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Synnerstad, Ingrid
Publications (10 of 17) Show all publications
Mobacken, H., Berg, M., Angesjö, E., Dunér, K., Svensson, M. & Synnerstad, I. (2018). Dags att minska användningen av antibiotika vid rosacea [Time to limit the use of antibiotics in rosacea!]. Läkartidningen, 115
Open this publication in new window or tab >>Dags att minska användningen av antibiotika vid rosacea [Time to limit the use of antibiotics in rosacea!]
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2018 (English)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115Article, review/survey (Refereed) Published
Abstract [en]

Rosacea is a chronic inflammatory disease with facial erythema and papulopustules. It is common in middle-aged/elderly persons and often affects self-perception and social well-being. It is generally classified into four subtypes. Improved understanding of pathophysiology has resulted in novel treatment approaches, but routine management in health care usually follows old trails. Most patients are managed in primary care. Greater attention to the reduced skin barrier, avoidance of exacerbating factors, better topicals and encouragement to topical maintenance treatment should reduce the use of oral tetracyclines. Low-dose isotretinoin is reserved for treatment-resistant patients, but relapses are frequent unlike its use in acne. In order to reduce antibiotic use, we propose that patients should be referred to a dermatologist for optimization of therapy including consideration of isotretinoin following tetracycline treatment of a maximum of 4-6 months.

Place, publisher, year, edition, pages
Läkartidningen förlag, 2018
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-155847 (URN)29714807 (PubMedID)
Available from: 2019-03-29 Created: 2019-03-29 Last updated: 2019-03-29
Lyth, J., Carstensen, J., Synnerstad, I. & Lindholm, C. (2016). Stage-specific direct healthcare costs in patients with cutaneous malignant melanoma. Journal of the European Academy of Dermatology and Venereology, 30(5), 789-793
Open this publication in new window or tab >>Stage-specific direct healthcare costs in patients with cutaneous malignant melanoma
2016 (English)In: Journal of the European Academy of Dermatology and Venereology, ISSN 0926-9959, E-ISSN 1468-3083, Vol. 30, no 5, p. 789-793Article in journal (Refereed) Published
Abstract [en]

Background Clinical stage at diagnosis is a strong prognostic factor for death in cutaneous malignant melanoma (CMM), with worse prognosis at higher stages. However, few studies have investigated how direct healthcare cost per patient varies with clinical stage.

Objective The aim of this study was to determine the stage-specific direct healthcare costs for CMM patients compared to the healthcare costs in the general population in the County of Östergötland, Sweden.

Methods CMM patients in the County of Östergötland diagnosed 2005-2012 were identified from the Swedish cancer registry. Information on clinical stage was collected from the Swedish Melanoma Register (SMR) and cost data from the Cost per Patient database (CPP) for 1 075 CMM patients in Östergötland. CPP contains costs associated with all healthcare contacts per patient including inpatient, outpatient, and primary care. The CMM-related costs were defined as the difference in mean healthcare costs between CMM patients and general population.

Results The first year after CMM diagnosis, the average healthcare costs for CMM patients was 2.8 times higher than in the general population. The healthcare cost ratio varied from 2.0 (stage I) to 10.1 (stage IV) and the CMM-related costs per patient-year varied from €2 670 (stage I) to €29 291 (stage IV). The mean healthcare costs decreased over time but remained significantly higher than in the general population for all clinical stages. During the first year after diagnosis, patients in clinical stage III-IV (7% of CMM patients) accounted for 27% of the total CMM-related healthcare costs.

Conclusions The direct healthcare costs for CMM patients were significantly higher than in the general population independent of clinical stage. CMM patients diagnosed in clinical stage III-IV were associated with particularly high costs and the healthcare system may save resources by finding CMM patients in earlier stages.

National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:liu:diva-113144 (URN)10.1111/jdv.13110 (DOI)000374554200007 ()
Note

Funding agencies:Regional cancer center South East in Linkoping

Vid tiden för disputation förelåg publikationen som manuskript

Available from: 2015-01-12 Created: 2015-01-12 Last updated: 2017-05-03
Thunell, L., Bivik, C., Wäster, P., Fredrikson, M., Stjernstrom, A., Synnerstad, I., . . . Enerbäck, C. (2014). MDM2 SNP309 promoter polymorphism confers risk for hereditary melanoma. Melanoma research, 24(3), 190-197
Open this publication in new window or tab >>MDM2 SNP309 promoter polymorphism confers risk for hereditary melanoma
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2014 (English)In: Melanoma research, ISSN 0960-8931, E-ISSN 1473-5636, Vol. 24, no 3, p. 190-197Article in journal (Refereed) Published
Abstract [en]

The p53 pathway regulates stress response, and variations in p53, MDM2, and MDM4 may predispose an individual to tumor development. The aim of this study was to study the impact of genetic variation on sporadic and hereditary melanoma. We have analyzed a combination of three functionally relevant variants of the p53 pathway in 258 individuals with sporadic malignant melanomas, 50 with hereditary malignant melanomas, and 799 healthy controls. Genotyping was performed by PCR-restriction fragment length polymorphism, pyrosequencing, and allelic discrimination. We found an increased risk for hereditary melanoma in MDM2 GG homozygotes, which was more pronounced among women (P=0.035). In the event of pairwise combinations of the single nucleotide polymorphisms, a risk elevation was shown for MDM2 GG homozygotes/p53 wild-type Arg in hereditary melanoma (P=0.01). Individuals with sporadic melanomas of the superficial spreading type, including melanoma in situ, showed a slightly higher frequency of the MDM2 GG genotype compared with those with nodular melanomas (P=0.04). The dysplastic nevus phenotype, present in the majority of our hereditary melanoma cases and also in some sporadic cases, further enhanced the effect of the MDM2 GG genotype on melanoma risk (P=0.005). In conclusion, the results show an association between MDM2 SNP309 and an increased risk for hereditary melanoma, especially among women. Analysis of sporadic melanoma also shows an association between MDM2 and the superficial spreading melanoma subtype, as well as an association with the presence of dysplastic nevi in sporadic melanoma.

Place, publisher, year, edition, pages
Lippincott, Williams andamp; Wilkins, 2014
Keywords
superficial spreading melanoma; MDM2; hereditary melanoma; MDM4; p53; dysplastic nevi
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-107446 (URN)10.1097/CMR.0000000000000063 (DOI)000335683500002 ()
Available from: 2014-06-12 Created: 2014-06-12 Last updated: 2017-12-05
Verma, D., Bivik, C., Farahani, E., Synnerstad, I., Fredrikson, M., Enerbäck, C., . . . Söderkvist, P. (2012). Inflammasome polymorphisms confer susceptibility to sporadic malignant melanoma. Pigment Cell & Melanoma Research, 25(4), 506-513
Open this publication in new window or tab >>Inflammasome polymorphisms confer susceptibility to sporadic malignant melanoma
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2012 (English)In: Pigment Cell & Melanoma Research, ISSN 1755-1471, E-ISSN 1755-148X, Vol. 25, no 4, p. 506-513Article in journal (Refereed) Published
Abstract [en]

Genetic variants of NLRP3 and NLRP1 are known to modulate levels of pro-inflammatory cytokine interleukin (IL)-1 beta. The purpose of this study was to investigate the association of NLRP3/NLRP1 polymorphisms with susceptibility and clinical features of malignant melanoma in a Swedish casecontrol study. Common variants in NLRP3/NLRP1 were investigated in sporadic malignant melanoma patients and healthy controls followed by analysis using logistic regression. NLRP3 variant (rs35829419) was significantly more common in male patients than in controls (OR, 2.22; CI, 1.273.86). Upon stratification, significant association with nodular melanoma was observed (OR, 2.89; CI, 1.336.30), which intensified in male patients (OR 4.03, CI 1.4011.59). The NLRP1 variant (rs12150220) was significantly more common in fair-skinned female patients (OR, 1.85; CI, 1.043.33) and showed strong associations with nodular melanoma (OR, 6.03; CI, 1.3325). Our data suggest that NLRP3/NLRP1 polymorphisms are associated with melanoma susceptibility; these findings warrant validation in other independent populations.

Place, publisher, year, edition, pages
Blackwell Publishing, 2012
Keywords
inflammasome; NLRP1; NLRP3; CIAS1; SNP; melanoma; IL-1 ss
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-79688 (URN)10.1111/j.1755-148X.2012.01008.x (DOI)000305511200015 ()
Available from: 2012-08-13 Created: 2012-08-13 Last updated: 2017-12-07
Tinghög, G., Carlsson, P., Synnerstad, I. & Rosdahl, I. (2009). How costly is skin cancer for society?. Forum for Nordic Dermato-Venerology, 14(1), 12-14
Open this publication in new window or tab >>How costly is skin cancer for society?
2009 (English)In: Forum for Nordic Dermato-Venerology, ISSN 1402-2915, Vol. 14, no 1, p. 12-14Article in journal (Other academic) Published
Abstract [en]

The annual cost of skin cancer in Sweden in 2005 was estimated to be -142.4 million (-15/inhabitant). When comparing direct costs only cost associated with medical consumption, skin cancer is more costly than the equivalent costs of both multiple sclerosis and brain tumours, and is close to the cost of breast cancer.

Place, publisher, year, edition, pages
Uppsala, Sweden: Nordic Dermatology Association, 2009
National Category
Dermatology and Venereal Diseases Cancer and Oncology
Identifiers
urn:nbn:se:liu:diva-18872 (URN)2-s2.0-62649165148 (Scopus ID)
Available from: 2009-06-05 Created: 2009-06-05 Last updated: 2015-11-11Bibliographically approved
Synnerstad, I., Fredrikson, M., Ternesten-Bratel, A. & Rosdahl, I. (2008). Low risk of melanoma in patients with atopic dermatitis. Journal of the European Academy of Dermatology and Venereology, 22(12), 1423-1428
Open this publication in new window or tab >>Low risk of melanoma in patients with atopic dermatitis
2008 (English)In: Journal of the European Academy of Dermatology and Venereology, ISSN 0926-9959, E-ISSN 1468-3083, Vol. 22, no 12, p. 1423-1428Article in journal (Refereed) Published
Abstract [en]

Background: There is a possible association between atopy and cancer based on the concept of atopic diseases as a hyper-reactive state of the immune system. Melanoma is an immunogenic tumour, and since patients with atopic dermatitis (AD) are subjected to local and systemic immunosuppressives, it would be expected to find an influence of AD on the melanoma risk. There is a positive correlation between the number of naevi and melanoma risk, and children and adults with AD have fewer naevi than controls although many patients receive ultraviolet treatment.

Objective: This study aims to investigate the melanoma risk in a retrospective cohort of AD patients compared with the population.

Study design: 6280 AD patients born 1935–1979 visited five Dermatology clinics during 1986–2004. Mean follow-up time was 36.7 years (SD 6.9) corresponding to 230 742 person-years at risk. The cohort file was linked to the National Cancer register.

Results: Six AD patients with melanoma were identified, and the Poisson regression analysis adjusted for age group, sex and year resulted in an incidence rate ratio of 0.49 (95% confidence interval: 0.27–1.35, P = 0.08) for the AD group compared with the total population in the region.

Conclusion: A low risk to develop melanoma was found in AD patients. However, the results must be interpreted with caution since the small number of expected cases of melanoma makes the risk estimate sensitive to chance effects. We hypothesize that formation of naevi and progression to melanoma is counteracted by the inflammatory process in the skin of AD patients.

Keywords
atopic dermatitis, atopy, melanocytic naevi, melanoma
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16131 (URN)10.1111/j.1468-3083.2008.02888.x (DOI)
Available from: 2009-01-08 Created: 2009-01-07 Last updated: 2017-12-14
Tinghög, G., Carlsson, P., Synnerstad, I. & Rosdahl, I. (2008). Societal Cost of Skin Cancer in Sweden 2005. Acta Dermato-Venereologica, 88(5), 467-473
Open this publication in new window or tab >>Societal Cost of Skin Cancer in Sweden 2005
2008 (English)In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 88, no 5, p. 467-473Article in journal (Refereed) Published
Abstract [en]

Skin cancer is one of the most rapidly increasing cancers among the Swedish population and a significant cause of illness and death. This study aims to estimate the total societal cost of skin cancer in Sweden 2005, using a prevalence based cost-of-illness approach. The total cost of skin cancer was estimated to € 142.4 million (€ 15 per inhabitant), of which € 79.6 million (€ 8 per inhabitant) were spent on health services and € 62.8 million (€ 7 per inhabitant) were due to production loss. The main cost driver was resource utilisation in outpatient care, amounting to 42.2% of the total cost. Melanoma was the most costly skin cancer diagnosis. Non-melanoma skin cancer was however the main cost driver for health services alone. In the future it is important to establish effective preventive measures to avoid increasing costs and suffering caused by skin cancer.

Keywords
skin cancer, cost, cost-of-illness, Sweden
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-15347 (URN)10.2340/00015555-0523 (DOI)
Note
Original publication: Gustav Tinghög, Per Carlsson, Ingrid Synnerstad and Inger Rosdahl, Societal Cost of Skin Cancer in Sweden 2005, 2008, Acta Dermato-Venereologica, (88), 5, 467-473.http://dx.doi.org/10.2340/00015555-0523. Copyright © Taylor & Francis Group, an informa businessAvailable from: 2008-11-04 Created: 2008-11-04 Last updated: 2017-12-14Bibliographically approved
Kertat, K., Rosdahl, I., Sun, X.-F., Synnerstad, I. & Zhang, H. (2008). The Gln/Gln genotype of XPD codon 751 as a genetic marker for melanoma risk and Lys/Gln as an important predictor for melanoma progression: A case control study in the Swedish population. Oncology Reports, 20(1), 179-183
Open this publication in new window or tab >>The Gln/Gln genotype of XPD codon 751 as a genetic marker for melanoma risk and Lys/Gln as an important predictor for melanoma progression: A case control study in the Swedish population
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2008 (English)In: Oncology Reports, ISSN 1021-335X, E-ISSN 1791-2431, Vol. 20, no 1, p. 179-183Article in journal (Refereed) Published
Abstract [en]

The Xeroderma pigmentosum complementation group D (XPD) is a critical protein in the nucleotide excision repair system for DNA damage. Genetic variations in XPD exert an important effect on the capacity of DNA repair. In this study, we examined Lys751Gln polymorphism at the XPD gene in 244 melanoma patients and 251 healthy individuals (as controls) from the south-eastern region of Sweden. The associations of polymorphism with melanoma risk, as well as with melanoma features and pigment phenotypes of the melanoma patients were analysed. DNA was extracted from the mononuclear cells of venous blood of the melanoma patients and controls. XPD codon 751 was genotyped by the PCR restriction fragment length polymorphism technique. Results showed that there was no difference in the distribution of the XPD codon 751 genotypes between the melanoma patients and healthy controls. However, the Gln/Gln genotype was found to be associated with melanoma risk in the male population. Furthermore, the frequency of the Gln/Gln genotype was significantly higher in the early stages of melanomas, whereas Lys/ Gln was more frequent in the later stages and in the patients with melanoma located on intermittently UV-exposed areas. No correlations between the polymorphisms and phenotypes of the patients were found. In conclusion, Gln/Gln was a useful genetic marker for melanoma risk in the males, while Lys/Gln was an important predictor for melanoma progression.

Keywords
Adult Aged Case-Control Studies *Codon Disease Progression Female Genetic Markers Genetic Predisposition to Disease Genotype Hair Color Humans Male Melanoma/*genetics/pathology Middle Aged Risk Factors Xeroderma Pigmentosum Group D Protein/*genetics
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-43368 (URN)73654 (Local ID)73654 (Archive number)73654 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
Zhang, H., Sun, X.-F., Synnerstad, I. & Rosdahl, I. (2007). Importance of FAS-1377, FAS-670, and FASL-844 polymorphisms in tumor onset, progression, and pigment phenotypes of Swedish patients with melanoma: a case-control analysis.. Cancer Journal, 13(4), 233-237
Open this publication in new window or tab >>Importance of FAS-1377, FAS-670, and FASL-844 polymorphisms in tumor onset, progression, and pigment phenotypes of Swedish patients with melanoma: a case-control analysis.
2007 (English)In: Cancer Journal, ISSN 0765-7846, E-ISSN 1292-8658, Vol. 13, no 4, p. 233-237Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Human skin melanoma at later stages usually has an extremely poor prognosis. It is of importance to search for biologic markers to identify and monitor individuals at risk for melanoma for early diagnosis and to avoid tumor progression. The FAS gene and its natural ligand (FASL) gene initiate the death signal cascade, playing a central role in the apoptotic signaling pathway and tumor growth and metastasis. PATIENTS AND METHODS: In this study, we analyzed polymorphisms in 229 patients with melanoma and 351 age- and gender-matched tumor-free individuals. Genomic DNAs were isolated from mononuclear cells in peripheral vein blood, and the polymorphisms were examined with polymerase chain reaction-restriction fragment length polymorphism techniques. Frequency in distribution of the polymorphisms was compared between the patients with melanoma and the healthy control subjects, and associations with patients' pigment phenotypes, age at diagnosis, and melanoma characteristics were analyzed. RESULTS AND CONCLUSIONS: The FAS-1377, FAS-670, and FASL-844 polymorphisms were not found to be markers of melanoma risk (P > 0.05). In patients with melanoma, frequencies of the FAS-1377, FAS-670, and FASL-844 polymorphisms were different between the patients aged <50 and > or =50 years (P < or = 0.025, P < or = 0.025, and P < or = 0.01). Moreover, the FAS-670 polymorphism correlated with tumor Breslow thickness (P < or = 0.01) and Clark level (P < or = 0.001) and was associated with tumors developing in sun-exposed locations (P < or = 0.001). FAS and FASL were not markers for melanoma risk but might be important in the development and progression of sun-induced melanoma independently of skin type.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-40457 (URN)10.1097/PPO.0b013e318046f214 (DOI)53296 (Local ID)53296 (Archive number)53296 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
Hansson, J., Bergenmar, M., Hofer, P.-A., Lundell, G., Mansson-Brahme, E., Ringborg, U., . . . Rosdahl, I. (2007). Monitoring of kindreds with hereditary predisposition for cutaneous melanoma and dysplastic nevus syndrome: Results of a Swedish preventive program. Journal of Clinical Oncology, 25(19), 2819-2824
Open this publication in new window or tab >>Monitoring of kindreds with hereditary predisposition for cutaneous melanoma and dysplastic nevus syndrome: Results of a Swedish preventive program
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2007 (English)In: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 25, no 19, p. 2819-2824Article in journal (Refereed) Published
Abstract [en]

Purpose To evaluate a program initiated in 1987 by the Swedish Melanoma Study Group aiming to provide preventive surveillance to kindreds with hereditary cutaneous melanoma and dysplastic nevus syndrome. Patients and Methods Overall, 2,080 individuals belonging to 280 melanoma families were followed for 14 years between 1987 and 2001 at 12 participating centers. Data were registered in a central database. Results Among 1,912 skin lesions excised during follow-up, 41 melanomas were removed in 32 individuals. Of these, 15 (37%) were in situ melanomas and 26 (63%) invasive melanomas. The median tumor thickness of invasive melanomas was 0.5 mm. Ulceration was absent in 24 of 26 invasive melanomas (92%) and 12 (46%) lacked vertical growth phase. Compared with melanomas in the general Swedish population, the melanomas identified in these kindreds during follow-up had better prognostic characteristics. All melanomas except one were diagnosed in families with two or more first-degree relatives with melanoma. Diagnosis of melanoma occurred in three of eight kindreds with germline CDKN2A mutations, supporting that families with such mutations are at increased risk for melanoma development. Of the 32 individuals who developed melanoma during follow-up, 21 (66%) had had at least one previously diagnosed melanoma. Conclusion This study shows that a coordinated program aimed at detecting and offering skin surveillance in kindreds with hereditary cutaneous melanoma results in a low incidence of melanomas during the follow-up period and that the tumors that do arise have favorable prognostic characteristics.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-45943 (URN)10.1200/JCO.2007.11.4108 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13
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