摘要：Objectives. To review the contribution of the Nurses’ Health Studies (NHSs) to identifying epidemiological factors associated with multiple skin diseases, including skin cancer, psoriasis, and other inflammatory and autoimmune skin diseases. Methods. We carried out a narrative review of NHS articles published between 1976 and 2016. Results. The NHSs have identified environmental and lifestyle factors related to psoriasis, supporting obesity and smoking as psoriasis risk factors; associations between psoriasis and diabetes, myocardial infarction, and Crohn’s disease, supporting psoriasis as a systemic disorder; and associations of pigmentary traits, ultraviolet radiation, and lifestyle factors such as citrus consumption with risk of skin cancer. Genetic studies have identified novel genetic loci for skin pigmentation (e.g., IRF4 , SLC24A4 , NID1 , and EDNRB ) and skin cancer (e.g., TET2 and HERC2-OCA2 ). Work continues on highly prevalent but less studied skin conditions such as rosacea, acne, and atopic dermatitis. The NHS results have influenced public health policies on indoor tanning devices. Conclusions. The NHSs have provided invaluable resources on skin disease population science and contributed to the etiological understanding of multiple skin disorders. Skin is the largest human organ. Skin conditions combined rank as the fourth leading cause of all human diseases, affecting almost one third of the world’s population. 1 In addition to direct costs, skin diseases involve extremely high indirect costs and quality-of-life losses; for example, in 2004, these diseases accounted for a total economic burden of approximately $96 billion in the United States. 2 The burden of skin diseases highlights the need to strengthen research on their epidemiology and causes, which will promote disease prevention and treatment. We gathered detailed data on skin-related outcomes collected through the Nurses’ Health Studies (NHSs), including the NHS (initiated in 1976), the NHS II (initiated in 1989), and most recently the NHS3 (initiated in 2010). We had access to comprehensive data on multiple skin diseases, including, predominantly, skin cancer and major inflammatory and autoimmune skin diseases, skin phenotypes, and exposures related to skin conditions. Numerous epidemiological studies on skin outcomes based on the NHSs have been conducted since the 1980s, leading to more than 100 publications and contributing significantly to the dermatoepidemiology field. Here we narratively review the major data the NHSs have collected and the primary findings and contributions based on the NHS cohorts.
