ABSTRACT
BACKGROUND: Higher vitamin D status has been associated with symptom improvement and decreased risk of various autoimmune disorders. Our objective was to determine whether higher serum 25-hydroxyvitamin D (25OHD) concentration correlated with less severe first-diagnosed bullous pemphigoid (BP) in older inpatients. METHODS: This cross-sectional study was performed from November 2012 to February 2014 among 30 consecutive older inpatients (21 women; mean ± SD, 83 ± 7 years; all Caucasian) with a de novo diagnosis of active BP recruited in the Department of Dermatology of Angers University Hospital, France. The severity of BP was graded clinically on the basis of i) the number of bullae during the first three days of hospitalization (grade 0-4, worse), and ii) the extent of the lesions (grade 0-5, worse). RESULTS: Sixteen participants had ≤ 5 bullae at the time of diagnosis, 8 had 6-20 bullae, 3 had 20-50 bullae, and 3 had >50 bullae. The lesions were spread over 5 cutaneous areas in 5 participants (17%). The median 25OHD concentration was 23 [IQR, 16-42] nmol/L. Serum 25OHD concentration was inversely correlated with the bullae grade (ρ = - 0.38, p = 0.04) and the lesion extension grade (ρ = - 0.50, p = 0.005). CONCLUSIONS: Higher serum 25OHD concentration correlated with less severe BP prior to initiation of treatment among our sample of older inpatients. This result suggests that vitamin D may be involved in the pathophysiology of BP and could serve as prognostic biomarker of BP.
Subject(s)
Pemphigoid, Bullous/prevention & control , Vitamin D/analogs & derivatives , Aged, 80 and over , Cross-Sectional Studies , Female , France , Health Services for the Aged , Humans , Male , Pemphigoid, Bullous/blood , Pemphigoid, Bullous/complications , Pemphigoid, Bullous/pathology , Severity of Illness Index , Vitamin D/blood , Vitamin D Deficiency/blood , Vitamin D Deficiency/complications , White PeopleABSTRACT
OBJECTIVES: To compare serum vitamin D status in older inpatients with bullous pemphigoid (BP) and matched inpatients without BP, and to examine whether hypovitaminosis D, a high comorbidity burden or their combination were associated with BP. METHODS: This prospective case-control study was performed from November 2012 to February 2014. A total of 90 consecutive older inpatients (31 consecutive inpatients with a de novo diagnosis of active BP, and 59 matched controls without BP) were recruited in the Department of Dermatology of Angers University Hospital, France. Hypovitaminosis D was defined as serum 25-hydroxyvitamin D (25OHD) concentration<50nmol/L. Age, gender, functional level, sun exposure, season, comorbidity burden and cognitive performance were used as covariates. RESULTS: There was no significant difference between older inpatients with and without BP. Fully adjusted logistic regression showed a significant association between BP and hypovitaminosis D (odds ratio [OR]=3.7, P=0.046). The analysis of interaction between hypovitaminosis D and comorbidity burden showed that only the association of both was significantly associated with PB (OR=3.1, P=0.042). CONCLUSIONS: BP was significantly associated with hypovitaminosis D solely in patients with a high comorbidity burden among the older in-patients studied. This result suggests a complex interplay between hypovitaminosis D and BP, explaining the mixed results reported previously in the literature.
Subject(s)
Pemphigoid, Bullous/epidemiology , Vitamin D Deficiency/epidemiology , Vitamin D/analogs & derivatives , Aged , Aged, 80 and over , Case-Control Studies , Comorbidity , Female , France , Humans , Inpatients , Logistic Models , Male , Prospective Studies , Seasons , Vitamin D/bloodABSTRACT
BACKGROUND: Bathing is a therapeutic measure commonly advised in atopic dermatitis (AD). Whether baths improve skin condition remains yet unclear. Our objectives were to appreciate the effect of 1-month tap water bathing on the submerged skin of AD patients, and to evaluate the proportion of AD patients in favour of baths. METHODS: A Medline search of the last 30 years was performed in November 2012 using the Medical Subject Heading terms 'Atopic Dermatitis' OR 'Eczema' combined with 'Baths' OR 'Bath' OR 'Hydrotherapy' OR 'Cleansing' OR 'Soak'. Interventional studies measuring skin changes after tap water bathing were selected for the first analysis. Observational studies reporting the proportion of AD patients favourable to baths were selected for the second analysis. Important details regarding methods and results were independently extracted by two authors. Random-effects models were used to combine data on outcomes and conduct meta-analyses. RESULTS: Of the 271 abstracts initially identified, seven studies met the selection criteria. All were of good quality. The number of patients with AD ranged from 89 to 260 (41.4-66.3% female). The pooled effect size of skin changes after baths was -0.10 (95% confidence interval: -0.47 to 0.28) in random-effects meta-analysis. The meta-analytical pooled proportion of AD patients in favour of baths was 29.1% (18.5-42.7). CONCLUSIONS: We found no evidence of an effect of 1-month tap water bathing on skin changes in AD. Only 29 percent of AD patients were favourable to baths. Use of baths in AD should be decided together with the patient.
