Among these studies, 10 articles reported IL-18 levels in serum,[11,17,18,21–27] and 1 reported IL-18 levels in tear.[28] IL-18 levels in pSS patients were significantly higher than those in HCs, (SMD = 1.28, 95% CI 0.75–1.82, P < .001), with substantial heterogeneity (I2 = 90%, P < .001) among the studies. Here, IL18 is linked to peeling skin syndrome.