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One question - on the basis that most eczema patients would be receiving long term topical and/or systemic treatment with steroids, has it been considered that the steroid could be a contributing factor to the increased risk of cardiovascular problems?
The association between active atopic eczema and cardiovascular disease (CVD) found by Silverwood et al.1 is interesting, but there may be another explanation to the association than the one they suggest. Although all individuals with any kind of CVD were excluded, more among those who developed eczema were obese and more had hyperlipidaemia, hypertension and diabetes than among the controls. Considering the widespread use of statin treatment as primary prevention of CVD, the development of eczema may have been caused by such treatment, because experiments both on animals and humans2-4 have shown that eczema may be an adverse effect from statin treatment. I would therefore suggest the authors to study how many of the participants who are or have been on such treatment.
1. Silverwood RJ, Forbes HJ, Abuabara K et al. Severe and predominantly active atopic eczema in adulthood and long term risk of cardiovascular disease: population based cohort study. BMJ 2018;361:k1786 http://dx.doi.org/10.1136/bmj.k1786.
2. Feingold KR, Man MQ, Proksch E et al. The lovastatin-treated rodent: a new model of barrier disruption and epidermal hyperplasia. J Invest Dermatol 1991;96:201-9.
3. Proksch E, Holleran WM, Menon GK et al. Barrier function regulates epidermal lipid and DNA synthesis. Br J Dermatol 1993;128:473-82.
4. Proksch E. Antilipemic drug-induced skin manifestations. Hautarzt 1995;46:76-80.