PHOSPHODIESTERASE IN PSORIASIS

SUMMARY. .
Phosphodiesterase activity was determined by a fluorometric method using thymidine-5'-3–0-methoxy fluorescein phosphate as a substrate, in blood serum, finger-blood, normal skin, foreskin and psoriatic skin.
Higher enzyme activity was found in psoriasis both in blood-serum and finger-blood in comparison with normal controls. Higher enzyme activity was found in involved psoriatic skin in comparison with uninvolved skin and normal skin. The paper supports the theory that in psoriasis there are specific defects in the enzyme systems concerned with protein metabolism.     

PSORIASIS IN DRRMATOLOGY PRACTICE

A survey of psoriasis patients attending dermatologists in Methourne showed that one quarter of patients were newly diagnosed, three quarters of patients were in the working age groups of the community, and most patients were assessed as having mild or moderate psoriasis. These findings are discussed, and it is concluded that dermatologists have an important role in educating the community about psoriasis.     

SUICIDAL IDEATION IN PSORIASIS

Background. Psoriasis has been associated with depressive disease and case reports of completed suicide. Methods. 217 consenting psoriasis patients completed the Carroll Rating Scale for Depression (CRSD), a 52-item self-rated scale, with four of the Items directly addressing wishes to be dead and suicidal ideation. The patients also self-rated the severity of their psoriasis. Results. 9.7% of patients reported a wish to be dead, and 5.5% reported active suicidal ideation at the time of the study. The death wish and suicidal ideation were associated with higher depression scores (P < 0.0001) and higher patient self-ratings of psoriasis severity (P < 0,05). Patient self-reports of psoriasis severity correlated directly with the overall depression scores (r = 0.39), P < 0.0001). Conclusions. The comorbidity between depressive symptoms, suicidal ideation, and psoriasis severity is in contrast with reports that severe depression and suicidal ideation are mainly a feature of life-threatening medical disorders such as malignancies. Our finding may have important implications in the management of psoriasis.     

LIVER BIOPSY IN PSORIASIS

SUMMARY. Liver biopsy was performed in 3 patients who had previously received methotrexate treatment and in 32 patients considered for this treatment. One of the methotrexate treated patients had a granulomatous hepatitis and pronounced steatosis. The other 2 had moderate fatty infiltration. Pathological steatosis was observed in 16 of 32 patients not given methotrexate. Two of these patients had cirrhosis of the liver. Abuse of alcohol and obesity were common among patients with pathological liver findings. Fatty liver may be of special clinical significance in patients receiving hepatotoxic therapy like methotrexate.     

ECCRINE SWEATING IN PSORIASIS

SUMMARY.— The lesions of psoriasis produce very much less sweat on pharmacological stimulation than clincally unaffected adjacent skin. The Na⁺ K⁺ concentrations of this sweat are very much decreased.
The sweat rate increased after the lesions were stripped, sweat Na⁺ and K⁺ increased, but to a lesser extent.
It is concluded that there are two abnormalities of sweat gland function in the plaques of psoriasis: (i) superficial obstruction of the ducts leading to hypohidrosis, (ii) an abnormality of absorption by the duct leading to inappropriately low sweat electrolyte concentration.
The absence of miliaria despite duct blockage is discussed in relationship to the hypothesis that miliaria is due to an imbalance between the capacity of the coil to secrete and the ability of the duct to absorb.     

JOINT COMPLAINTS IN PSORIASIS PATIENTS

Four hundred and fifty-nine psoriasis patients seen at the Department of Dermatology, Bowman Gray School of Medicine of Wake Forest University, responded to a questionnaire concerning current or past joint complaints. Of these, 17% reported a previous diagnosis of psoriatic arthritis, and over 53% had a current or past history of arthralgias. Additional information on those patients reporting arthralgias focused on the cutaneous sites of involvement with psoriasis and which joints were most likely to be involved in patients with various types of arthritis. Previous treatments for skin involvement with psoriasis were more aggressive in those patients with a diagnosis of psoriatic arthritis. A significant proportion of patients presenting to dermatologists for treatment of psoriasis have joint complaints, and the percentage of patients with psoriatic arthritis is greater than generally appreciated by non-dermatologists.     

ENDOTHELIAL CELL ADHESION MOLECULES IN PSORIASIS

Skin biopsies from patients with psoriasis and normal controls were examined for the expression of cell adhesion molecules including intercellular adhesion molecule-1 (ICAM-1) endothelial leukocyte adhesion molecule-1 (ELAM-1), HECA-452 and 4D10, using an immunoperoxidase techique. This study demonstrates that psoriatic skin exhibits a wide variety of markers of endothelial cell activation which are either induced or increased expression (ICAM-1, ELAM-1 & 4D10). Moreover, ICAM-1 & HECA-452 are also on leukocytes. These antigens may facilitate the adhesion of inflammatory cells to endothelium and antigen-presenting cells in psoriatic skin. Thus, they may play a role in faciliating the infiltration of leukocytes into psoriatic skin.     

MONOCYTE ADHESION TO FIBRONECTIN IN PSORIASIS

Background. After vascular extravasation, mononuclear cells (MNC) undergo chemotaxis and adhesion to extracellular matrix proteins, resulting in their differentiation into macrophages. Although endothelial adhesion and chemotaxis are altered in psoriasis, MNC adhesion to extracellular matrix proteins has not been previously studied in the disease. Since MNC adhesion to endothelial cells is abnormally regulated in psoriasis by TGF-beta, we tested they hypothesis that in psoriasis substance P also regulates the adhesion of monocytes to the extracellular matrix protein fibronectin. Methods. Monocytes from 16 normal controls and 11 psoriatic individuals were isolated and purified using a two-step gradient centrifugation procedure. Adhesion to fibronectin was studied by plating monocyte suspensions onto fibronectin-precoated microtiter plates. The number of adherent cells was quantified by measuring their hex-osaminidase activity. Results. Although statistically significant differences in the basal (unstimulated) adhesion or in the substance P-stimulated adhesion between normal control monocytes and those obtained from psoriatic individuals were not observed, a subpopulation of psoriatics was identified who responded to substance P. Furthermore, this in vitro response to substance P was correlated with the clinical status of the subpopulation which was characterized by unstable psoriasis triggered by stressful life events. Conclusions. The results of this study indicate that priming of monocytes by the extracellular matrix protein fibronectin or by elevated levels of substance P are not critical steps in the pathogenesis of stable, chronic psoriasis. Substance P may contribute to the appearance of new lesions in some individuals with unstable psoriasis.