Hormone replacement therapy (HRT) is widely used to relieve symptoms of menopause with proven efficacy. However, there has been significant controversy surrounding the use of HRT because of its potential link with an increased risk of cancer, particularly female reproductive organ cancers. That HRT increases the risk of melanoma is also disputed, and several cohort studies have produced variable results. To delineate the association between HRT and melanoma in Taiwan, we conducted a population-based retrospective cohort study on 14 291 patients who had received HRT and 57 164 population controls in Taiwan between 2000 and 2013. Multivariate odds ratios (ORs) were calculated utilizing conditional logistic regression. Overall, the use of HRT was not significantly correlated with a higher risk of developing melanoma in Taiwan (95% confidence interval 0.386-1.099; p = 0.341). The hazard ratio analysis of melanoma and different HRTs showed there was no significant association between melanoma and the use of oral or external estrogens alone, including conjugated estrogens, estradiol, and estriol. Estrogen plus progesterone combined therapy was associated with a lower risk of melanoma. Only one case of melanoma was observed among the 2880 patients in this subgroup.
Vitiligo is perceived as an autoimmune skin disease. Previous studies showed conflicting data about vitiligo and pregnancy outcomes. To delineate the associations between vitiligo and the pregnancy outcomes, we used the National Health Insurance Research Database of Taiwan to conduct a retrospective cohort study from January 1, 2000 to December 31, 2015. This study population was composed of 1,096 women with vitiligo and 4,384 women without vitiligo, who were all matched according to age, comorbidity, and index year. Compared with the non-vitiligo controls, women with vitiligo had a higher risk of abortion (aHR 1.158, 95% confidence interval (CI) 1.095–1.258, P < .001). Perinatal events, such as preterm delivery, pre-eclampsia/eclampsia, gestational diabetes mellitus, stillbirth, and intrauterine growth retardation, were not different between both groups (aHR 1.065, 95% CI 0.817–1.157, P = .413). To determine if systemic treatment before conception decreases the risk of abortion, we assessed the medical history of pregnant women with vitiligo 1 year before pregnancy. Patients who were treated with oral medications had a lower risk of abortion than those who were not (aHR: 0.675, 95% CI: 0.482–0.809, P < .001). Our study indicates that there is a higher risk of abortion in pregnant women with vitiligo and the control of disease activity with systemic treatment before conception could improve pregnancy outcomes.
Abstract Hidradenitis suppurativa ( HS ) has been reported to be associated with metabolic syndrome and coronary artery disease ( CAD ). Nevertheless, a nationwide study of this relationship in the Asian population has not been conducted. The aim of the present study was to clarify the cardiovascular disease risk factors, and the occurrence of CAD and cerebral infarction among patients with HS by using a nationwide database in Taiwan. We obtained data from the National Health Insurance Research Database of Taiwan. After adjusting for confounding factors, we used Cox proportional hazards analysis to reveal the risk of incident hypertension ( HTN ), diabetes mellitus ( DM ), dyslipidemia, CAD and cerebral infarction in HS patients. We identified 478 patients with newly diagnosed HS and 1912 patients in the control cohort during the 10‐year follow‐up period. Compared with the controls, HS patients had a higher risk of dyslipidemia (adjusted hazard ratio [ aHR ], 3.858; 95% confidence interval [ CI ], 2.785–5.346; P < 0.001), HTN ( aHR , 1.910; 95% CI , 1.463–2.493; P < 0.001), DM ( aHR , 1.709; 95% CI , 1.127–2.591; P = 0.012). Regarding comorbidities, our results also revealed a higher risk of CAD in HS patients ( aHR , 2.722; 95% CI , 1.628–4.553; P < 0.001), but not cerebral infarction ( aHR , 0.514; 95% CI , 0.119–2.231; P = 0.375). Our results indicate that there is a higher risk of dyslipidemia, HTN , DM and CAD in HS patients.
Cutaneous adverse drug reactions (CADRs) are the common adverse reactions ranging from mild self-limiting skin rash to the life-threatening severe cutaneous adverse reactions. Aims: The aim of the study was to describe the demographic characteristics of patients, different clinical patterns, and implicated drugs. Methods: This was a retrospective study by analyzing the database established for all ADRs reported from January 1, 2018, to December 31, 2018, in a tertiary care teaching hospital in Taipei, Taiwan. Results: A total of 126 cases of CADRs were reported in 2018. The mean age of patients was 59.06 ± 21.63 years, with a peaking at 60–79-year-old (31.7%) and followed by 40–59-year-old (25.4%). The male-to-female ratio was 1.03:1. The most common skin reaction pattern was maculopapular eruptions (59.5%), followed by angioedema (11.9%), phlebitis (6.3%), and urticaria (6.3%). Most of the CADRs were reported with antibacterials (66.7%), followed by anti-inflammatory products (11.9%), contrast media (4.8%), and antithrombotic agents (3.2%). Conclusions: We listed the patient characteristics, each pattern of CADRs, and their associated drugs. Such information could help health-care professionals to assess CADRs and evaluate suspected drugs timely and accurately.
Pretibial myxedema (PM) is an unusual extrathyroidal manifestation of Graves' disease (GD), which affects approximately 1%–5% of the patients. In addition, PM usually occurs in the hyperthyroid state of GD, and the high level of thyroid autoantibodies is considered to be the cause of PM. Here, we present a rare case of a patient who developed PM after undergoing I-131 ablation therapy, with normal levels of thyroid autoantibodies. Our report aims to document the features of PM in a male adult with hypothyroidism and to provide a potential mechanism of the onset of PM.
Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder. Since 1860, only 200 case reports of BRBNS have been reported. BRBNS is characterized by numerous malformations of the vascular system that significantly involve the skin, gastrointestinal tract, and other internal organs. We describe a 72-year-old Taiwanese man with BRBNS. Besides typical adult-onset cutaneous lesions, he had venous malformation in the central nervous system, which caused massive intracerebral hemorrhage. He has been in a stupor ever since. Physicians should recognize cutaneous BRBNS lesions early and be aware of the possible complications that arise from internal organs involved.
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