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. 2020 Jul 26;9(8):2384.
doi: 10.3390/jcm9082384.

Skin Phototype Could Be a Risk Factor for Multiple Sclerosis

Patricia Urbaneja  1   2   3 , Isaac Hurtado-Guerrero  1   2   3 , Miguel Ángel Hernández  3   4 , Begoña Oliver-Martos  1   2   3 , Celia Oreja-Guevara  3   5 , Jesús Ortega-Pinazo  1   2 , Ana Alonso  1   2   3 , Francisco J Barón-López  1   6   7 , Laura Leyva  1   2   3 , Óscar Fernández  1   8 , María Jesús Pinto-Medel  1   2   3
Affiliations

Skin Phototype Could Be a Risk Factor for Multiple Sclerosis

Patricia Urbaneja et al. J Clin Med. .

Abstract

Environmental and genetic factors are assumed to be necessary for the development of multiple sclerosis (MS), however its interactions are still unclear. For this reason here, we have not only analyzed the impact on increased risk of MS of the best known factors (HLA-DRB1*15:01 allele, sun exposure, vitamin D levels, smoking habit), but we have included another factor (skin phototype) that has not been analyzed in depth until now. This study included 149 MS patients and 147 controls. A multivariate logistic regression (LR) model was carried out to determine the impact of each of the factors on the increased risk of MS. Receiver Operating Characteristics (ROC) analysis was performed to evaluate predictive value of the models. Our multifactorial LR model of susceptibility showed that females with light brown skin (LBS), smokers and who had HLA-DRB1*15:01 allele had a higher MS risk (LBS: OR = 5.90, IC95% = 2.39-15.45; smoker: OR = 4.52, IC95% = 2.69-7.72; presence of HLA-DRB1*15:01: OR = 2.39, IC95% = 1.30-4.50; female: OR = 1.88, IC95% = 1.08-3.30). This model had an acceptable discriminant value with an Area Under a Curve AUC of 0.76 (0.69-0.82). Our study indicates that MS risk is determined by complex interactions between sex, environmental factors, and genotype where the milieu could provide the enabling proinflammatory environment that drives an autoimmune attack against myelin by self-reactive lymphocytes.

Keywords: HLA; multiple sclerosis; skin phototypes; smoking; vitamin D.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Map of world ultraviolet radiation erythemal index, with the three provinces reported in this study. This index is a measure of ultraviolet radiation (UVR) at ground level on the Earth, being an estimation of the UV levels that have important effects on human skin. Modified from: http://www.temis.nl/uvradiation/UVI/uvief0_wd.gif (accessed 24th of May 2019).
Figure 2
Figure 2
Receiver operating characteristics (ROC) curves generated from the logistic regression analysis to evaluate the models of MS risk. The discriminating power (the area under the ROC curve (AUC)) of the models performed was increased in the following order: model 3 (independent variable: HLA-DRB1*15:01), model 1 (independent variable: skin tone) and model 2 (independent variable: smoking habit). The predictive capacity was the highest in the multifactorial model 4 (independent variables: HLA-DRB1*15:01, skin tone, smoking habit).
Figure 3
Figure 3
Frequencies for accumulative risk model. Frequencies for each group according to the combination of different risk factors.
See this image and copyright information in PMC

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