Dermatological Findings in Glaucoma Patients: Comparison Between Pseudoexfoliative and Primary Open-angle Glaucoma

Abstract

Purpose: To compare the frequency of dermatological manifestations between patients with pseudoexfoliative glaucoma and those with primary open-angle glaucoma.


Methods: A cross-sectional study was done on all consecutive pseudoexfoliative glaucoma (PEXG) and primary open-angle glaucoma (POAG) patients evaluated in a tertiary eye hospital during the study period. Eligible patients were referred to the dermatology department for complete skin, hair, nail, and mucosal examinations.


Results: Twenty-one patients in the PEXG group and 26 patients in the POAG group were included in this study. The most common skin manifestations in the study were seborrheic dermatitis, dry skin, and cherry angioma. The frequency of lentigines was significantly higher in the PEXG patients than in the POAG group (P = 0.013). More than half of the study population had seborrheic dermatitis (57.1% and 61.5% in the PEXG and POAG groups, respectively); however, the difference between the groups was not statistically significant (P = 0.775). Similarly, the frequencies of skin dryness, cherry angioma, nevus, psoriasis, contact dermatitis, itching, seborrheic keratoses, notalgia paresthetica, and vitiligo in the two groups were not statistically significantly different (P > 0.1 for all comparisons). There was no significant association between the frequency of the investigated skin manifestations and patients’ age, visual acuity, intraocular pressure, and cup-to-disc ratio.


Conclusion: Integumentary system disorders are pervasive in glaucoma patients, and dermatologic evaluation in glaucoma patients should be considered for diagnostic and therapeutic purposes.

Keywords:

Dermatitis, Dermatologic Finding, Glaucoma, Open-angle Glaucoma, Pseudoexfoliation

References
1. Schlötzer-Schrehardt UM, Koca MR, Naumann GO, Volkholz H. Pseudoexfoliation syndrome. Ocular manifestation of a systemic disorder? Arch Ophthalmol 1992;110:1752–1756.

2. Djordjevic-Jocic J, Jovanovic P, Bozic M, Tasic A, Rancic Z. Prevalence and early detection of abdominal aortic aneurysm in pseudoexfoliation syndrome and pseudoexfoliation glaucoma. Curr Eye Res 2012;37:617– 623.

3. Sarenac-Vulovic TS, Petrovic MA, Vulovic DD, Pavlovic SM, Simovic S, Zdravkovic NS. Systemic manifestations of pseudoexfoliation. Serb J Exp Clin Res 2014;15:29–32.

4. Kaya E, Öztürk F. Evaluation of regional brain perfusion in patients with pseudoexfoliation syndrome. Neuroophthalmology 2011;35:255–258.

5. Cahill M, Early A, Stack S, Blayney AW, Eustace P. Pseudoexfoliation and sensorineural hearing loss. Eye 2002;16:261–266.

6. Prince AM, Streeten BW, Ritch R, Dark AJ, Sperling M. Preclinical diagnosis of pseudoexfoliation syndrome. Arch Ophthalmol 1987;105:1076–1082.

7. Ritch R. Exfoliation syndrome-the most common identifiable cause of open-angle glaucoma. J Glaucoma 1994;3:176–177.

8. Ritch R. Exfoliation syndrome and occludable angles. Trans Am Ophthalmol Soc 1994;92:845–944.

9. Ritch R, Schlötzer-Schrehardt U. Exfoliation syndrome. Surv Ophthalmol 2001;45:265–315.

10. Streeten BW, Li ZY, Wallace RN, Eagle RC Jr, Keshgegian AA. Pseudoexfoliative fibrillopathy in visceral organs of a patient with pseudoexfoliation syndrome. Arch Ophthalmol 1992;110:1757–1762.

11. Weinreb RN, Khaw PT. Primary open-angle glaucoma. Lancet 2004;363:1711–1720.

12. Santos V, Castro R, Lima C, Moraes M, Sugai TJ. Skin eruption and thrombocytopaenia in a woman with glaucoma. West Indian Med J 2010;59:102.

13. Erb C, Gast U, Schremmer D. German register for glaucoma patients with dry eye. I. Basic outcome with respect to dry eye. Graefes Arch Clin Exp Ophthalmol 2008;246:1593–1601.

14. Cantisani C, Ambrifi M, Frascani F, Fazia G, Paolino G, Lisi R, et al. Glaucoma eye drops adverse skin reactions. Recent Pat Inflamm Allergy Drug Discov 2014;8:192–195.

15. Nouri-Mahdavi K, Nosrat N, Sahebghalam R, Jahanmard M. Pseudoexfoliation syndrome in central Iran: A population-based survey. Acta Ophthalmol Scand 1999;77:581–584.

16. Weinreb RN, Aung T, Medeiros FAJJ. The pathophysiology and treatment of glaucoma: A review. JAMA 2014;311:1901–1911.

17. Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol 2006;90:262–267.

18. Ritch R. Systemic associations of exfoliation syndrome. Asia Pac J Ophthalmol 2016;5:45–50.

19. Holló G, Katsanos A, Konstas AG. Management of exfoliative glaucoma: Challenges and solutions. Clin Ophthalmol 2015;9:907–919.

20. Ritch R. Ocular findings in exfoliation syndrome. J Glaucoma 2018;27:S67–S71.

21. Aragon-Martin JA, Ritch R, Liebmann J, O’Brien C, Blaaow K, Mercieca F, et al. Evaluation of LOXL1 gene polymorphisms in exfoliation syndrome and exfoliation glaucoma. Mol Vis 2008;14:533–541.

22. Zenkel M, Kruse FE, Naumann GO, Schlötzer-Schrehardt U. Impaired cytoprotective mechanisms in eyes with pseudoexfoliation syndrome/glaucoma. Invest Ophthalmol Vis Sci 2007;48:5558–5566.

23. Damji KF, Bains HS, Stefansson E, Loftsdottir M, Sverrisson T, Thorgeirsson E, et al. Is pseudoexfoliation syndrome inherited? A review of genetic and nongenetic factors and a new observation. Ophthalmic Genet 1998;19:175–185.

24. Elhawy E, Kamthan G, Dong CQ, Danias J. Pseudoexfoliation syndrome, a systemic disorder with ocular manifestations. Hum Genomics 2012;6:22.

25. Amini H, Daneshvar R, Eslami Y, Moghimi S, Amini N. Earlyonset pseudoexfoliation syndrome following multiple intraocular procedures. J Ophthalmic Vis Res 2012;7:190– 196.

26. Aviv U, Ben Ner D, Sharif N, Gur Z, Achiron A. Pseudoexfoliation: An ocular finding with possible systemic implications. Isr Med Assoc J 2017;19:49–54.

27. Gonen KA, Gonen T, Gumus B. Renal artery stenosis and abdominal aorta aneurysm in patients with pseudoexfoliation syndrome. Eye 2013;27:735–741.

28. Singham NV, Zahari M, Peyman M. Association between ocular pseudoexfoliation and sensorineural hearing loss. J Ophthalmol 2014;2014:825936.

29. Temporale H, Karasinska-Klodowska A, Turno-Krecicka A, Morawska-Kochman M, Dorobisz K, Dudek K, et al. Evaluating the hearing of patients with pseudoexfoliation syndrome. Adv Clin Exp Med 2016;25:1215–1221.

30. Schlötzer-Schrehardt U, Küchle M, Naumann GO. Electronmicroscopic identification of pseudoexfoliation material in extrabulbar tissue. Arch Ophthalmol 1991;109:565–570.

31. Zenkel M, Lewczuk P, Jünemann A, Kruse FE, Naumann GO, Schlötzer-Schrehardt U. Proinflammatory cytokines are involved in the initiation of the abnormal matrix process in pseudoexfoliation syndrome/glaucoma. Am J Pathol 2010;176:2868–2879.

32. Yilmaz A, Tamer L, Ateş NA, Çamdeviren H, Değirmenci U. Effects of apolipoprotein E genotypes on the development of exfoliation syndrome. Exp Eye Res 2005;80:871–875.

33. Schlötzer-Schredhardt U, Küchle M, Dörfler S, Naumann GO. Pseudoexfoliative material in the eyelid skin of pseudoexfoliation-suspect patients: A clinicohistopathological correlation. Ger J Ophthalmol 1993;2:51–60.

34. Sugino T. [Exfoliative materials in the skin of patients with exfoliation syndrome]. Nippon Ganka Gakkai Zasshi 1990;94:856–869.

35. Sanders MG, Pardo LM, Franco OH, Ginger RS, Nijsten T. Prevalence and determinants of seborrhoeic dermatitis in a middle-aged and elderly population: The Rotterdam Study. Br J Dermatol 2018;178:148–153.

36. Baş Y, Seçkin HY, Kalkan G, Takci Z, Çitil R, Önder Y, et al. Prevalence and related factors of psoriasis and seborrheic dermatitis: A community-based study. Turk J Med Sci 2016;46:303–309.

37. Sampaio AL, Mameri ÂC, Vargas TJ, Ramos-e-Silva M, Nunes AP, Carneiro SC. Seborrheic dermatitis. An Bras Dermatol 2011;86:1061–1071.

38. Eslami Y, Amini H, Zarei R, Fakhraie G, Moghimi S, Mohammadi SF, et al. Socioeconomic factors and disease severity at glaucoma presentation. J Curr Ophthalmol 2011;23:19–26.

39. Daniel BS, Orchard D. Ocular side-effects of topical corticosteroids: What a dermatologist needs to know. Australas J Dermatol 2015;56:164–169.

40. Rynerson JM, Perry HD. DEBS - A unification theory for dry eye and blepharitis [Internet]. Clin Ophthalmol 2016;10:2455–2467.