EditorThe prevalence of smoking in rosacea patients has only been examined twice 1,2 with different results. In this study, we aimed to evaluate if rosacea is a disorder predominantly affecting non-or ex-smokers.A multicentre case-control study was performed in the dermatology departments of Lorraine's hospitals, France, between January and June 2008. All patients were adults clinically diagnosed with rosacea by a dermatologist using the criteria of Wilkin et al. 3 The control group consisted of dermatological patients without rosacea. Each rosacea case was matched by age (±5 years), gender and dermatology department with one control case. All participants gave informed oral consent to be included in the study.Data collection was based on an anonymous questionnaire. The questionnaire included: (i) the patient profile items; (ii) smoking habits; and (iii) rosacea subtype and severity. 2 We defined smoking status as follows: (i) non-smokers never exposed to tobacco; (ii) smokers, active or ex-smokers; (iii) exsmokers; and (iiii) ex-smokers for more than 1 year (to avoid the short-term effects of tobacco).Univariate analysis was performed with the odds ratio (OR) method with a 95% confidence interval (CI). Pearson's chi 2 test was used to compare data. P-values of 0.05 or less were considered significant.Among 240 questionnaires, 34 questionnaires were excluded because of the absence of a matched control, incomplete responses or cases of rosacea induced by medication to avoid bias caused by drug-induced modifications. A resulting 206 questionnaires were analysed (Table 1).The prevalence of smoking among cases and controls was not different (P = 0.26). No significant difference was found between active smokers and those never exposed to tobacco (P = 0.60). The proportion of ex-smokers at the time of the study was larger in the case group than in the control group, but the difference was not significant (Table 2). When ex-smokers were defined as patients who stopped smoking for more than 1 year, the difference became significant ( Table 2).The prevalence of smoking differed with respect to the stage of the disease: 17% of smokers were present among the 46 cases of subtype 1 rosacea, 9% in subtype 2, 30% in subtype 3 and none in subtype 4. No difference could be evaluated regarding the subtypes of rosacea and smoking status because of the size of the groups.
Increased susceptibility to infections is among the main safety concerns raised by anti-TNF-α agents. We describe two cases of cutaneous actinomycosis in patients undergoing anti-TNF-α therapy: a 49-year-old female treated with etanercept for rheumatoid arthritis and a 57-year-old female treated with infliximab for psoriasis. Both patients had discharge with the intermittent presence of sulfur granules occurring at the site of previous surgical wounds. Bacteriological culture demonstrated Actinomyces. Since in both cases laboratory findings and medical imaging ruled out visceral actinomycosis, oral antibiotics were introduced without discontinuing anti-TNF-α. The first patient did not relapse after 2 years. The second one did and received a second course of antibiotics combined with transient interruption of the anti-TNF-α therapy. The risk of developing actinomycosis is reported to be similar in immunocompetent and immunocompromised patients, however cases of cutaneous actinomycosis occurring during anti-TNF-α therapy need to be recognized and may be under-reported.
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