiovascular and metabolic profile of subjects with acne in a cohort of middle-aged patients:a general population study of 1,932 subjects

Abstract Acne vulgaris is one of the most common inflammatory skin diseases, but there are few studies of adult acne and its association with general health. The aim of this study was to examine the prevalence and clinical characteristics of adult acne at the population level among 1,932 subjects belonging to the Northern Finland Birth Cohort 1966 Study. In addition, cardiovascular and metabolic profiles of acne cases and their controls were analysed. The prevalence of adult acne was 7.9% (n = 150) with no statistical difference between the sexes. The majority of subjects presented with papulopustular acne (77.1%). Comedo acne (10.8% of all subjects) was more common in females than in males (p < 0.005). Males with acne had more abnormality in their metabolic factors than did acne-free controls; plasma glucose and insulin levels at 60 min after the 75 g glucose load were higher in males with acne than in controls (p < 0.01 for both). Corresponding associations were not seen in females. In conclusion, adult acne is common in middle-age, presenting a slightly different clinical picture in females than in males. In addition, male subjects with acne may have a higher risk of metabolic disturbances than do controls, and thus, comprehensive evaluation of patients with adult acne is needed