CLINICAL REPORT
627 Advances in dermatology and venereology ActaDV Acta Dermato-Venereologica ActaDV
Gallstone Risk in Adult Patients with Atopic Dermatitis and Psoriasis : Possible Effect of Overweight and Obesity
Alexander EGEBERG 1 , Yuki M . F . ANDERSEN 1 , Gunnar H . GISLASON 2 – 4 , Lone SKOV 1 and Jacob P . THYSSEN 1
1
Department of Dermatology and Allergy , 2 Department of Cardiology , Herlev and Gentofte Hospital , University of Copenhagen , Hellerup ,
3
The Danish Heart Foundation , and 4 The National Institute of Public Health , University of Southern Denmark , Copenhagen , Denmark
Adult atopic dermatitis ( AD ) is associated with overweight , obesity and cardiovascular diseases ( CVD ) in Americans , similarly to psoriasis , but no increased risk of CVD has been shown in European patients with AD . This study investigated the prevalence and risk of gallstones in adults with AD and in those with psoriasis as a proxy for obesity using nationwide data for all Danish citizens ≥ 30 years of age . Outcome was a diagnosis of gallstones . Odds ratios ( ORs ) were calculated by logistic regression ( cross-sectional study ) and hazard ratios ( HRs ) were estimated by Cox regression ( cohort study ). The study comprised 6,742 patients with AD , 53,810 patients with psoriasis , and 3,534,164 general population subjects . The prevalence of gallstones was 3.8 %, 3.5 % and 5.0 % in the general population , AD and psoriasis patients , respectively . Adjusted ORs were 0.81 ( 0.71 – 0.92 ) for AD and 1.18 ( 1.14 – 1.23 ) for psoriasis . During follow-up , adjusted HRs were 0.72 ( 0.56 – 0.90 ) for AD and 1.10 ( 1.02 – 1.18 ) for psoriasis . The findings highlight important differences in obesity and lifestyle factors among patients with AD and those with psoriasis .
Key words : psoriasis ; atopic dermatitis ; BMI ; obesity ; gallstones . Accepted Jan 24 , 2017 ; Epub ahead of print Jan 25 , 2017 Acta Derm Venereol 2017 ; 97 : 627 – 631 .
Corr : Alexander Egeberg , Department of Dermatology and Allergy , Herlev and Gentofte Hospital , University of Copenhagen , DK-2900 Hellerup , Denmark . E-mail : alexander . egeberg @ gmail . com
Atopic dermatitis ( AD ) is a chronic relapsing inflammatory skin disease that affects many adults , a large number of whom will have lived with their condition since childhood ( 1 ). Well-established co-morbidities include not only food allergies , asthma and rhinitis , but also psychiatric conditions , including anxiety , depression and attention deficit hyperactivity disorder ( ADHD ) ( 2 – 4 ). However , there is growing interest in possible cardiovascular co-morbidities , since chronic low-grade inflammation could potentially increase the risk of such conditions . For example , US cohorts of adult patients with AD and eczema have found increased risks of hypertension , angina , heart attack , and stroke , as well as pre-diabetes ( 5 , 6 ). Similarly , a study from Taiwan showed a dose-dependent increased risk of stroke in patients with AD ( 7 ). However , we have not been able to replicate the increased risk of cardiovascular disease ( CVD ) in adult Danish patients with AD ( 8 ). We have speculated that the explanation could be a difference in risk factors between the populations . Indeed , a meta-analysis showed that obesity and overweight were significantly associated with AD in American and Asian populations , but not in Europeans ( 9 ). This is in line with our clinical impression that Danish patients with AD are rarely overweight or obese . Conversely , Danish patients with psoriasis have a higher prevalence of overweight and obesity ( 10 ). In fact , obesity is significantly and independently associated with the presence and severity of psoriasis ( 11 ), probably resulting from obesity-induced systemic low-grade inflammation ( 12 , 13 ). While obese patients show decreased response to anti-psoriatic therapy ( 14 ), weight loss has been suggested as a potential therapeutic option for patients with psoriasis ( 15 , 16 ). Hypertension , dyslipidaemia , and diabetes also frequently occur in patients with psoriasis , and there is a high prevalence of smoking and alcohol consumption among these patients ( 17 , 18 ).
Gallstones ( cholelithiasis ) is one of the most common medical problems leading to surgical intervention in Western countries , resulting in approximately 500,000 cholecystectomies in the US each year ( 19 ). Gallstones affect approximately 10 % of the adult population in the USA , whereas in Europe , prevalence rates from 6 % in Italy to 22 % in Norway have been found ( 20 , 21 ). While certain subtypes exist ( cholesterol , brown pigment , and black pigment gallstones , respectively ), in general the risk factors predisposing to gallstone formation include obesity , diabetes , dyslipidaemia , oestrogen and pregnancy , haemolytic diseases , and cirrhosis ( 19 , 22 ). Moreover , while gallstones may cause subsequent inflammation of the gallbladder , inflammation itself does not appear to be a significant contributor to the development of gallstones ( 19 ).
A fundamental limitation of many large-scale registries is the lack of data on body mass index ( BMI ). Since gallstones are significantly associated with overweight and obesity , these may serve as a useful proxy to examine potential differences in obesity between study groups . We therefore examined the prevalence and risk of gallstones in patients with adult AD and psoriasis , compared with the general Danish population , using cross-sectional and cohort study designs .
This is an open access article under the CC BY-NC license . www . medicaljournals . se / acta Journal Compilation © 2017 Acta Dermato-Venereologica . doi : 10.2340 / 00015555-2622 Acta Derm Venereol 2017 ; 97 : 627 – 631