Atopic eczema is significantly associated with excessive scarring in new UK analysis

Effects of comorbidities on disfigurement from Keloids and hypertrophic scars (excessive scarring) is being investigated in a new comprehensive analysis of data from the UK Biobank and the results highlight the need for additional research on the pathophysiology of excessive scarring. , found that atopic eczema was significantly associated with excessive scarring.

Although they arise from similar causes—in both casesSkin Damage and Inflammation—Keloid scars persist, whereas hypertrophic scars may disappear over time following skin-related wounds. research researchers JAMA Dermatology Using data on several established comorbidities of excessive cutaneous scarring, including hypertension, uterine leiomyoma, vitamin D deficiency, and atopic eczema, we validate previous findings and uncover new comorbidities There is a possibility.

“Understanding disease comorbidities offers both biological and clinical benefits, such as highlighting novel mechanisms and providing opportunities for targeted early clinical intervention.” the researcher writes. “Previous studies on the comorbidities of keloids and hypertrophic scarring have been limited to candidate diseases based on their inferred biological or demographic similarity.”

Their patient cohort of 230,078 included 972 individuals with excessive scarring identified by diagnostic code (n = 740, keloid scarring; n = 110, hypertrophic scarring; n = 177, any type of scarring). study group and 229,106 healthy controls were included. Man. There were more female patients in the study group (65% vs. 55%) and fewer Caucasian patients (86% vs. 95%). The mean (SD) overall age he was 64 (8) years.

The self-reported ethnic background of the entire patient cohort was Asian or Asian-British (2.1%), Black or Black-British (1.1%), Chinese (0.3%), mixed (0.5%), and Caucasian (94.9%). %), and others. (0.7%). Among the three most representative ethnic groups, black patients had the highest prevalence of excessive scarring compared with Asian and Caucasian patients: 2.4% vs 1.1% vs 0.4%.

Among all participants, the most common complication was hypertension in 37.2% of the scarring group and 34.3% of the control group. This was followed by uterine leiomyoma at 14.5% and 11.2%, respectively. 10.2% and 5.8% atopic eczema. Vitamin D deficiency is 5.1% and 2.4%.

“All previously studied comorbidities (hypertension, uterine leiomyoma, vitamin D deficiency, atopic eczema) were more common in individuals with excessive scarring,” the authors wrote. added that no differences were found in these major comorbidities within the group with excessive scarring between those who received treatment and those who did not.

Using two models, we investigated an independent association with excessive scarring.

• A ‘minimal model’ adjusted for age, sex (uterine leiomyoma was restricted to female participants), and ethnicity
• “Full model” adjusted for age. gender (excluding uterine leiomyoma); ethnicity; influence of body mass index (BMI); Townsend Deprivation Index smoking status with respect to (TDI), hypertension, uterine leiomyoma, and vitamin D deficiency. Effects of BMI, TDI, allergic rhinitis, and asthma on atopic eczema

Four comorbidities were universally associated with excessive scarring. [OR]95% CI, 0.96-1.51) from uterine leiomyoma, 24% (OR, 1.24; 95% CI, 1.08-1.43) from hypertension, 42% (OR, 1.42; 95% CI, 1.05-1.93) vitamin from D deficiency, and 78% (OR, 1.78; 95% CI, 1.44-2.19). In the full model, the corresponding higher risks were 19% (OR, 1.19; 95% CI, 0.95-1.49), 11% (OR, 1.11; 95% CI, 0.96-1.30), 47% (OR, 1.47; 95% CI, 1.08-1.99), and 68% (OR, 1.68; 95% CI, 1.36-2.07).

However, in the minimal model, statistically significant associations were found only between excessive scarring and hypertension (P. = .002) or atopic eczema (P. < .001). And in the full model, only the presence of atopic eczema showed a significant association (P. < .001).

The authors’ sub-analysis of self-reported ethnicity data provided these findings:

• Among black participants, there was a nominally significant association between excessive scarring and hypertension (OR, 2.05; 95% CI, 1.13-3.72; P. = .02) or uterine leiomyoma (OR, 1.93; 95% CI, 1.00-3.71; P. = .05)
• Among Asian participants, there was a significant association between excessive scarring and vitamin D deficiency (OR, 2.24; 95% CI, 1.26-3.97; P. = .006)
• For atopic eczema: Among Caucasian participants, there was a highly significant association with excessive scarring (OR, 1.68; 95% CI, 1.34-2.12; P. < .001); nominally significant association among Asian participants (OR, 2.17; 95% CI, 1.01-4.67; P. = .048); association tended to be statistically significant among black participants (OR, 1.89; 95% CI, 0.83–4.28; P. = .13)

In the phenome-wide association study, the final discovery analysis of the results of the excessive scarring group, 1518 phecodes were screened in 17 disease states. Within this sub-analysis, researchers found the strongest association with excessive scarring from sebaceous cysts (P. = 9.45 × 10⁻³⁰), non-epithelial skin cancer (P. = 2.03 × 10⁻²⁵), hair and follicle diseases (P. = 1.50 × 10⁻²²), and skin/subcutaneous infections, seborrheic keratosis, actinic keratosis, acne, and atopic/contact dermatitis (all, P. < 1.0 × 10⁻¹¹).

“Using the clinical codes currently available within the UK Biobank, it is possible to establish only heterogeneous excessive scarring cases without clinicopathologic correlations and based on potentially subjective clinical assessments. “Nevertheless, our results are in line with what is already known in the literature, as evidenced by the detection of both previously reported and new associations.” It will be added to whatever you have.”

The generalizability of these findings to other patient populations should be investigated in future studies, they stressed.

reference

Ung CY, Warwick A, Onoufriadis A, et al. Comorbidity of keloids and hypertrophic scarring in UK Biobank participants. JAMA DermatologyPublished online January 4, 2023. doi:10.1001/jamadermatol.2022.5607