IMMUNOPATHOLOGICAL STUDIES ON PSORIASIS

In vivo deposits of fibrin, fibrinogen, plasminogen, complements and immunoglobulins were observed using immunofluorescent (IF) staining of psoriatic lesions. Deposits of fibrin were seen in either the horny layer or the dermal papillae. A linear cytoplasmic appearance of fluorescence in the psoriatic scales was a common pattern of the staining. IF staining of the psoriatic horny layer for fibrinogen and plasminogen yielded essentially the same pattern as those of fibrin and IgG. These findings suggest that some fibrinolytic processes may be associated with an immune reaction in psoriatic skin, although they be secondary phenomena.     

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.     

银屑病患者伴发疾病的病例对照研究

在银屑病流行病学调查中,我们发现本病患者伴有高血压、冠心病等疾病较多,并有鉴于文献上对本病和恶性肿瘤及糖尿病等的关系,意见也不一致,为进一步检验本病与这些疾病的相关性,遂作此专题研究.结果证实,银屑病患者中,高血压和冠心病的发生率比一般人群明显增多,肝病发生率也显著增多.恶性肿瘤和糖尿病的发生率则与一般人群相同,结合文献进行了讨论,并提出了防治本病的设想.     

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.     

IMMUNOHISTOCHEMICAL STUDY ON THE PATTERN OF 50 KD CYTOKERATIN IN PSORIASIS

Three biopsies of normal skin and 15 biopsies collected from patients with psoriasis vulgaris were analyzed for the expression of the 50 kd cytokeratin using direct immunofluorescence and ABC technique before and after local treatment with anthralin 0.1% in a petrolatum base, with 0.05% betamethasone dipropionate cream, and finally, after PUVA treatment. Antiserum against the 50 kd anti-cytokeratin reacted with tissue sections of normal skin, staining cells in the basal layer, while the psoriatic skin sections before the various treatments showed a staining concerning the whole thickness of the epidermis. After the various therapies, the 50 kd cytokeratin immunoreactivity was observed only in the basal layer of those psoriatic skin sections that showed complete clinical clearing, while it was observed in the whole thickness of psoriatic patches that did not clear. These data suggest that the normalization of the 50 kd cytokeratin expression pattern can be considered as a marker of clinical remission of psoriasis.     

UPDATE ON NUTRITION AND PSORIASIS

Background. It has been established that severe psoriasis may lead to nutrient depletion, especially of protein, folate, and iron. Nutrient loss occurs due to the accelerated loss of nutrients from the hyperproliferation and desquamation of the epidermal layer of skin in psoriasis. We have proposed that nutritional support as a secondary form of therapy may be beneficial in aiding some psoriasis patients return to a state of remission. Methods. To determine how frequently nutritional abnormalities occur in hospitalized psoriasis patients, a retrospective analysis was done of the nutritional status of 50 patients admitted for the treatment of psoriasis. Chart records were analyzed and laboratory data were interpreted in consideration of concurrent medical problems. Protein status and anemia were the primary nutritional indicators studied. Results. We found that of those parameters that may be used as indicators of nutritional status, 18% of the patients had a decreased total protein, 16% of the patients had a decreased serum albumin, 38% had an elevated mean corpuscular volume, and 39% had a decreased hematocrit. Conclusions. Our findings support the concept that widespread psoriasis places the patient at risk to develop minor nutritional abnormalities in protein and folate status even when accounting for confounding medications and coexistent diseases.     

银屑病患者血清精胺水平的测定

本文报告对35例寻常型泛发性银屑病惠者,进行血清精胺水平测定,结果x±s=1.8529±0.6680,并对35例健康人进行了测定比较,其x±s=0.6951±0.1621,0.002>P>0.001,差异有高度显著性意义。在患者组中进行期23例,x±s=109432±0.7187,P<0.001;静止期12例,x±s=1.70±0.5388,P<0.001。显示进行期较静止期更显著,证明参与细胞增殖的精胺水平之升高程度,直接影响着细胞的生长、分裂和分化的速度,也进一步证明了精胺升高程度与银屑病病情轻重有密切关系。     

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.