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Infantile infection and antibiotic exposure in association with pediatric psoriasis development: A nationwide nested case-control study - 13/01/21

Doi : 10.1016/j.jaad.2020.12.014 
Yi-Ju Chen, MD, PhD a, b, c, , Hsiu J. Ho, PhD c, d, Chen-Yi Wu, MD, PhD c, e, f, Chao-Kuei Juan, MD a, b, Chun-Ying Wu, MD, PhD b, c, d, g, h, i,
a Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan 
b Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan 
c Taiwan Microbiota Consortium, Taipei, Taiwan 
d Institute of Biomedical Informatics, Institute of Public Health, National Yang-Ming University, Taipei, Taiwan 
e Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan 
f Department of Public Health, National Yang-Ming University, Taipei, Taiwan 
g Division of Translational Research and Center of Excellence for Cancer Research, Taipei Veterans General Hospital, Taipei, Taiwan 
h College of Public Health, China Medical University, Taichung, Taiwan 
i National Institute of Cancer Research, National Health Research Institutes, Miaoli, Taiwan 

Reprint requests: Yi-Ju Chen, MD, PhD, Department of Dermatology, Taichung Veterans General Hospital, Taichung and Faculty of Medicine, School of Medicine, National Yang-Ming University, No. 155, Section 2, Linong St, Taipei 11221, Taiwan.Department of DermatologyTaichung Veterans General HospitalTaichung and Faculty of MedicineSchool of MedicineNational Yang-Ming UniversityNo. 155, Section 2, Linong StTaipei11221TaiwanChun-Ying Wu, MD, PhD, Institute of Biomedical Informatics, Institute of Public Health, National Yang-Ming University and Division of Translational Research and Center of Excellence for Cancer Research, Taipei Veterans General Hospital, Taipei, No. 155, Section 2, Linong St, Taipei 11221, Taiwan.Institute of Biomedical InformaticsInstitute of Public HealthNational Yang-Ming University and Division of Translational Research and Center of Excellence for Cancer ResearchTaipei Veterans General Hospital, TaipeiNo. 155, Section 2, Linong StTaipei11221Taiwan
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Abstract

Background

Microbiol dysbiosis and antibiotic exposure have been implicated in the pathogenesis of pediatric inflammatory diseases.

Objectives

To investigate the impacts of infantile infection and antibiotic exposure on pediatric psoriasis development.

Methods

This is a nationwide nested case-control study. From the National Health Insurance Research Database of Taiwan, a total of 1527 patients with pediatric psoriasis were identified and matched with 15,270 reference individuals without psoriasis, for the period of 2000 to 2017. Demographic characteristics and comorbidities were compared. Conditional stepwise logistic regression analysis was conducted to examine the associations.

Results

The mean ages were 9.9 ± 3.7 years in both groups. Atopic dermatitis (adjusted odds ratio [aOR], 2.07; 95% confidence interval [CI], 1.84-2.32) and family history of psoriasis, especially of the mother (aOR, 9.86; 95% CI, 6.89-14.10) or other first-degree relatives (aOR, 5.49; 95% CI, 3.91-7.70), were independently associated with pediatric psoriasis on multivariate analyses. Skin viral and bacterial infections (aOR, 1.35; 95% CI, 1.13-1.62) and fungal infections (aOR, 1.71; 95% CI, 1.44-2.04) in the first 2 years of life were significantly associated with pediatric psoriasis. Systemic antibiotic exposure was not. These results were consistent at different time periods across sensitivity analyses.

Limitation

Information about diet and lifestyle was not available.

Conclusion

Skin infections at an early age were associated with pediatric psoriasis development.

Le texte complet de cet article est disponible en PDF.

Key words : antibiotics, infantile, infection, microbiota, nested case-control study, pediatric psoriasis

Abbreviations used : aOR, CI, FDR, NHIRD, OR, Th


Plan


 Drs Chen and Wu contributed equally to this article.
 Funding sources: Supported by Ministry of Science and Technology, Taiwan (MOST 104-2314-B-010-051 MY3 to Dr Chen) and Taichung Veterans General Hospital, Taiwan (TCVGH-1066802C to Dr Chen).
 IRB approval status: Reviewed and approved by Taipei Veterans General Hospital IRB (no. 2017-08-005CC) and Taichung Veterans General Hospital IRB (no. CE20224B).


© 2020  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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