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