Julia Spoendlin

A study on the epidemiology of rosacea in the U.K.

Background  Rosacea is a chronic facial skin disease of unclear origin. Epidemiological data are scarce and controversial, with reported prevalences ranging from 0·09% to 22%. To our knowledge, incidence rates have not been quantified before.

The Epidemiology of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in the UK

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but life-threatening mucocutaneous diseases. SJS/TEN mostly manifest as a reaction to new drug use, but little is known about their incidence and epidemiology. We conducted a large observational study on the epidemiology of SJS/TEN using data from the UK-based Clinical Practice Research Datalink. Among 551 validated SJS/TEN patients, we calculated an incidence rate of 5.76 SJS/TEN cases per million person-years between 1995 and 2013, which was consistent throughout the study period and was highest in patients aged 1-10 years and 80 years or older. Within a 1:4 matched case-control analysis, black and Asian patients were at a 2-fold risk of SJS/TEN when compared with white patients. Among patients with epilepsy and gout, odds ratios for SJS/TEN were significantly increased only in the presence of recent new drug treatment with antiepileptics or allopurinol, respectively. We observed statistically significant associations between SJS/TEN and pre-existing depression, lupus erythematosus, recent pneumonia, chronic kidney disease, and active cancer, but confounding by drug use needs to be followed up. This large and longitudinal observational study on the epidemiology of SJS/TEN contributes to the understanding of this still underinvestigated severe skin disease in a European and largely white study population.

Migraine, triptans, and the risk of developing rosacea: A population-based study within the United Kingdom

BACKGROUND Rosacea is a common skin disease, involving neurogenic inflammation and neurovascular dysregulation. Migraine has been associated with vascular changes and sterile inflammation. The 2 diseases have been associated over decades, but evidence is scarce. Triptans have vasoconstricting and antiinflammatory properties, but a potential impact of this drug class on rosacea remains uninvestigated. OBJECTIVE We sought to analyze the association between migraine or triptan exposure and the risk of developing rosacea within the United Kingdom. METHODS We conducted a case-control study using the United Kingdom-based General Practice Research Database. We identified patients with incident rosacea between 1995 and 2009 (cases), and matched 1 rosacea-free control subject to each case. We compared the prevalence of diagnosed migraine and exposure to triptans before the first-time rosacea diagnosis between cases and controls using multivariate conditional logistic regression. RESULTS Among 53,927 cases and 53,927 controls, we observed a small overall association between rosacea and migraine in women (adjusted odds ratio 1.22, 95% confidence interval 1.16-1.29), but not in men. This effect was somewhat more distinct in female migraineurs aged 50 to 59 years (odds ratio 1.36, 95% confidence interval 1.21-1.53). Female triptan users also revealed slightly increasing risk estimates with increasing age, with the highest odds ratio of 1.66 (95% confidence interval 1.30-2.10) in women aged 60 years or older. LIMITATIONS This is a retrospective case-control study, for which a certain degree of bias and confounding cannot be ruled out. CONCLUSIONS We observed a slightly increased risk for female migraineurs to develop rosacea, particularly in women with severe migraine aged 50 years or older.

Rosacea in Patients with Ulcerative Colitis and Crohn's Disease: A Population-based Case-control Study

Background:Cutaneous manifestations are common in patients with inflammatory bowel diseases (IBDs) (ulcerative colitis [UC] and Crohns disease [CD]). Previous case reports described patients with IBD who developed rosacea. IBD and rosacea are inflammatory epithelial diseases, presumably associated with changes in the innate immune system. We explored the association between IBD and incident rosacea. Methods:We conducted a population-based matched (1:1) case–control analysis on the association between IBD and rosacea, stratified by IBD disease duration and severity. We used data from the UK-based Clinical Practice Research Datalink. Cases had an incident diagnosis of rosacea recorded between 1995 and 2013. Results:Among 80,957 rosacea cases and the same number of controls, a history of UC was associated with an increased risk of rosacea (odds ratio [OR] 1.65, 95% confidence interval [CI], 1.43–1.90), with the highest OR in those with short UC duration (OR 2.85, 95% confidence interval, 1.80–4.50 for patients with <2 years of disease history). A history of CD yielded an overall OR of 1.49 (95% CI, 1.25–1.77), which did not correlate with disease duration. Additional analyses on IBD disease severity yielded evidence for a higher risk of rosacea in those with higher UC and CD activity. Conclusions:Our findings provide evidence that patients with IBD may be at increased risk of rosacea (higher in UC), particularly during phases of increased IBD-associated gastrointestinal tract inflammation.

The association between psychiatric diseases, psychotropic drugs and the risk of incident rosacea.

Psychological conditions, such as traumatic events or stress, have been discussed controversially as aetiological factors for rosacea.

The risk of Stevens-Johnson syndrome and toxic epidermal necrolysis in new users of antiepileptic drugs

Older antiepileptic drugs (AEDs) are known to cause Stevens‐Johnson syndrome and toxic epidermal necrolysis (SJS/TEN). However, evidence for newer AED is sparse. We quantified risks of SJS/TEN in association with use of all AEDs in the United Kingdom.

Type II diabetes mellitus and incident osteoarthritis of the hand: a population-based case–control analysis

OBJECTIVES Emerging evidence suggests that diabetes may be a risk factor for osteoarthritis (OA). However, previous results on the association between diabetes and all OA were conflicting. We aimed to comprehensively analyse the association between type II diabetes mellitus (T2DM) and osteoarthritis of the hand (HOA) specifically. METHODS We conducted a matched (1:1) case-control study using the UK-based Clinical Practice Research Datalink (CPRD) of cases aged 30-90 years with an incident diagnosis of HOA from 1995 to 2013. In multivariable conditional logistic regression analyses, we calculated odds ratios (OR) for incident HOA in patients with T2DM, categorized by T2DM severity (HbA1C), duration, and pharmacological treatment. We further performed sensitivity analyses in patients with and without other metabolic diseases (hypertension (HT), hyperlipidaemia (HL), obesity). RESULTS Among 13,500 cases and 13,500 controls, we observed no statistically significant association between T2DM and HOA (OR 0.95, 95% confidence interval (CI) 0.87-1.04), regardless of T2DM severity, duration, or pharmacological treatment. Having HT did not change the OR. Although we observed slightly increased ORs in overweight T2DM patients with co-occurring HL with or without coexisting HT, none of these ORs were statistically significant. CONCLUSIONS Our results provide evidence that T2DM is not an independent risk factor for HOA. Concurrence of T2DM with HT, HL, and/or obesity did not change this association significantly.

Antihypertensive drugs and the risk of incident rosacea

Despite scarce evidence, use of calcium channel blockers is discouraged in patients with rosacea, whereas beta‐blockers are recommended as an off‐label treatment for erythematotelangiectatic rosacea.

Oral and inhaled glucocorticoid use and risk of Achilles or biceps tendon rupture: a population-based case-control study

Background. Tendinotoxicity of glucocorticoids (GC) has been shown, but evidence on how this translates into clinical practice remains scarce. Objectives. To explore the association between oral or inhaled GC use and the risk of Achilles or biceps tendon rupture (ATR/BTR). Methods. We identified patients aged 18 to 89 years with incident ATR or BTR (1995–2013) for a matched (1:4) case-control analysis using the UK-based Clinical Practice Research Datalink. We stratified oral GC use by indication, timing and duration of use, continuous versus intermittent use, cumulative dose, and average daily dose. We stratified inhaled GC use by timing and number of prescriptions. Results. Among 8,202 cases, we observed increased odds ratios (ORs) around 3.0 for continuous oral GC use, which declined shortly after therapy cessation (similarly across indications). Odds ratios increased with average daily dose (≥ 10 mg/day, OR 4.05, 95% CI 2.32–7.08) and were elevated after one cycle of high-dose oral GC (≥ 20 mg/day). There was no effect of inhaled GC at any level of exposure. Conclusion. Our results provide evidence that oral GC therapy increases the risk of tendon rupture in a dose–response relationship. A single short-term high-dose GC treatment course may be sufficient transiently to increase the risk of tendon rupture.

Validation of Stevens-Johnson syndrome or toxic epidermal necrolysis diagnoses in the Clinical Practice Research Datalink

To evaluate the validity of recorded diagnoses of Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in the Clinical Practice Research Datalink (CPRD).