Plasma concentration of selected neuropeptides in patients suffering from psoriasis

The aim of this study was to evaluate plasma levels of substance P (SP), calcitonin gene-related peptide (CGRP), vasoactive intestinal peptide (VIP) and neuropeptide Y (NPY) during psoriasis course. METHODS: Seventy-three patients with psoriasis and 32 healthy volunteers were included. Detailed demographic and disease anamnesis was obtained from every patient. The disease severity was assessed using the Psoriasis Area and Severity Index score. Plasma levels of SP, CGRP, VIP and NPY were measured radioimmunologically. RESULTS: Plasma levels of SP and NPY did not significantly differ between patients with psoriasis and controls (median SP: 52.8 and 57.9 pg/ml, respectively; P = 0.32; median NPY: 8.5 and 8.2 pg/ml, respectively; P = 0.67). CGRP plasma concentration was significantly elevated in psoriatic individuals both before (median 43.1 pg/ml) and after treatment (median 45.4 pg/ml), in comparison with healthy donors (median 13.5 pg/ml; P < 0.01 and P = 0.03, respectively). Treatment did not significantly influence plasma CGRP levels (P = 0.3). Median VIP plasma concentration in psoriatics before treatment was significantly higher compared with healthy controls (medians 66.9 and 60.1 pg/ml, respectively; P = 0.04), but the therapy resulted in significant decrease in VIP plasma level (median 19.0 pg/ml; P < 0.001). In psoriatic patients significant correlations were noted between NPY and VIP (R = 0.34; P < 0.01), and VIP and CGRP plasma levels, both before (R = 0.28; P = 0.03) and after the treatment (R = 0.44; P < 0.01). CONCLUSIONS: Based on our results and previous literature data it could be suggested that neuropeptides may be involved in the development of psoriatic lesions.     

Itching for an answer: A review of potential mechanisms of scalp itch in psoriasis

Scalp psoriatic itch is a common complaint and often poses a therapeutic challenge. The pathophysiology of this phenomenon is unclear. The unique anatomy of the scalp contains richly innervated hair follicles, abundant vasculature and perifollicular inflammatory cytokines which may all contribute to this common sensory complaint. The mast cell, in particular, is portrayed as one of the main itch conductors for its ability to trigger neurogenic inflammation, activate the peripheral hypothalamic‐pituitary‐adrenal‐axis, process and integrate itch signalling through its interactions with the scalp hair follicles. Herein, we explain and speculate upon potential mechanisms underlying itchy scalp psoriasis, involving interconnections between the neuroimmune, neurovascular and neuroendocrine systems. Many factors may play roles in itchy scalp psoriasis including the scalp hair structure, immune system, endocrine system, nervous system and vascular system. These may warrant further exploration as therapeutic targets that go beyond the application of mere anti‐inflammatory agents.     

Itching from wool fibres in atopic dermatitis

In 24 girls with atopic dermatitis and a history of irritation to wool, more intense itching was provoked on normal skin on the abdomen by a material with coarse wool fibres (36 microns) than with thinner fibres (20 microns). The probability of the materials causing itching could be predicted by the girls by handling the materials.     

Circulating androgens in male patients suffering from systemic scleroderma

Summary The excretion of collagen metabolites and circulating androgens was measured in ten males suffering from progressive systemic sclerosis. Significantly higher levels of sex hormone-binding globuline, total testosterone and dihydrotestosterone (DHT) (P<0.01), and total oestradiol (P<0.05), were found in patients when compared with age-matched controls. Urinary excretion of hydroxyproline in patients was found to correlate significantly with total testosterone (P=0.035), with DHT (P=0.005) and dehydroepiandrosteronsulphate (DHEAS) (P=0.034). Similarly the hydroxyproline peptide fraction was found to correlate significantly with total testosterone (P=0.037), with DHT (P=0.005) and with DHEAS (P=0.008). Hydroxylysine peptide in the urine correlated significantly with free testosterone (P=0.035) and DHT (P=0.040). Oestrogens did not correlate with urinary excretion of collagen metabolites. These findings suggest that androgens may play a role in the pathogenesis of scleroderma in male patients.     

Increased frequency of self-reported parasomnias in patients suffering from vitiligo

Vitiligo is a skin disorder of unknown aetiology, affecting 0.1-2% of the general population. The aim of the present study was to investigate its relationship with sleep disorders, especially parasomnias. Two hundred and sixteen individuals were examined. Among them, 116 were suffering from vitiligo, 52 from other dermatological diseases and 48 were healthy subjects, serving as a control group. An inventory including items related to sleep disorders from childhood and adolescence was used. The study was focused specifically on parasomnias. Patients suffering from vitiligo reported a significantly higher occurrence of sleepwalking, nocturnal enuresis, night illusions, sleep terrors and nightmares than that of the control group, prior to the manifestation of the disease. Patients suffering from other dermatological diseases only reported significantly more often nightmares and nocturnal enuresis compared to the control group. A relationship between parasomnias during early life and later development of vitiligo was detected. This finding supports the hypothesis that neural mechanisms involving monoaminergic systems (especially the serotoninergic one) may potentially be involved in the aetiopathology of vitiligo.     

Lipid synthesis from the liver in patients with psoriasis

Summary In psoriatic patients with hyperlipidemia we studied the hepatic lipidic synthesis from (1-¹⁴C)-acetate in human liver biopsy specimens in vitro by a thin-layer radio-chromatography.In psoriatics type IV (according to Fredrickson) a significant increase in (1-¹⁴C)-acetate hepatic incorporation especially into phospholipids (25%) and triglycerides (52%) was observed; in type IIb increased lipogenesis was accompanied by a greater hepatic incorporation of labelled acetate into phospholipids (24.5%), free cholesterol (44.4%) and triglycerides (29%).Abnormal lipid metabolism often coexists with glucose intolerance in psoriasis; no correlation between hyperinsulinemia and augmented (1-¹⁴C)-acetate incorporation into hepatic triglycerides was found.This paper was presented in part at the 57th National Congress of the Italian Society of Dermatology and Venereology     

Chemotactic lipoxygenase products in sera from patients with psoriasis

Summary Sera obtained from 12 patients with moderate to severe psoriasis were investigated for the presence of arachidonate lipoxygenase metabolites using reverse-phase high-performance liquid chromatography after extraction on silicic acid columns. Peaks which co-chromatographed with standards of synthetic leukotriene B₄ (LTB₄) were collected, and the material was tested for chemotactic activity. In the sera of 5 of the patients, chemotactic activity was demonstrable in these LTB₄ peaks. Although minor peaks cochromatographing with LTB₄ were found in control sera, none of them contained chemotactic material. Isolated monocytes from the psoriasis patients showed enhanced chemotactic activity as compared to monocytes obtained from healthy controls. The results of our study support the view that abnormal 5-lipoxygenase activity is present in psoriasis. Further investigation is required to determine whether LTB₄ is released from circulatory leukocytes or the skin.     

Itching in the psychiatric ward

Chronic itch is known to have psychogenic elements; however, there is no data on itch prevalence and characteristics among hospitalized psychiatric patients. We investigated the prevalence and types of itching among hospitalized psychiatric patients who met DSM-IV criteria for schizophrenia, affective or other psychiatric disorders. A validated itch questionnaire based on the McGill Pain Questionnaire, which examines the incidence and characteristics of itching, was administered to 111 patients, hospitalized in an Israeli university hospital. Patients with atopic eczema, psoriasis, or systemic diseases that cause pruritus were excluded. Thirty-six patients (32% of those screened) reported itching. Few sought help or used anti-pruritic therapy. Itching should be addressed during psychiatric assessments, in order to provide appropriate treatment.