BMJ  2003;327:316 (9 August), doi:10.1136/bmj.327.7410.316

Paper

Past exposure to sun, skin phenotype, and risk of multiple sclerosis: case-control study

I A F van der Mei, PhD student1, A-L Ponsonby, associate professor2, T Dwyer, professor1, L Blizzard, biostatistician1, R Simmons, principal research fellow3, B V Taylor, neurologist4, H Butzkueven, neurologist5, T Kilpatrick, associate professor5

1 Menzies Centre for Population Health Research, University of Tasmania, Hobart, TAS 7000, Australia, 2 National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia, 3 Australian MS Longitudinal Study, Canberra Hospital, Canberra, Australia, 4 Royal Hobart Hospital, Hobart, Australia, 5 Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia

Correspondence to: I A F van der Mei Ingrid.vanderMei{at}utas.edu.au

Objective To examine whether past high sun exposure is associated with a reduced risk of multiple sclerosis.

Design Population based case-control study.

Setting Tasmania, latitudes 41-3°S.

Participants 136 cases with multiple sclerosis and 272 controls randomly drawn from the community and matched on sex and year of birth.

Main outcome measure Multiple sclerosis defined by both clinical and magnetic resonance imaging criteria.

Results Higher sun exposure when aged 6-15 years (average 2-3 hours or more a day in summer during weekends and holidays) was associated with a decreased risk of multiple sclerosis (adjusted odds ratio 0.31, 95% confidence interval 0.16 to 0.59). Higher exposure in winter seemed more important than higher exposure in summer. Greater actinic damage was also independently associated with a decreased risk of multiple sclerosis (0.32, 0.11 to 0.88 for grades 4-6 disease). A dose-response relation was observed between multiple sclerosis and decreasing sun exposure when aged 6-15 years and with actinic damage.

Conclusion Higher sun exposure during childhood and early adolescence is associated with a reduced risk of multiple sclerosis. Insufficient ultraviolet radiation may therefore influence the development of multiple sclerosis.


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Rapid Responses:

Read all Rapid Responses

Sun and multiple sclerosis: another environmental benefit
John H. Lange
bmj.com, 9 Aug 2003 [Full text]
MS and sunshine
Sir Donald Acheson
bmj.com, 15 Aug 2003 [Full text]
Sun exposure and multiple sclerosis
Oliver Lily
bmj.com, 1 Sep 2003 [Full text]
MS and SUNSHINE or MS and PINEAL GLAND?
Gaston E. F. MERCKX
bmj.com, 4 Sep 2003 [Full text]
Risk factors in MS
Robert T Ross
bmj.com, 10 Sep 2003 [Full text]
Authors' reply
Anne-Louise Ponsonby, et al.
bmj.com, 23 Sep 2003 [Full text]
Letter to the Editor
Geoffrey Dean
bmj.com, 17 Nov 2003 [Full text]
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