ASSOCIATION OF DERMATOLOGICAL CONDITIONS WITH GLAUCOMA

 

DR. YUSRA TANVEER

P.G. SCHOLAR, DEPT OF DERMATOLOGY

AJMAL KHAN TIBBIYA COLLEGE AND HOSPITAL

ALIGARH MUSLIM UNIVERSITY, ALIGARH, INDIA

 

Some types of glaucoma such as pseudo-exfoliative glaucoma (PXG) resemble certain integumentary disorders. In PXG a dandruff-like material is seen covering the ocular surfaces. The exact composition and pathogenesis of this pseudo-exfoliative material is unknown. However, the resemblance of this material to dandruff makes us wonder if glaucoma could be associated with dermatological conditions.

There appears to be a lack of studies in the literature regarding this association. Kang et al. reported a survey of 79,102 American women and 41,205 American men older than 40 years of age and at risk for glaucoma. They also reviewed the participants’ histories of skin cancer such as basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and non-melanoma skin cancer. They found a 40% higher risk of PXG associated with a history of any non-melanoma skin cancer. This association was observed even with 4- and 8-year lags in non-melanoma skin cancer history. Also, the non-melanoma skin cancer association was stronger in patients younger than 65 than those older than 65. They also found that those living in northern latitudes had a significantly stronger association than those residing in southern latitudes. [1]

Another study was conducted by Ahmadpour et al. at the Mashhad University of Medical Sciences, Iran, to compare the frequency of dermatological manifestations between patients with PXG and those with primary open-angle glaucoma (POAG). The study involved 21 patients from the PXG group and 26 patients from the POAG group.

All PXG patients and 24 (92.3%) POAG patients had at least one abnormal dermatological finding (P = 0.495). [2]

The most common dermatological manifestations in patients with PXG were seborrheic dermatitis, dry skin, and cherry angioma. Other dermatologic manifestations of these patients included idiopathic guttate, hypomelanosis on the trunk and limbs, xeroderma pigmentosome and severe aging, lentigo maligna, and cafe au lait macules. In patients with POAG, the most common dermatological findings were seborrheic dermatitis, cherry angioma, and dry skin. Other specific manifestations seen in these patients included androgenic alopecia, telogen effluvium due to acetazolamide, nail-biting, pityrosporum folliculitis, sebaceous hyperplasia, nail fungal infection, alopecia areata, photosensitivity, macular amyloidosis, lipoma, and venous lake.

The most common dermatological condition found in all glaucoma patients was seborrheic dermatitis which was seen in 57.1–61.5%individuals. 12 patients with PXG and 16 with POAG had seborrheic dermatitis (P = 0.775). One patient in the PXG group and two in the POAG group had seborrheic findings on both head and face.

Eleven patients in the PXG group and seven in the POAG group had dry skin manifestations, mainly in their extremities. Although the frequency of dry skin was almost twice in those with PXG compared to the POAG group, the difference failed to reach the level of statistical significance (P = 0.130). Lentigines were observed in five PXG patients, while none of the POAG patients had this finding (P = 0.013).

There was no significant difference in the frequency of nevus and angiomas between the two groups. Also, no association between gender or patients’ age and the frequency of dermatologic manifestations (P > 0.154 for all comparisons) was found.

The frequency of dermatologic findings did not correlate with visual acuity, intra-ocular pressure, or cup-disc ratio (CDR) (P > 0.142 for all comparisons).

It is not clear how glaucoma is associated with skin disorders. One hypothesis is that glaucoma patients because of their age, lower socioeconomic status, and poor vision are unable to take care of themselves, leading to an increased frequency of these skin disorders. On the contrary, dermatological conditions could contribute directly to glaucoma, such as that seen in PXG. Also, corticosteroids used to treat skin diseases can contribute to steroid-induced glaucoma.

STEROID-INDUCED GLAUCOMA: https://ourgsc.blogspot.com/search?q=steroid

Therefore, it may be advantageous to assess glaucoma patients for any dermatological conditions especially if they are being planned for surgery as any infections could be a potential risk. Also, steroid-induced glaucomas may confound the diagnosis unless specifically asked for as the patients may be reluctant to reveal their dermatological conditions themselves.

REFERENCES:

1. Kang JH, VoPham T, Laden F, Rosner BA, Wirostko B, Ritch R, Wiggs JL, Qureshi A, Nan H, Pasquale LR. Cohort Study of Nonmelanoma Skin Cancer and the Risk of Exfoliation Glaucoma. J Glaucoma. 2020 Jun;29(6):448-455. doi: 10.1097/IJG.0000000000001496. PMID: 32487970; PMCID: PMC7317065.
2. Ahmadpour F, Nahidi Y, Daneshvar R. Dermatological Findings in Glaucoma Patients: Comparison Between Pseudoexfoliative and Primary Open-angle Glaucoma. J Ophthalmic Vis Res 2022;17:479–485.