30

ABO BLOOD GROUPS AND SKIN DISEASES.

MARJORY P. M A C S W E E N , M.B., CH.B. AND UNA A. SYME. M.A,Dermatology Department, University of Glasgow, GiaBgow, W,2.

As long ago as 1921, Buchanan and Higley demonstrated a relation.^hipl)etween pernicious anaemia and the ABO blood group.s. Since that timeother investigators have brought to light the association of cancer of the stomachwith group A (Aird and Bentall, 1953), i)eptic ulceration with group O (Airdet al, 1964), diabetes mellitus with group A (McConnell, 1955) and otherassociations where the evidence was less convincing (Frasor Roberts. 1959).No association could be demonstrated between cancer of the colon, breast andbronchns and the ABO blood groups (Aird et al. 1954). A and B antigens areknown to be present on human duodenal cells (Gowan, 1962), and the relation-ship between duodenal nlccration and group O is the strongest yet established.As A and B antigens have also been demonstrated in human epidermal cells(Nclken et al, 1957) it seemed reasonable to investigate the possibility of therebeing an association between diseases of the skin and the ABO blood group>s.The majority of previous investigations have had negative resnits (Nardelli, 1928;Dorn, 1959 ; Readett, 1964).

INVESTIGATION.

A saline suspension of red cells was obtained by finger-prick from all ])atit'ntsreferred to the Dermatological Outpatient clinics at the Western lnfirmar\- and tlieSouthern (Jencral Hospital. Glasgow, over a six numtli period from .Janutiry to .riiiiei1903. Every jjatient referred during this jK'riod VMIS imludcd in the investigation,regardless of age and sex. Cases where the diagnosis remained in (ioul)t. however, weresubsefjuently excluded, leaving a total of 1.1)94 unselect<'d jiaticnts.

The data from 5.898 consecutive new donor registrations from the West of ScotlandRegional Blood Transfusion Service were adoptetl as the ABO control series. l''orRhesus control, figures from 4,fi32 random blood donors in Glasgow and the West ofScotland were selected.

The ABO group of the red cells of each specimen was determined by the tube tech-nitpie (Dunsford and Bowley. 1955) using auti-A and anti-B sera at room tcniin-rature.The KhesTis-1) grouj) was determined—also by tube technique—using albumin anti-l)serimi and ])apain. Results for analysis were recorded on piinrh eards. inuler theheadings of h(jspital unit number, age group, sex. diagnosis. ABO anil Hhe^vis bloorlgroups. This method j>rovided a permanent record and made subsequent extractionof data simple and rapid by the usual method of needling.

RESULTS.

Tables I and II show that the general distribution of the ABO and Rhesus-Dblood groups amongst the 1994 patients is very similar to that which occurs inthe corresponding control series. For the purposes of this paper, groups B and

ABO BLOOD GROUPS AND SKIN DISEASES 31

TABLE I.—Distribution of ABO Groups.

Control series of Affectedrandom donors. patients.

Group Nos. % Nos. %O . . . 3177 (53-88) . 1(143 (52-31)A . . . 1906 (32 31) . 662 (33-21)B+AB . . 815 (13-82) . 289 (14-5)

Total , . 5898 . 1994

TABLE II.—Distribution of Rhesus-D Groups.Affected

Control serieB. patients.

Group No8. % Nos. %R h D Positive . 3837 (82-84) . 1648 (82-64)RhDNegat ive . 795 (17-16) . 346 (17-36)

Total . . 4632 . 1994

AB have at all times been combined since the small number in tliese groupsprevents satisfactory statistical manijiulation. However, in two cases, whichwill be discussed later, the combined group became involved in statisticalsignificance and was separated into its two components.

The patients were divided into categories according to the diagnosis and eachdisease subdivided by blood group, combining groups B and AB as before. Theresults obtained were compared with the control figures and exposed tostatistical analysis by the x^ test (Bradford Hill, 1942), a significance level of5-99 (P< 0-05) indicating that the figures under comparison were deviatingsignificantly from each other due to influences other than chance.

A significant difference could be demonstrated in two categories (Table III),The first of these—seborrhoeic dermatitis—included 45 patients exhibiting

TABLE III.—ABO Groups in SeborrJiotic Dermatitis and Lichen Planus.Seborrhoeic Lichen planus

Control series. patients. patients.

Group Nos. % Nos. % Noa. %O . - 3177 (53-88) . 19 (42-22) . 7 (41-18)A . . IJMMi (32-31) . 14 (31 11) . 10 (58-82)B+AB. . 637 + 178 (13-82) . 10 + 2 (26-67) . 0 (0)

Total . . 5898 . 4 5 . 1 7 %

either seborrhoea corporis or seborrhoeic dermatitis. The second category,involving 17 patients, was lichen planus, a clearly defined condition. Forthese figures, ,Y was 7-09 and 6-53 respectively. In two further categories,urticaria (papular and non-papular) aud lupus erythematosus (discoid anddisseminated), the value oi x^ (5-2) failed to reach the required level of signifi-

MARJORY P. M A C S W E E N AND UNA A. SYME

canee (5-9i), P < 0-05) but approached it closely enough to warrant furtlierstudy (Table IV).

No relationship could be demonstrated between the ABO blood groups andthe list of skin diseases summarized in Table \ .

TABLE IV.—ABO Groups in Urticaria and Lupus Erythematosus.

Control Beriea.Lupus

Urticaria erythematoBue.

Group.OAB+AB .

Total .

NO8.3177HtOti

0/

/o{53-88)(32-31)(13-82)

5898

Nos. %16 (41-0)13 (33-3)

o + r. (25-7)

39

Group 0. 106

2830492815

27203014712

. 119

. 373727

. 231

Group A.73321721271911

1112lR7597425Hi21

. 117

GroupIS + AB.25127712124

551233138164954

Total204795258885930

433768241522231783757402

TABLE V.—ABO Groups and Other Skin Diseases.

Skin disease.Acne vulgaris . . . . . .Alojwcia (all tyjit's) . . . . .Atopic eczema (imi. infantile eczema) .Derm, infectiosa and inf. eczematoid dprni. .Derm, venenata (indust. and non.indust.)Fungal infections (nioniliasis and tinea, all types)Infestations (pediculosis, scabies) . . . .Malignant conditions (rodent ulcer, Bowen's disease

squamous cell carcinoma)Naovi (all ty]»6s) . . . .Neunidormatitia (lichen simplex chromcus)PityriaaiB rosea .PompholyxPruritus (all tj-pes)PsoriasisRosacea . . . . . . . .Septic conditions (impetigo, folliculitis, furunculosis)Ulcers, Htasis . . . . . . .Warts (verruca plantaris, verruca vulfraris) ,

There remained erythema multiforme, erythema nodosum, erythemainduratum. herpes simplex, herpes zoster, molluseum contagiosum and amiscellaneous group of 211 cases, where insufficient numbers prevented anyconclusion from being drawn.

DISCUSSION.

This investigation was undertaken in the hope of discovering a relationshipbetween at least some of the skin diseases and the AKO blood groups. It ishoped that, sinee the general distribution of the AliO blood groups amongst theafFected patients is so closely similar to that of the control series, the somewhatelementary grouping techniques can be exonerated from eriticiam.

In the majority of cases negative results were obtained. Amongst those maybe specially mentioned jjsoriasis, one of the (wnimoner skin diseases, held to begenetically determined, although the mode of inheritance has not been eluci-

ABO BLOOD GROUPS AND SKIN DISEASES 3S

dated (Steinberg d al. 1051 ; Lomliolt. 1963). No relationship between thisdisease and the ABO blood groups has been established (ef. Hargraves audHellier, 195S).

It is well doeumented that diseases with an established relationship to theblood groups tend also to be associated with diseases of the upper gastro-intestinal traet, e.g. duodenal ulcer, gastrie carciuoma. It would have beeninteresting to have been able to demonstrate a link between acne rosacea andthe blood groups, rosacea sometimes being associated with gastritis (Usher,1941). This, however, it was not possible to do.

From the results obtained, persons of the combined blood group B and ABare more proue to the seborrhoeic group of diseases, whereas those of group 0may have some resistance to the disease. Iu this case, the combined group Band AB was separated into its two compouents (Table III). Omitting groupAB (insufficient numbers) and applying the same statistical methods to thefigures for groups O, A and B, x^ (*>-*J P < 0-05) remains significant, indicatingtliat group B itself is significantly linked with the seborrhoeic group of diseases.The figures for group AB are too small to allow any conclusion to be drawn.

Secondly, the frequency of blood group A is greater and the frequency ofblood group O less in patients suffering from lichen planus than in the controlseries.

The results also suggest a link between lupus erythematosus and group O andbetween urticaria and the combined group B and AB. In the latter case, ifgroups B and AB are separated (Table IV) the proportion of group AB is5/39 = 12-8% eompared with the eontrol value of 3-02%. This is an indica-tion of a difference between the urticaria group and the controls. Theseresults, however, fall short of statistical significance and further work is proceed-ing with these disease groups.

SUMMARY.

The ABO and Rhesus blood group of 1994 unseiected patients with a varietyof skin diseases was determined.

The seborrhoeic diathesis is commoner in persons of blood group B.Lichen planus is commoner in persons of group A.

The authoi-8 are iudebti-d to Dr. John A. Milne, Dopartinent of Dermatology, University of(ilasgow. and to Dr. John K. Anderson. Dopartnirnt of Pathology, Western Infirmary, for all theirlielp and eiirouragenient; to Dr. John Wallace of the Regional Blood Transfusion Service forproviding all sera used in the investigations ; to the medi(/al and nursing staffs of t ht? DermatologicalOut-Patient Depts. of the Western Infirmary and Southern General Hsopital, Glasgow, for collec-tion of specimens ; and also to Dr. R. A. Rohh of the Mathematics Dept.. University of Glasgow,who carried out the statistical analyses involved in thie paper.

REFERENCES,

, I. and BENTALL. H . H . (1953) Brit. med. .J.. i. 799., MEHIGAN, J . A. and ROBERTS, J. A. F. (1954) Ibid., ii. 315.

J A d H, , d OBERTS, J. A. F. (1954) Ibid., ii. 315.

BUCHANAN, J. A. and HIGI^Y, E . T. (1921) Brit. J. exp. Path.. 2, 247.

34 MARJORY P. M A C S W E E N AND UNA A. SYME

COWAN, W . K . (lOliii) Brit. med. J., ii, 946.DORN, H . (19r)9) Acta allerg., Kbh., 13, 442.DtTNSFORD, I. and BOWLEY, C. C. (1955) Techniques in Blood Grouping. Edinburgh : Oliver and

Boyd.HABGRKAVES, G. K . and HELLIER, F . F . (1958) Arch. Derm., 78, 438.HILL, A. B. (1942) Principles of Medical Statistics. 3rd edition. London : The Lancet Ltd.LoMiiOLT, G. (191)3) Psoriasis ; Prevalence, Spontaneous Course and Genetics. Copenhagen : G.E.C.

Gad.MLICONNKLL, R . B . (1955) Proc. R. Soc. Med., 48, 291.NARDELLI, L . (1928) G. ital. Derm. Sif., 69, 943.NELKEM, D. . Gl-REViTCH. J., and NEUMAN, Z. (1957) J . clin. Invest., 86, 749.READE-i-r, M. D. (1964) Brit. J. Derm., 76, 126.ROBERTS, J. A. F. (1957) Brit. J. prev. aoc. Med., 11, 107.

(1959) Bril. med. Bull., 15, 129.STEINBERG. A. G., BECKEH, S, W . , Jr., FITZPATRICK, T . B . and KIERLAND. R. R . (1951) Amer. J.

hum. Genet.. 3. 267.USHER, B . (1941) Arch. Derm. Syph., Chicago, 44, 251.