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.     

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.     

LEUKOCYTE-EXTRACELLULAR MATRIX INTERACTIONS IN PSORIASIS

Background. The basic phenomenon in psoriasis appears to be a directed leukocyte migration that in a great part, depends on the cell-extracellular matrix (ECM) interactions. Methods. To evaluate the leukocyte-ECM interactions in psoriasis, we investigated the adherence of peripheral blood mononuclear cells (PBMC) and polymorphonuclear leukocytes (PMNL) to ECM components (collagen type I, IV, laminin, and fibronectin), using crystal violet staining and measuring absorbance at 570 nm. Results. In the most active cases of psoriasis (pin-point and guttate type) of short duration, we found a decreased adherence of PBMC to collagen type IV. In a majority of cases of actively spreading plaque psoriasis of large extent and longer duration, there was decreased adherence to all ECM components, especially to collagen type IV and laminin. The adhesion of PMNL to collagen type IV (but not to other ECM components) was increased only in cases of short duration. Preliminary data suggest that etretinate treatment may modulate leukocyte adherence to the ECM components in patients with psoriasis. Conclusions. The decreased in vitro adherence of PBMC to ECM components, especially those of the basement membrane, may reflect their in vivo activation and migration to the epidermis, which is a basic phenomenon in psoriasis that could be affected by etretinate therapy.