The differentiating effect of COVID-19-associated stress on the morbidity of blood donors with symptoms of hidradenitis suppurativa, hyperhidrosis, or psoriasis.

PURPOSE: The burden of different skin diseases may vary leading individuals to have different sensitivity to stress. Therefore, we compared the health-related quality of life (HRQoL) and stress before and during the universal stress from the severe acute respiratory syndrome coronavirus-2-pandemic in individuals with and without hyperhidrosis, hidradenitis suppurativa, or psoriasis. METHODS: The study cohort was the Danish Blood Donor Study. Overall, 12,798 participants completed a baseline questionnaire before the pandemic, in 2018-2019, and a follow-up questionnaire during the pandemic, in 2020. Regression determined the association between the skin diseases and outcomes. Outcomes were the physical and mental component summary (MCS, PCS, respectively), which assess the mental and physical HRQoL, and the perceived stress scale, which assesses stress in the past four weeks. RESULTS: Overall, 1168 (9.1%) participants had hyperhidrosis, 363 (2.8%) had hidradenitis suppurativa, and 402 (3.1%) had psoriasis. At follow-up, the participants with hyperhidrosis had worse MCS (coefficient -0.59 [95% confidence interval (CI) -1.05, -0.13]) and higher odds of moderate-to-severe stress (odds ratio 1.37 [95% CI 1.13, 1.65]) and the participants with hidradenitis suppurativa worse PCS (coefficient -0.74 [95% CI -1.21, -0.27]) than the control groups. The associations were independent of baseline HRQoL, stress, the Connor-Davidson Resilience scale, and other covariables. Psoriasis was not associated with the outcomes. CONCLUSION: Individuals with hyperhidrosis or hidradenitis suppurativa experienced worse mental or physical well-being and individuals with hyperhidrosis also had higher stress during the pandemic compared to healthy individuals. This suggests that individuals with these skin diseases are particularly susceptible to external stress.

The temporal association of hyperhidrosis and its comorbidities - a nationwide hospital-based cohort study.

BACKGROUND: Research on hyperhidrosis comorbidities has documented the co-occurrence of diseases but has not provided information about temporal disease associations. OBJECTIVE: To investigate the temporal disease trajectories of individuals with hospital-diagnosed hyperhidrosis. METHODS: This is a hospital-based nationwide cohort study including all patients with a hospital contact in Denmark between 1994 and 2018. International Classification of Diseases version-10 diagnoses assigned to inpatients, outpatients and emergency department patients were collected from the Danish National Patient Register. The main outcome was the temporal disease associations occurring in individuals with hyperhidrosis, which was assessed by identifying morbidities significantly associated with hyperhidrosis and then examining whether there was a significant order of these diagnoses using binomial tests. RESULTS: Overall, 7 191 519 patients were included. Of these, 8758 (0.12%) patients had localized hyperhidrosis (5674 female sex [64.8%]; median age at first diagnosis 26.9 [interquartile range 21.3-36.1]) and 1102 (0.015%) generalized hyperhidrosis (606 female sex [59.9%]; median age at first diagnosis 40.9 [interquartile range 26.4-60.7]). The disease trajectories comprised pain complaints, stress, epilepsy, respiratory and psychiatric diseases. The most diagnosed morbidities for localized hyperhidrosis were abdominal pain (relative risk [RR] = 121.75; 95% Confidence Interval [CI] 121.14-122.35; P < 0.001), soft tissue disorders (RR = 151.19; 95% CI 149.58-152.80; P < 0.001) and dorsalgia (RR = 160.15; 95% CI 158.92-161.38; P < 0.001). The most diagnosed morbidities for generalized hyperhidrosis were dorsalgia (RR = 306.59; 95% CI 302.17-311.02; P < 0.001), angina pectoris (RR = 411.69; 95% CI 402.23-421.16; P < 0.001) and depression (RR = 207.92; 95% CI 202.21-213.62; P < 0.001). All these morbidities were diagnosed before hyperhidrosis. CONCLUSIONS: This paper ascertains which hospital-diagnosed morbidities precede hospital-diagnosed hyperhidrosis. As hyperhidrosis mainly is treated in the primary health care sector, the trajectories suggests that these morbidities may lead to a worse disease course of hyperhidrosis that necessitates treatment in hospitals. Treating these morbidities may improve the disease course of hyperhidrosis.

The association of metabolic syndrome and psoriasis: a population- and hospital-based cross-sectional study.

BACKGROUND: Psoriasis (PS) has been suggested to be associated with the metabolic syndrome (MetS) in numerous studies with conflicting results. The vast majority of previous data were based on PS subjects from hospitals, and when based on data from the general population the PS subjects were often identified in insurance health databases. Furthermore, many studies used a single method approach, e.g. self-reported diagnosis. OBJECTIVE: We have therefore investigated a possible association between PS and MetS on PS subjects from the hospital as well as the general population using combined methods, i.e. self-reported diagnosis, physical examinations and blood samples. METHODS: A population- and hospital-based cross-sectional study of the possible association between PS and MetS. RESULTS: Thirty-six hospital PS subjects, 860 population PS subjects and 14,016 non-PS subjects were identified. The odds ratios (ORs) for hospital PS subjects and population PS subjects vs. population non-PS subjects, respectively, were 5.14 (2.47-10.69) and 1.29 (1.09-1.53) for MetS, 4.55 (1.91-10.85) and 1.16 (0.85-1.59) for diabetes, 1.92 (0.87-4.22) and 1.00 (0.86-1.17) for hypertension, 4.34 (1.86-10.10) and 1.15 (1.00-1.34) for hypertriglyceridaemia, 3.88 (1.96-7.69) and 1.19 (1.01-1.42) for hypoHDL, 5.77 (2.89-11.52) and 1.19 (1.00-1.41) for general obesity and 2.92 (1.45-5.88) and 1.34 (1.16-1.55) for abdominal obesity. Obesity acted as a possible confounder. A uniform pattern of higher ORs for hospital PS subjects when compared to population PS subjects was observed. The severity and duration of PS did not seem to affect the results. As this is a cross-sectional study we cannot demonstrate causality. CONCLUSION: The data suggested an association between PS and MetS as well as its individual parameters on a hospital-based level, with the exception of hypertension. On a population-based level the associations were only significant for MetS, hypoHDL and abdominal obesity.

The prevalence of inverse recurrent suppuration: a population-based study of possible hidradenitis suppurativa.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory disease involving inverse recurrent suppuration (IRS). The epidemiology of the disease is not well described, with previous studies reporting prevalence estimates from 0·00033% to 4%. OBJECTIVE: To determine the prevalence of IRS in a large population-based survey. METHODS: Data were obtained from a general cross-sectional population study in Denmark. A validated self-administered questionnaire was used to identify IRS. Persons with the combination of outbreaks of 'boils' during the last 6 months in predefined areas and a minimum of two boils were identified. RESULTS: A total of 16 404 adults aged 30-89 years provided data and the overall prevalence of IRS was found to be 2·10% [95% confidence interval (CI) 1·88-2·32]; in men it was 1·58% (95% CI 1·29-1·86) and in women 2·56% (95% CI 2·21-2·86). No data for adults aged 20-29 years were included. The prevalence declined with age. The majority of cases (72·9%) had a body mass index of ≥ 25 kg m(-2) and 77·7% were current or ex-smokers. The mean number of inflamed lesions was 6·5 (range 2-67) during the last 6 months. The lesions affected mostly the genitalia (43·4%) and groin (39·8%) for women and 'other places' (not specified) (78·8%) for men. CONCLUSIONS: Data on IRS suggest that HS may be more prevalent than previously suggested, and the prevalence may be comparable to other major dermatoses, e.g. psoriasis. However, as no physician examination was done, the risk of recall and information bias is a major limitation.

Daylight-mediated photodynamic therapy of moderate to thick actinic keratoses of the face and scalp: a randomized multicentre study.

BACKGROUND: Photodynamic therapy (PDT) is an attractive therapy for nonmelanoma skin cancers and actinic keratoses (AKs). Daylight-mediated PDT is a simple and tolerable treatment procedure for PDT. Methyl aminolaevulinate (MAL)-PDT is approved for the treatment of thin or nonhyperkeratotic AKs on the face and scalp. However, thick AK lesions are often treated as well when present in the field-cancerized treatment area. OBJECTIVES: In a randomized multicentre study to evaluate efficacy of daylight-mediated PDT for different severity grades of AKs. METHODS: One hundred and forty-five patients with a total of 2768 AKs (severity grades I-III) of the face and scalp were randomized to either 1½ or 2½ h exposure groups. After application of a sunscreen (sun protection factor 20) and gentle lesion preparation, MAL was applied to the entire treatment area. Patients left the clinic immediately after application and exposed themselves to daylight according to randomization. Daylight exposure was monitored with a wrist-borne dosimeter. RESULTS: No difference in lesion response was found between the 1½ and 2½ h exposure group. The mean lesion response rate was significantly higher in grade I lesions (75·9%) than in grade II (61·2%) and grade III (49·1%) lesions (P < 0·0001). Most grade II (86%) and III AKs (94%) were in complete response or reduced to a lower lesion grade at follow-up. Large variations in response rate of grade II and III AKs were found between centres. No association was found between response rate and light dose in patients who received an effective light dose of > 3·5 J cm(-2). CONCLUSIONS: Daylight-mediated PDT of moderate to thick AKs was less effective than daylight-mediated PDT of thin AKs especially in some centres. However, nearly all thicker lesions (grades II and III) were reduced to a lower lesion grade at 3 months after a single treatment of daylight-mediated PDT.

Efalizumab for severe refractory atopic eczema: retrospective study on 11 cases.

BACKGROUND: Efalizumab is a recombinant humanized murine monoclonal antibody against CD11a, approved for the treatment of plaque psoriasis. However, recent reports suggest that it also may be effective in the treatment of severe atopic dermatitis (AD). OBJECTIVE: To evaluate the clinical effect of efalizumab in AD. METHODS: A systematic retrospective study of the medical files of patients treated with efalizumab for AD in Danish dermatology departments. Positive outcome was defined as improvement of the disease registered in the patient's file over a period exceeding 6 months. RESULTS: Two of eleven patients had a positive outcome. Nine patients stopped treatment due to progression of AD or lack of effect. LIMITATIONS: Retrospective study. CONCLUSIONS: Only a minority of patients with severe AD responded to efalizumab treatment in a standard dose.