Acta Dermato-Venereologica issue 50:1 98-1CompleteContent | Page 18

INVESTIGATIVE REPORT 65 The Association Between Low Grade Systemic Inflammation and Skin Diseases: A Cross-sectional Survey in the Northern Finland Birth Cohort 1966 Suvi-Päivikki SINIKUMPU 1 , Laura HUILAJA 1 , Juha AUVINEN 2 , Jari JOKELAINEN 2 , Katri PUUKKA 3 , Aimo RUOKONEN 3 , Markku TIMONEN 2 and Kaisa TASANEN 1 Department of Dermatology and Medical Research Center Oulu, PEDEGO Research Unit, University of Oulu, Oulu University Hospital Oulu, Center for Life Course Health Research, Faculty of Medicine, University of Oulu and Oulu University Hospital, 3 NordLab Oulu, Medical Research Center Oulu, Oulu University Hospital and Department of Clinical Chemistry, University of Oulu, Oulu, Finland 1 2 Low grade inflammation is associated with many non- communicable diseases. The association between skin diseases in general and systemic inflammation has not previously been studied at the population level. A whole-body investigation on 1,930 adults belonging to Northern Finland Birth Cohort 1966 was performed and high sensitive C-reactive protein (CRP) level was measured as a marker of low grade inflammation in order to determine the association between low grade inflammation and skin diseases in an unselected adult population. After adjustment for confounding factors the following skin disorders were associated with low grade inflammation in multinomial logistic regression analysis: atopic eczema (OR 2.2, 95% CI 1.2–3.9), onychomycosis (OR 2.0, 1.2–3.2) and rosacea (OR 1.7, 1.1–2.5). After additionally adjusting for body mass index and systemic diseases, the risks for atopic ec- zema (OR 2.4, 1.3–4.6) and onychomycosis (OR 1.9, 1.1–3.1) remained statistically significant. In conclu- sion, low grade inflammation is present in several skin diseases. not previously been studied at the population level. The relationship has, to date, only been investigated in a disease-specific manner, most comprehensively among psoriasis patients (7, 11, 12): an extensive meta-analysis of data from such studies has shown that CRP levels are elevated in patients with psoriasis compared with healthy subjects (7). Studies with limited sample size have showed that low grade inflammation is also present in chronic urticaria (n = 58) (13), lichen ruber planus (n = 55) (14) and rosacea (n = 60) (15). Recent studies have demonstrated that children and young adults with atopic eczema or allergic sensitization have elevated CRP levels (16–18). In contrast, no association has been found between acne vulgaris and elevated CRP (12). By using data from the unique 1966 Northern Finland Birth Cohort 1966 (NFBC1966) we aimed to determine, in an unselected adult population, any association bet- ween low grade inflammation and any of the most com- mon skin diseases. Key words: atopic eczema; epidemiology; fungal skin infection; low grade inflammation; rosacea. METHODS Accepted Sep 13, 2017; Epub ahead of print Sep 13, 2017 Study design and population Acta Derm Venereol 2018; 98: 65–69. This was a cross-sectional population-based study that drew from the NFBC1966 cohort. Since birth, cohort members, and their mothers since the 1965/1966 pregnancy (in mean from the 16 th gestational week), have been followed regularly via health questionnaires and clinical health surveys, resulting in a diverse data set concerning health and life-style. This population sample included all individuals in the two northernmost provinces of Finland whose expected day of birth fell between 1 st January and 31 th December 1966 (n = 12,058; 5,889 females and 6,169 males). When the cohort members reached the age of 46 years 10,321 of them were still alive and address was known in Finland. All those living within 100 km of the center of the city of Oulu (n = 3,118; 1,497 females and 1,621 males) were invited to participate in the comprehensive clinical follow-up examination. The data was collected between April 2012 and May 2013. This visit included both health questionnaires and several clinical investigations, including skin evaluation. The Ethical Committee of the Northern Ostrobothnia Hospi- tal District approved the present study (§94/2011), which was performed according to the principles of the 1983 Declaration of Helsinki. The participants took part on a voluntary basis and signed their informed consent. The data were handled on a group level, with personal information being replaced by identification codes, resulting in complete anonymity. Corr: Suvi-Päivikki Sinikumpu, Department of Dermatology, Oulu Uni- versity Hospital, P.B.20, FIN-90029 Oulu, Finland. E-mail: suvi-paivikki. [email protected] L ow grade inflammation is a chronic, subclinical and systemic condition (1), which contributes to the pathogenesis of many noncommunicable diseases, such as atherosclerosis (2), type 2 diabetes (3), metabo- lic syndrome (4), obesity (5), and depression (6). Low grade inflammation is detectable via a minor elevation of certain inflammatory markers, such as C-reactive protein (CRP), and it is usually measured by a high sensitivity CRP (hs-CRP) test (5, 7). Many factors including age, sex, body mass index (BMI) (8), lifestyle factors (9) and ethnic background (10) have an influence on CRP level. Although several skin diseases such as psoriasis, most eczemas and sebaceous gland diseases (7, 11, 12) have an inflammatory background, the association between skin diseases in general and systemic inflammation has This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2018 Acta Dermato-Venereologica. doi: 10.2340/00015555-2795 Acta Derm Venereol 2018; 98: 65–69