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Psoriasis: Case Rate – HL-A Antigen Frequency Correlations

Psoriasis: Case Rate – HL-A Antigen Frequency Correlations Dermatologica 154: 23-31 (1977) R obert J . T homas1 Department of Epidemiology, Johns Hopkins University, School of Hygiene and Public Health, Baltimore, Md. Key Words. Psoriasis • HL-A • Histocompatibility antigens • Case rate • International comparisons Abstract. HL-A antigen B17, associated with a high familial frequency of psoriasis, is significantly correlated (r = 0.8242) with psoriasis case rates in several countries but HL-A antigen BI3 alone, associated with 'early age onset’ cases of psoriasis, is not significantly correlated (r = 0.4299) with case rate. A sum of the B13 and B17 antigen frequencies, since either antigen has been associated to psoriasis, is correlated with case rate in the populations surveyed (r = 0.7405) and is statistically significant. Psoriasis, the chronic skin disease, occurs among Caucasians and is common in all European populations, less frequent among Asiatics, and very rare in pure Blacks [1], Incidence and prevalence data have been difficult to obtain because of the nature of the disease: ‘the disease of the healthy’ [2], and the previous nonsuccess of therapy protocols does not encourage many psoriatics to seek either any further therapy or medical observation. Be r e- st r o n and C e c c o l in i [3] found only 54 psoriatics in 20,000 consecutive US military inductees in World War II (0.3% period prevalence). Today, the National Psoriasis Foundation (US) estimates that 4% of the US population have psoriasis, a possible overestimate. The question of period prevalence in the United States is being queried as part of the National Center for Health 1 Supported by a Cancer Epidemiology Postdoctoral Fellowship (I T32 CA09002 from the National Cancer Institute). Received: July 5, 1976; accepted: August 21, 1976. 24 T h o m a s Statistics’ Health and Nutrition Survey (HANES) which may provide a better ‘national’ estimate. For some individual national or racial groups, estimates have been reported as a ‘psoriasis case rate of all dermatological cases’ [1,4-14], In several infrequent citations, an attempt to document case rate differences within countries or on a specific continent has been made. In Japan [11], the case rate has been presented as differing from a low of less than 4/1,000 dermatological cases in Southern Japan to more than 5 psoriasis cases /1,000 in the North (opposite to the distribution of skin cancer). D ovzhanski [15] in a review of psoriasis in the USSR presents a case rate difference from 0.68 to 4.43% psoriasis cases in all dermatology cases in different medical centers in the Soviet Union. Lomholt [13] has summarized case rate differences in Africa and K enney [14] has used the difference, West Africa (Nigeria 0-0.5% ) versus East Africa (Kenya 3.2%), to explain the paucity of psoriasis in American Blacks who mainly originated from West Africa. Several authors [11, 13] attribute the frequency differences to environ­ mental variation affecting the exhibition of the disease or suggest genetic variation, without a correlative marker, as the cause of the variation [12,14]. A familial occurrence of psoriasis has been suggested in several reviews and surveys of psoriasis [6, 9-11, 15-18], These approaches, for example Lomholt' s extensive pedigree documentation of the Faroe Islands [10], have examined the type of inheritance pattern and it is generally agreed that psoriasis is an autosomal dominant disorder with ‘variable expression' (penetrance) [19-26] which does not eliminate a polygenic inheritance pat­ tern. With the development of histocompatibility typing (HL-A), several authors have found that psoriatics possess either HL-A B13 or B17 antigens [27-34]. They have also found antigen B13 associated with an early age of onset and B17 with familial aggregation. S vejgaard el at. [29] have cal­ culated an odds ratio (OR) for psoriasis and these antigens: B13 OR = 4.01 and B17 OR = 6.57. If the HL-A antigen B13 and/or antigen B17 are associated with the skin disease psoriasis, then the frequency of the HL-A antigens in a population should be correlated positively to the best frequency data of psoriasis in that population. Methods To test this hypothesis, the psoriasis case frequency within all dermatological cases (from a review of H ellgren [35], S idi el al. [36] and a special study of South American native Indians [12]) was correlated to HL-A BI3 and B17 antigens. Control groups for Psoriasis: Case R ate HL-A 25 studies other than HL-A/psoriasis correlations (i.e., population descriptions or HL-A/ cancer correlations) yielded HL-A antigen frequency data [37-49]. One-variable correlation coefficients were calculated and an extrapolation method (assuming no correlation) [50] was used for significance testing (p 0.05). Observations and Discussion The psoriasis case frequency varys from no occurrence in the North and South American native Indian populations to a high of 8.2% in Icelanders (table I). Overall, HL-A antigen B17 has a higher frequency than HL-A antigen BI3 in any reported population. The correlation of psoriasis case rate with HL-A antigen BI3 is r = 0.4299 and is not statistically significant (fig. 1). HL-A antigen B17, the antigen associated with a familial occurrence of psoriasis, is correlated with psoriasis case rate (r = 0.8242) and is statis­ tically significant ( p <0.05; fig. 2). Since either HL-A B13 or B17 antigens Table I. The psoriasis case rate as a percentage of psoriasis cases reported from a derm ato­ logical clinic or as a special survey and reported HL-A antigen frequencies, B13 and BI7, for the respective country or population group, is presented Country, Psoriasis Antigen (phenotype) frequency, % population group case rate, % ' HL-A BI3 HL-A BI7 HL-A B13 plus B17 Iceland 8.2 1.8 8.7 10.5 France 6.21 2 4.2 7.5 11.7 West Germany 6.0 8.0 8.0 16.0 6.0 3.0 9.0 12.0 England Denmark 5.2 2.8 8.2 11.0 Netherlands 4.7 6.2 4.4 10.6 2.21 6.22 8.43 Norway 4.5 2.7 7.8 USA (Whites) 4.0 5.1 2.57 3.5 6.5 10.0 Australia Koreans (in Korea) 0.68 4.8 6.6 11.4 Japanese (in Korea) 0.29 1.6 2.5 4.1 1.0 1.0 North American Indians 0 0 South American Indians O3 0 0.64 0.64 1 H ellgren [35] except for France and South American Indians. 2 Sidi et al. [36], 3 K erdel-Vegas [12], T h o m a s P so ria sis cases o f a ll derm atological ca se s, °/o Fig. 1. A graphical presentation of HL-A antigen B13 and psoriasis case rate correla­ tion for surveyed countries shows some correlation (r = 0.4299) but the correlation is not statistically significant for so few observations. P so ria sis c a se s o f a ll derm atological c a s e s , “/» Fig. 2. A high degree o f correlation (r = 0.8242), statistically significant (p<0.05), exists for the correlation of HL-A antigen B17 and psoriasis case rate in the countries surveyed. Psoriasis: Case R ate HL-A 27 Fig. 3. Correlation between psoriasis case rate and the sum of both associated HL-A antigens, BI3 and B17, is close (r = 0.7405) to the correlation of antigen BI7/psoriasis alone and for the small sample size is still statistically significant (p<0.05). have been associated to psoriasis, a correlation of the sum of the antigen frequencies (disregarding the low probabilities of HL-A haplotypes xx-13/ xx-13, xx-17/xx-17, and xx-13/xx-17) and psoriasis case rate should be, and is, significantly correlated (r = 0.7405, p < 0 .0 5 ; fig. 3). Psoriasis as a disease is in the penultimate position of HL-A antigen/ disease associations, second only to the HL-A antigen B27/ankylosing spondylitis association [51, 52], Several assumptions have been made and may bias these correlations. A case frequency of a disease in a clinic is not necessarily a good measure of prevalence of the disease in a population. A choice of a control group for HL-A typing within a given country may in itself be biased. The bias of case selection/attendance of psoriatics at a dermatological clinic, though, may be the same as the bias of selection/ volunteers for a control group in HL-A studies and would not affect a c o r­ relation analysis. 28 T h o m a s Burch and R o w e l l’s [23] suggestion of two genotypes for the etiology of psoriasis is consistent with the observations of this report. The suggestion by Seignalet et al. [31] that though HL-A B13 antigen frequency was ele­ vated in the population they tested but was not statistically significant and that HL-A B17 antigen frequency was elevated and is statistically significant, was confirmed in this analysis of HL-A antigen frequency and case rate association. The variation of psoriasis case frequency, country to country, appears to be associated primarily with variation of HL-A antigen B17. The second associated HL-A antigen, B13, is not significantly associated to psoriasis case frequency alone but the sum of the antigen frequencies (B13 plus BI7) is still significantly associated to psoriasis case frequency. Psoriasis case frequency variations attributed to environmental, psychosocial factors, etc. may be untenable unless HL-A B13 and B17 antigen frequencies for the populations are considered. Environmental or psychosocial factors may prove significant as onset or exacerbation factors when the population of psoriatics is adjusted for the possession of HL-A B13 and/or B17 antigens. References 1 F ärber, E.M .; G rauer, F., and Z aruba, F.: Racial incidence of psoriasis. Cslka Derm. 40: 289-297 (1965). 2 H olzmann, H.; H oede, N. und K ra pp, R.: Gutachterliche Probleme bei der Beurtei­ lung der Psoriasis. Z. Hautkr. 49: 493-496 (1974). 3 Bereston, E.S. and C eccolini, E.M .: Incidence of dermatoses in twenty-thousand army induction examinations. Archs Derm. 47: 844-848 (1943). 4 C avalieri, R.: Cronogenetica della Psoriasi. Acta Genet, med. Gemell. 23: 299-301 (1973). 5 Ingram, J .T .: The significance and management of psoriasis. Br. med. J. ii: 823-828 (1954). 6 C oltoiu, A.: Dermatoze Dispositionale (Editura Medicala, Bucuresti 1973). 7 F indlay, G .H .: Dermatology of the Bantu. A survey. S. Afr. med. J. 31: 471-474 (1957). 8 M arshall, J.: Skin diseases in South Africa. Arch. Derm. 87: 419-427 (1963). 9 R omanus, T . : Psoriasis from a prognostic and hereditary point of view. Acta dernt.- vener., Stockh. 26: suppl. 12, pp. 1-137 (1945). 10 Lomholt, G . : Psoriasis - prevalence, spontaneous course and genetics. A census study on the prevalence of skin diseases on the Faroe Islands (BEC Gad, Copenhagen 1963). 11 Yasuda, T.; Ishikaw a, E., and Mori, S.: Psoriasis in the Japanese; in F ärber and Cox International symposium on psoriasis, chapter 5 (Stanford University Press, Stanford 1971). Psoriasis: Case R ate HL-A 29 12 K erdel-V egas, F .: Psoriasis in South America. Geographic and racial factors; in F ärber and Cox International symposium on psoriasis, chapter 6 (Stanford University Press, Stanford 1971). 13 Lomholt, G .: Psoriasis in Uganda. A comparative study with other parts of Africa; in F ärber and Cox International symposium on psoriasis, chapter 7 (Stanford Uni­ versity Press, Stanford 1971). 14 K enney, J.A.: Psoriasis in the American Black; in F ärber and Cox International symposium on psoriasis, chapter 8 (Stanford University Press, Stanford 1971). 15 D ovzhanski, S.I.: Psoriaz (Saratov University, Saratov 1973). 16 F ärber, E.M. and M cC lintock, R.P., j r . : A current review of psoriasis. Calif. Med. 108: 440-457 (1968). 17 F ärber, E.M .; Bright, R.D., and N all, M .L.: Psoriasis. A questionnaire survey of 2,144 patients. Archs Derm. 98: 248-259 (1968). 18 F ärber, E.M. and N all, M .L .: The natural history of psoriasis in 5,600 patients. Dermatológica 148: 1-18 (1974). 19 Steinberg, A .G .; Becker, S.W.; F itzpa trick, T.B., and K ierland, R.R.: A genetic and statistical study of psoriasis. Am. J. hum. Genet. 3: 267-281 (1951). 20 Steinberg, A .G .; Becker, S.W.; F itzpa trick, T.B., and K ierland, R.R.: A further note on the genetics of psoriasis. Am. J. hum. Genet. 4: 373-375 (1952). 21 W ard, J.H. and Stephens, F.E.: Inheritance of psoriasis in a Utah kindred. Archs Derm. 84: 105-108 (1961). 22 A bele, D .C.; D obson, R.L., and G raham, J.B .: Heredity and psoriasis. Archs Derm. 88: 38-47 (1963). 23 Burch, P.R.J. and R owell, N .R.: Psoriasis. Aetiological aspects. Acta derm.-vener., Stockh. 45: 366-380 (1965). 24 F ärber, E.M. and N all, M .L.: Genetics of psoriasis. Twin study; in F ärber and Cox International symposium on psoriasis, chapter 2 (Stanford University Press, Stanford 1971). 25 W atson, W .; C ann, H .M .; Färber, E.M ., and N all, M .L .: The genetics o f psoriasis. Arch. Derm. 105: 197-207 (1972). 26 K imberling, W. and D obson, R.L.: The inheritance o f psoriasis. J. invest. Derm. 60: 538-540 (1973). 27 R ussell, T .J.; Schultes, L.M., and K uban, D .J .: Histocompatibility (HL-A) antigens associated with psoriasis. New Engl. J. Med. 287: 738-740 (1972). 28 W hite, S.H.; N ewcomer, V.D.; M ickey, M .R., and T erasaki, P.I.: Disturbance of HL-A antigen frequency in psoriasis. New' Engl. J. Med. 287: 740-743 (1972). 29 Svejgaard, A.; Svfjgaard, E.; Staub-N ielsen, L., and J acobsen, B.: Some specula­ tions on the associations between HL-A and disease based on studies of Psoriasis patients and their families. Transplant. Proc. 5: 1797-1798 (1973). 30 Schoefinius, H .-H .; Braun-F alco, O .; Sch olz, S .; Steinbauer-R osenthal, L; W ank, R. und A lbert, E.D.: Histokompatibilitätsantigene (H L-A ) bei Psoriasis. Dt. med. Wschr. 99: 440-444 (1974). 31 Seignalet, J.; C lot, J.; G uilhou, J.J.; D untze, F.; M eynadier, J., and R obinet- Levy, M .: HL-A antigens and some immunological parameters in psoriasis. Tissue Antigens 4: 59-68 (1974). 32 Svejgaard, A.; Staub-N ielsen, L.; Svejgaard, E .; Kissmeyer-N ielsen.F . ; H jortshoj 30 T h o m a s A., and Z achariae, H .: HL-A in psoriasis vulgaris and in pustular psoriasis. Popula­ tion and family studies. Br. J. Derm. 91: 145-153 (1974). 33 K rulig, L.; F ärber, E.M .; G rumet, F.C., and Payne, R .O .: Histocompatibility (HL-A) antigens in psoriasis. Archs Derm. I l l : 857-860 (1975). 34 Stenszky, V.; N agy, E.; Szerze, P., and Ladanyi, E.: HL-A antigens and lympho- cytotoxic antibodies in psoriasis vulgaris. Derm. Mschr. 162: 35-38 (1976). 35 H ellgren, L . : Psoriasis. The prevalence in sex, age and occupational groups in total populations in Sweden. Morphology, inheritance and association with other skin and rheumatic diseases (Almquist & Wiksells, Stockholm 1967). 36 Sidi, E.; Z agula-M ally, Z.W., and H incky, M.: Psoriasis (Thomas, Springfield 1968). 37 L amm, L .U .; K issmeyer-N ielsen, F.; K jerbye, K .E .; J orgensen, J .; Bruun Peter­ sen, G .; G ürtler, H., and T ordarson, C .: The HL-A types in an Icelandic popula­ tion; in Histocompatibility testing - 1972 (Munksgaard, Copenhagen 1973). 38 D ausset, J.; C olombani, J.; Legrand, L.; L epage, V.; M arcelli-Barge, A., and D ehay, C .: Population and family studies in a French population with special reference to non-HL-A antibodies; in Histocompatibility testing - 1972 (Munksgaard, Copen­ hagen 1973). 39 A lbert, E.D.; Sch o lz, S.; R osenthal, L; Baltin, H., and Bertrams, J.: Study of the HL-A system in the Turkish and German populations; in Histocompatibility testing - 1972 (Munksgaard, Copenhagen 1973). 40 H arris, R .; W entzel, J .; C arroll, C.A., and J ennison, R .F .: HL-A frequencies in West Pakistanis (Punjabi) in the United Kingdom; in Histocompatibility testing - 1972 (Munksgaard, Copenhagen 1973). 41 A lbert, E.D .; Ko, S.S.; P retorius, A.M.G., and Bertrams, J.: Study of the HL-A system in the Korean population; in Histocompatibility testing - 1972 (Munksgaard, Copenhagen 1973). 42 D oes, J.A. Van d e r ; E lkerbout, F .; D 'A maro, J.; Steen, G. Van d e r; Loghem, E. Va n ; M eer K ahn, P .; Bernini, L .F.; Leuwen, A. Van, and R ood, J.J. Va n : HL-A typing in Dutch patients with Hodgkin’s disease; in Histocompatibility testing - 1972 (Munksgaard, Copenhagen 1973). 43 T horsby, E.; B ratlie, A., and E ngeset, A.: HL-A antigens in Hodgkin's disease. II. Clinico-pathological correlation analysis of 132 Norwegian patients; in Histo­ compatibility testing - 1972 (Munksgaard, Copenhagen 1973). 44 K issmeyer-N ielsen, F .; L amm, L .U .; K jerbye, K .E.; Bjorn J ensen, K .; N ordentoft, A.M.; T horling, K ., and H astrup, J .: HL-A phenotypes in Hodgkin's disease; in Histocompatibility testing - 1972 (Munksgaard, Copenhagen 1973). 45 D ausset, J. and C olombani, J.: Histocompatibility testing - 1972, appendix A3 (Munksgaard, Copenhagen 1973). 46 A lbert, E.D .; M ickey, M.R., and T erasaki, P.I.: Genetics of the HL-A system in four populations. American Caucasians, Japanese Americans, American Negroes, and Mexican Americans; in Histocompatibility testing - 1972 (Munksgaard, Copen­ hagen 1973). 47 T ing, A. and Morris, P.J.: The relationship of six ethnic groups (Chinese, Malays, Indians, New Guinea Highlands and Coastal Natives, Australian Caucasians) based Psoriasis: Case R ate HL-A 31 on the HL-A system; in Histocompatibility testing - 1972 (Munksgaard, Copenhagen 1973). 48 C orley, R.B.; Spees, E.K.; G abrera, M .G.; Swanson, J.L., and A mos, D.B.: HL-A antigens of the Guatemalan Ixils; in Histocompatibility testing - 1972 (Munksgaard, Copenhagen 1973). 49 Perkins, H.A.; Payne, R.O.; K idd, K.K., and H uestis, D .W .: HL-A and Gm typing of Papago Indians; in Histocompatibility testing - 1972 (Munksgaard, Copenhagen 1973). 50 D ixon, W.J. and M assey, F.J.: Introduction of statistical testing (McGraw-Hill, New York 1969). 51 Schlosstein, L . ; T erasaki, P.I.; Bluestone, R .,a n d Pearson, C.M.: High association of an HL-A antigen, W27, with ankylosing spondylitis. New Engl. J. Med. 288: 704-706 (1973). 52 Svejoaard, A.; Platz, P.; R yder, L.P.; Staub-N ielsen, L., and T homsen, M.: HL-A and disease associations. A survey. Transplantn Rev. 22: 3-43 (1975). Robert J. T homas, PhD, MPH, Dermatology, Baltimore City Hospitals, 4940 Eastern Avenue, Baltimore, MD 21224 (USA) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Dermatology Karger

Psoriasis: Case Rate – HL-A Antigen Frequency Correlations

Thomas, Robert J.
Dermatology , Volume 154 (1): 9 – Jan 1, 1977
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Publisher
Karger
Copyright
© 1977 S. Karger AG, Basel
ISSN
1018-8665
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1421-9832
DOI
10.1159/000251026
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Abstract

Dermatologica 154: 23-31 (1977) R obert J . T homas1 Department of Epidemiology, Johns Hopkins University, School of Hygiene and Public Health, Baltimore, Md. Key Words. Psoriasis • HL-A • Histocompatibility antigens • Case rate • International comparisons Abstract. HL-A antigen B17, associated with a high familial frequency of psoriasis, is significantly correlated (r = 0.8242) with psoriasis case rates in several countries but HL-A antigen BI3 alone, associated with 'early age onset’ cases of psoriasis, is not significantly correlated (r = 0.4299) with case rate. A sum of the B13 and B17 antigen frequencies, since either antigen has been associated to psoriasis, is correlated with case rate in the populations surveyed (r = 0.7405) and is statistically significant. Psoriasis, the chronic skin disease, occurs among Caucasians and is common in all European populations, less frequent among Asiatics, and very rare in pure Blacks [1], Incidence and prevalence data have been difficult to obtain because of the nature of the disease: ‘the disease of the healthy’ [2], and the previous nonsuccess of therapy protocols does not encourage many psoriatics to seek either any further therapy or medical observation. Be r e- st r o n and C e c c o l in i [3] found only 54 psoriatics in 20,000 consecutive US military inductees in World War II (0.3% period prevalence). Today, the National Psoriasis Foundation (US) estimates that 4% of the US population have psoriasis, a possible overestimate. The question of period prevalence in the United States is being queried as part of the National Center for Health 1 Supported by a Cancer Epidemiology Postdoctoral Fellowship (I T32 CA09002 from the National Cancer Institute). Received: July 5, 1976; accepted: August 21, 1976. 24 T h o m a s Statistics’ Health and Nutrition Survey (HANES) which may provide a better ‘national’ estimate. For some individual national or racial groups, estimates have been reported as a ‘psoriasis case rate of all dermatological cases’ [1,4-14], In several infrequent citations, an attempt to document case rate differences within countries or on a specific continent has been made. In Japan [11], the case rate has been presented as differing from a low of less than 4/1,000 dermatological cases in Southern Japan to more than 5 psoriasis cases /1,000 in the North (opposite to the distribution of skin cancer). D ovzhanski [15] in a review of psoriasis in the USSR presents a case rate difference from 0.68 to 4.43% psoriasis cases in all dermatology cases in different medical centers in the Soviet Union. Lomholt [13] has summarized case rate differences in Africa and K enney [14] has used the difference, West Africa (Nigeria 0-0.5% ) versus East Africa (Kenya 3.2%), to explain the paucity of psoriasis in American Blacks who mainly originated from West Africa. Several authors [11, 13] attribute the frequency differences to environ­ mental variation affecting the exhibition of the disease or suggest genetic variation, without a correlative marker, as the cause of the variation [12,14]. A familial occurrence of psoriasis has been suggested in several reviews and surveys of psoriasis [6, 9-11, 15-18], These approaches, for example Lomholt' s extensive pedigree documentation of the Faroe Islands [10], have examined the type of inheritance pattern and it is generally agreed that psoriasis is an autosomal dominant disorder with ‘variable expression' (penetrance) [19-26] which does not eliminate a polygenic inheritance pat­ tern. With the development of histocompatibility typing (HL-A), several authors have found that psoriatics possess either HL-A B13 or B17 antigens [27-34]. They have also found antigen B13 associated with an early age of onset and B17 with familial aggregation. S vejgaard el at. [29] have cal­ culated an odds ratio (OR) for psoriasis and these antigens: B13 OR = 4.01 and B17 OR = 6.57. If the HL-A antigen B13 and/or antigen B17 are associated with the skin disease psoriasis, then the frequency of the HL-A antigens in a population should be correlated positively to the best frequency data of psoriasis in that population. Methods To test this hypothesis, the psoriasis case frequency within all dermatological cases (from a review of H ellgren [35], S idi el al. [36] and a special study of South American native Indians [12]) was correlated to HL-A BI3 and B17 antigens. Control groups for Psoriasis: Case R ate HL-A 25 studies other than HL-A/psoriasis correlations (i.e., population descriptions or HL-A/ cancer correlations) yielded HL-A antigen frequency data [37-49]. One-variable correlation coefficients were calculated and an extrapolation method (assuming no correlation) [50] was used for significance testing (p 0.05). Observations and Discussion The psoriasis case frequency varys from no occurrence in the North and South American native Indian populations to a high of 8.2% in Icelanders (table I). Overall, HL-A antigen B17 has a higher frequency than HL-A antigen BI3 in any reported population. The correlation of psoriasis case rate with HL-A antigen BI3 is r = 0.4299 and is not statistically significant (fig. 1). HL-A antigen B17, the antigen associated with a familial occurrence of psoriasis, is correlated with psoriasis case rate (r = 0.8242) and is statis­ tically significant ( p <0.05; fig. 2). Since either HL-A B13 or B17 antigens Table I. The psoriasis case rate as a percentage of psoriasis cases reported from a derm ato­ logical clinic or as a special survey and reported HL-A antigen frequencies, B13 and BI7, for the respective country or population group, is presented Country, Psoriasis Antigen (phenotype) frequency, % population group case rate, % ' HL-A BI3 HL-A BI7 HL-A B13 plus B17 Iceland 8.2 1.8 8.7 10.5 France 6.21 2 4.2 7.5 11.7 West Germany 6.0 8.0 8.0 16.0 6.0 3.0 9.0 12.0 England Denmark 5.2 2.8 8.2 11.0 Netherlands 4.7 6.2 4.4 10.6 2.21 6.22 8.43 Norway 4.5 2.7 7.8 USA (Whites) 4.0 5.1 2.57 3.5 6.5 10.0 Australia Koreans (in Korea) 0.68 4.8 6.6 11.4 Japanese (in Korea) 0.29 1.6 2.5 4.1 1.0 1.0 North American Indians 0 0 South American Indians O3 0 0.64 0.64 1 H ellgren [35] except for France and South American Indians. 2 Sidi et al. [36], 3 K erdel-Vegas [12], T h o m a s P so ria sis cases o f a ll derm atological ca se s, °/o Fig. 1. A graphical presentation of HL-A antigen B13 and psoriasis case rate correla­ tion for surveyed countries shows some correlation (r = 0.4299) but the correlation is not statistically significant for so few observations. P so ria sis c a se s o f a ll derm atological c a s e s , “/» Fig. 2. A high degree o f correlation (r = 0.8242), statistically significant (p<0.05), exists for the correlation of HL-A antigen B17 and psoriasis case rate in the countries surveyed. Psoriasis: Case R ate HL-A 27 Fig. 3. Correlation between psoriasis case rate and the sum of both associated HL-A antigens, BI3 and B17, is close (r = 0.7405) to the correlation of antigen BI7/psoriasis alone and for the small sample size is still statistically significant (p<0.05). have been associated to psoriasis, a correlation of the sum of the antigen frequencies (disregarding the low probabilities of HL-A haplotypes xx-13/ xx-13, xx-17/xx-17, and xx-13/xx-17) and psoriasis case rate should be, and is, significantly correlated (r = 0.7405, p < 0 .0 5 ; fig. 3). Psoriasis as a disease is in the penultimate position of HL-A antigen/ disease associations, second only to the HL-A antigen B27/ankylosing spondylitis association [51, 52], Several assumptions have been made and may bias these correlations. A case frequency of a disease in a clinic is not necessarily a good measure of prevalence of the disease in a population. A choice of a control group for HL-A typing within a given country may in itself be biased. The bias of case selection/attendance of psoriatics at a dermatological clinic, though, may be the same as the bias of selection/ volunteers for a control group in HL-A studies and would not affect a c o r­ relation analysis. 28 T h o m a s Burch and R o w e l l’s [23] suggestion of two genotypes for the etiology of psoriasis is consistent with the observations of this report. The suggestion by Seignalet et al. [31] that though HL-A B13 antigen frequency was ele­ vated in the population they tested but was not statistically significant and that HL-A B17 antigen frequency was elevated and is statistically significant, was confirmed in this analysis of HL-A antigen frequency and case rate association. The variation of psoriasis case frequency, country to country, appears to be associated primarily with variation of HL-A antigen B17. The second associated HL-A antigen, B13, is not significantly associated to psoriasis case frequency alone but the sum of the antigen frequencies (B13 plus BI7) is still significantly associated to psoriasis case frequency. Psoriasis case frequency variations attributed to environmental, psychosocial factors, etc. may be untenable unless HL-A B13 and B17 antigen frequencies for the populations are considered. Environmental or psychosocial factors may prove significant as onset or exacerbation factors when the population of psoriatics is adjusted for the possession of HL-A B13 and/or B17 antigens. References 1 F ärber, E.M .; G rauer, F., and Z aruba, F.: Racial incidence of psoriasis. Cslka Derm. 40: 289-297 (1965). 2 H olzmann, H.; H oede, N. und K ra pp, R.: Gutachterliche Probleme bei der Beurtei­ lung der Psoriasis. Z. Hautkr. 49: 493-496 (1974). 3 Bereston, E.S. and C eccolini, E.M .: Incidence of dermatoses in twenty-thousand army induction examinations. Archs Derm. 47: 844-848 (1943). 4 C avalieri, R.: Cronogenetica della Psoriasi. Acta Genet, med. Gemell. 23: 299-301 (1973). 5 Ingram, J .T .: The significance and management of psoriasis. Br. med. J. ii: 823-828 (1954). 6 C oltoiu, A.: Dermatoze Dispositionale (Editura Medicala, Bucuresti 1973). 7 F indlay, G .H .: Dermatology of the Bantu. A survey. S. Afr. med. J. 31: 471-474 (1957). 8 M arshall, J.: Skin diseases in South Africa. Arch. Derm. 87: 419-427 (1963). 9 R omanus, T . : Psoriasis from a prognostic and hereditary point of view. Acta dernt.- vener., Stockh. 26: suppl. 12, pp. 1-137 (1945). 10 Lomholt, G . : Psoriasis - prevalence, spontaneous course and genetics. A census study on the prevalence of skin diseases on the Faroe Islands (BEC Gad, Copenhagen 1963). 11 Yasuda, T.; Ishikaw a, E., and Mori, S.: Psoriasis in the Japanese; in F ärber and Cox International symposium on psoriasis, chapter 5 (Stanford University Press, Stanford 1971). Psoriasis: Case R ate HL-A 29 12 K erdel-V egas, F .: Psoriasis in South America. Geographic and racial factors; in F ärber and Cox International symposium on psoriasis, chapter 6 (Stanford University Press, Stanford 1971). 13 Lomholt, G .: Psoriasis in Uganda. A comparative study with other parts of Africa; in F ärber and Cox International symposium on psoriasis, chapter 7 (Stanford Uni­ versity Press, Stanford 1971). 14 K enney, J.A.: Psoriasis in the American Black; in F ärber and Cox International symposium on psoriasis, chapter 8 (Stanford University Press, Stanford 1971). 15 D ovzhanski, S.I.: Psoriaz (Saratov University, Saratov 1973). 16 F ärber, E.M. and M cC lintock, R.P., j r . : A current review of psoriasis. Calif. Med. 108: 440-457 (1968). 17 F ärber, E.M .; Bright, R.D., and N all, M .L.: Psoriasis. A questionnaire survey of 2,144 patients. Archs Derm. 98: 248-259 (1968). 18 F ärber, E.M. and N all, M .L .: The natural history of psoriasis in 5,600 patients. Dermatológica 148: 1-18 (1974). 19 Steinberg, A .G .; Becker, S.W.; F itzpa trick, T.B., and K ierland, R.R.: A genetic and statistical study of psoriasis. Am. J. hum. Genet. 3: 267-281 (1951). 20 Steinberg, A .G .; Becker, S.W.; F itzpa trick, T.B., and K ierland, R.R.: A further note on the genetics of psoriasis. Am. J. hum. Genet. 4: 373-375 (1952). 21 W ard, J.H. and Stephens, F.E.: Inheritance of psoriasis in a Utah kindred. Archs Derm. 84: 105-108 (1961). 22 A bele, D .C.; D obson, R.L., and G raham, J.B .: Heredity and psoriasis. Archs Derm. 88: 38-47 (1963). 23 Burch, P.R.J. and R owell, N .R.: Psoriasis. Aetiological aspects. Acta derm.-vener., Stockh. 45: 366-380 (1965). 24 F ärber, E.M. and N all, M .L.: Genetics of psoriasis. Twin study; in F ärber and Cox International symposium on psoriasis, chapter 2 (Stanford University Press, Stanford 1971). 25 W atson, W .; C ann, H .M .; Färber, E.M ., and N all, M .L .: The genetics o f psoriasis. Arch. Derm. 105: 197-207 (1972). 26 K imberling, W. and D obson, R.L.: The inheritance o f psoriasis. J. invest. Derm. 60: 538-540 (1973). 27 R ussell, T .J.; Schultes, L.M., and K uban, D .J .: Histocompatibility (HL-A) antigens associated with psoriasis. New Engl. J. Med. 287: 738-740 (1972). 28 W hite, S.H.; N ewcomer, V.D.; M ickey, M .R., and T erasaki, P.I.: Disturbance of HL-A antigen frequency in psoriasis. New' Engl. J. Med. 287: 740-743 (1972). 29 Svejgaard, A.; Svfjgaard, E.; Staub-N ielsen, L., and J acobsen, B.: Some specula­ tions on the associations between HL-A and disease based on studies of Psoriasis patients and their families. Transplant. Proc. 5: 1797-1798 (1973). 30 Schoefinius, H .-H .; Braun-F alco, O .; Sch olz, S .; Steinbauer-R osenthal, L; W ank, R. und A lbert, E.D.: Histokompatibilitätsantigene (H L-A ) bei Psoriasis. Dt. med. Wschr. 99: 440-444 (1974). 31 Seignalet, J.; C lot, J.; G uilhou, J.J.; D untze, F.; M eynadier, J., and R obinet- Levy, M .: HL-A antigens and some immunological parameters in psoriasis. Tissue Antigens 4: 59-68 (1974). 32 Svejgaard, A.; Staub-N ielsen, L.; Svejgaard, E .; Kissmeyer-N ielsen.F . ; H jortshoj 30 T h o m a s A., and Z achariae, H .: HL-A in psoriasis vulgaris and in pustular psoriasis. Popula­ tion and family studies. Br. J. Derm. 91: 145-153 (1974). 33 K rulig, L.; F ärber, E.M .; G rumet, F.C., and Payne, R .O .: Histocompatibility (HL-A) antigens in psoriasis. Archs Derm. I l l : 857-860 (1975). 34 Stenszky, V.; N agy, E.; Szerze, P., and Ladanyi, E.: HL-A antigens and lympho- cytotoxic antibodies in psoriasis vulgaris. Derm. Mschr. 162: 35-38 (1976). 35 H ellgren, L . : Psoriasis. The prevalence in sex, age and occupational groups in total populations in Sweden. Morphology, inheritance and association with other skin and rheumatic diseases (Almquist & Wiksells, Stockholm 1967). 36 Sidi, E.; Z agula-M ally, Z.W., and H incky, M.: Psoriasis (Thomas, Springfield 1968). 37 L amm, L .U .; K issmeyer-N ielsen, F.; K jerbye, K .E .; J orgensen, J .; Bruun Peter­ sen, G .; G ürtler, H., and T ordarson, C .: The HL-A types in an Icelandic popula­ tion; in Histocompatibility testing - 1972 (Munksgaard, Copenhagen 1973). 38 D ausset, J.; C olombani, J.; Legrand, L.; L epage, V.; M arcelli-Barge, A., and D ehay, C .: Population and family studies in a French population with special reference to non-HL-A antibodies; in Histocompatibility testing - 1972 (Munksgaard, Copen­ hagen 1973). 39 A lbert, E.D.; Sch o lz, S.; R osenthal, L; Baltin, H., and Bertrams, J.: Study of the HL-A system in the Turkish and German populations; in Histocompatibility testing - 1972 (Munksgaard, Copenhagen 1973). 40 H arris, R .; W entzel, J .; C arroll, C.A., and J ennison, R .F .: HL-A frequencies in West Pakistanis (Punjabi) in the United Kingdom; in Histocompatibility testing - 1972 (Munksgaard, Copenhagen 1973). 41 A lbert, E.D .; Ko, S.S.; P retorius, A.M.G., and Bertrams, J.: Study of the HL-A system in the Korean population; in Histocompatibility testing - 1972 (Munksgaard, Copenhagen 1973). 42 D oes, J.A. Van d e r ; E lkerbout, F .; D 'A maro, J.; Steen, G. Van d e r; Loghem, E. Va n ; M eer K ahn, P .; Bernini, L .F.; Leuwen, A. Van, and R ood, J.J. Va n : HL-A typing in Dutch patients with Hodgkin’s disease; in Histocompatibility testing - 1972 (Munksgaard, Copenhagen 1973). 43 T horsby, E.; B ratlie, A., and E ngeset, A.: HL-A antigens in Hodgkin's disease. II. Clinico-pathological correlation analysis of 132 Norwegian patients; in Histo­ compatibility testing - 1972 (Munksgaard, Copenhagen 1973). 44 K issmeyer-N ielsen, F .; L amm, L .U .; K jerbye, K .E.; Bjorn J ensen, K .; N ordentoft, A.M.; T horling, K ., and H astrup, J .: HL-A phenotypes in Hodgkin's disease; in Histocompatibility testing - 1972 (Munksgaard, Copenhagen 1973). 45 D ausset, J. and C olombani, J.: Histocompatibility testing - 1972, appendix A3 (Munksgaard, Copenhagen 1973). 46 A lbert, E.D .; M ickey, M.R., and T erasaki, P.I.: Genetics of the HL-A system in four populations. American Caucasians, Japanese Americans, American Negroes, and Mexican Americans; in Histocompatibility testing - 1972 (Munksgaard, Copen­ hagen 1973). 47 T ing, A. and Morris, P.J.: The relationship of six ethnic groups (Chinese, Malays, Indians, New Guinea Highlands and Coastal Natives, Australian Caucasians) based Psoriasis: Case R ate HL-A 31 on the HL-A system; in Histocompatibility testing - 1972 (Munksgaard, Copenhagen 1973). 48 C orley, R.B.; Spees, E.K.; G abrera, M .G.; Swanson, J.L., and A mos, D.B.: HL-A antigens of the Guatemalan Ixils; in Histocompatibility testing - 1972 (Munksgaard, Copenhagen 1973). 49 Perkins, H.A.; Payne, R.O.; K idd, K.K., and H uestis, D .W .: HL-A and Gm typing of Papago Indians; in Histocompatibility testing - 1972 (Munksgaard, Copenhagen 1973). 50 D ixon, W.J. and M assey, F.J.: Introduction of statistical testing (McGraw-Hill, New York 1969). 51 Schlosstein, L . ; T erasaki, P.I.; Bluestone, R .,a n d Pearson, C.M.: High association of an HL-A antigen, W27, with ankylosing spondylitis. New Engl. J. Med. 288: 704-706 (1973). 52 Svejoaard, A.; Platz, P.; R yder, L.P.; Staub-N ielsen, L., and T homsen, M.: HL-A and disease associations. A survey. Transplantn Rev. 22: 3-43 (1975). Robert J. T homas, PhD, MPH, Dermatology, Baltimore City Hospitals, 4940 Eastern Avenue, Baltimore, MD 21224 (USA)

Journal

Dermatology – Karger

Published: Jan 1, 1977

Keywords: International comparisons; Psoriasis; HL-A; Histocompatibility antigens; Case rate

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