Internalized Stigma in Pediatric Psoriasis: A Comparative Multicenter Study

BackgroundInternalized stigma, adoption of negative attitudes and stereotypes of the society regarding persons'' illness, has not been studied previously in pediatric psoriasis patients.ObjectiveWe aimed to investigate the internalized stigma in pediatric psoriasis patients and to determine differences according to factors affecting internalized stigma compared to adult psoriasis patients.MethodsThis multicenter, cross-sectional, comparative study included 125 pediatric (55 female, 70 male; mean age±standard deviation [SD], 14.59±2.87 years) and 1,235 adult psoriasis patients (577 female, 658 male; mean age±SD, 43.3±13.7 years). Psoriasis Internalized Stigma Scale (PISS), Dermatology Life Quality Index (DLQI), Perceived Health Status (PHS), and the General Health Questionnaire (GHQ)-12 were the scales used in the study.ResultsThe mean PISS was 58.48±14.9 in pediatric group. When PISS subscales of groups were compared, the pediatric group had significantly higher stigma resistance (p=0.01) whereas adult group had higher scores of alienation (p=0.01) and stereotype endorsement (p=0.04). There was a strong correlation between mean values of PISS and DLQI (r=0.423, p=0.001). High internalized stigma scores had no relation to either the severity or localization of disease in pediatric group. However, poor PHS (p=0.007) and low-income levels (p=0.03) in both groups, and body mass index (r=0.181, p=0.04) in the pediatric group were related to high PISS scores.ConclusionInternalized stigma in pediatric patients is as high as adults and is related to poor quality of life, general health, and psychological illnesses. Unlike adults, internalized stigma was mainly determined by psoriasis per se, rather than disease severity or involvement of visible body parts, genitalia or folds.     

Characteristics of Pruritus according to Morphological Phenotype of Psoriasis and Association with Neuropeptides and Interleukin-31

BackgroundPruritus is a common symptom in psoriasis. However, few studies have assessed the characteristics of pruritus according to morphological phenotypes of psoriasis.ObjectiveTo investigate the characteristics of pruritus according to morphological phenotypes of psoriasis and to assess the association with inflammatory mediators related to pruritus.MethodsPsoriasis patients were divided into 2 groups according to clinical phenotype: eruptive inflammatory (EI) and chronic stable (CS). Clinical data of pruritus were assessed by an itch questionnaire. Serum neuropeptides and cytokines including substance P, histamine, vasoactive intestinal peptide, neuropeptide Y, calcitonin gene-related peptide and interleukin-31 (IL-31) were quantitatively measured.ResultsIn total, 50 patients with psoriasis (30 male, 20 female; mean age, 45.7 years) were studied (EI, n=15 and CS, n=35). Pruritus was reported by 80% of EI and CS patients. There were no significant differences in prevalence of pruritus, pruritus intensity, severity of psoriasis, serum neuropeptides, or IL-31 between the 2 groups.ConclusionThe morphological phenotype does not seem to be an important factor affecting the prevalence and characteristics of pruritus in psoriasis.     

The Gut Microbiome: Human Health and Inflammatory Skin Diseases

The human microbiome is a rich environment consisting of bacteria, fungi and other commensal microorganisms of the gut, mucosa and skin. The functional role of the gut microbiome includes facilitation in metabolism of macronutrients, maturation of the immune system, and production of pro- or anti-inflammatory signaling molecules and peptides. The identification of these resident organisms has brought about a new understanding of disease processes. Nevertheless, more questions remain regarding the interactions within the microbiome, its interactions with the host, and its contributions to the pathophysiology of disease. The purpose of this review is to examine the existing medical literature to highlight the role of the gut microbiome in human health, also paying attention to its role in several inflammatory skin diseases, namely atopic dermatitis, psoriasis, and rosacea.     

白细胞介素17A及其受体拮抗剂治疗银屑病的不良反应

白细胞介素17A在银屑病的发生发展中具有关键作用。目前,有多种白细胞介素17A及其受体拮抗剂在多个国家上市并应用于银屑病的治疗,取得了明确疗效。然而,该类生物制剂在临床试验阶段及上市后,仍然有多项不良反应报道,包括上呼吸道感染、念珠菌感染、中性粒细胞减少和炎症性肠病等,严重者甚至可危及生命。本文综述3种白细胞介素17A...     

细胞外信号调节激酶在寻常性银屑病皮损中的表达

目的 探讨细胞外信号调节激酶（ERK1/2）及其上游相关激酶表皮生长因子受体（EGFR）、下游作用底物激酶转录激活因子ETS样蛋白-1（ELK-1）在寻常性银屑病皮损中的表达、激活状况,探讨细胞外信号调节激酶通路与寻常性银屑病的关系。方法 用免疫组化及蛋白印迹的方法,检测磷酸化ERK1/2、EGFR、ELK-1在寻常性银屑病和正常人皮肤中的表达状况。结果 寻常性银屑病皮损中磷酸化ERK1/2、EGFR、ELK-1的表达（IOD值分别为269.85 ± 57.96、136.88 ± 30.33、237.61 ± 56.29）均高于正常人皮肤（分别为140.24 ± 24.42、110.66 ± 28.99和119.04 ± 21.99）（P均 < 0.05）。银屑病患者磷酸化EGFR与ERK1/2表达呈正相关（r = 0.57,P < 0.05）,ERK1/2与ELK-1表达亦呈正相关（r = 0.72,P < 0.05）。结论 磷酸化EGFR→ERK1/2→ELK-1这条信号通路的传导增强可能在寻常性银屑病的病理生理过程中起一定的作用。     

砷剂治疗某些皮肤病的研究进展

砷剂在银屑病、皮肤T细胞淋巴瘤和黑素瘤等方面具有一定的药理活性,砷剂在一定浓度下可抑制细胞增殖、诱导细胞凋亡,并促进皮肤肿瘤消退,具有一定的应用前景。砷剂同时具有细胞毒性,可积蓄中毒,累及身体各组织器官,根据流行病学研究,其可诱变致癌。砷有两面性,需要进行更多的基础实验和临床试验研究,选择最佳的治疗浓度,以减少毒副作用。同时如能根据影响砷毒副作用的基因多态性,采用个体化给药,使其更好地发挥治疗作用而降低不良反应的风险,成为某些皮肤病的治疗手段之一。     

寻常性银屑病外周血染色体不稳定性的研究

目的探讨体细胞染色体异常在银屑病发病机制中的作用。方法选取40例寻常性银屑病患者,根据临床资料分为初发组(18例)和经过系统治疗组(22例),并选取16例健康正常人作为对照组。以全血细胞体外培养后制备中期染色体,采用常规细胞遗传学方法染色体G显带行核型分析和姐妹染色单体互换实验,比较初发寻常性银屑病组和经过系统治疗组的差异。结果 40例寻常性银屑病患者及16例健康正常人外周血淋巴细胞中期染色体G显带均未发现异常核型;初发寻常性银屑病患者和经过系统治疗的寻常性银屑病患者外周血淋巴细胞的姐妹染色单体互换频率比正常人明显增加,差异均有统计学意义(P均<0.01);但初发的和经过系统治疗的银屑病患者间的外周血淋巴细胞姐妹染色单体互换频率比较,两者差异无统计学意义(P>0.05)。结论寻常性银屑病患者体细胞染色体存在不稳定性,其外周血淋巴细胞的姐妹染色单体互换频率明显高于正常人。     

活血解毒汤治疗银屑病血瘀证的临床疗效观察

目的观察活血解毒汤治疗银屑病血瘀证的临床疗效和安全性。方法 80例银屑病患者随机分为试验组和对照组,试验组给予活血解毒汤治疗,对照组给予安慰剂治疗,治疗12周后,进行银屑病面积与严重性指数(PASI)评分、中医主要临床症状、皮肤病生活质量指数(DLQI)、临床疗效及安全性评价。结果试验组总有效率为86.84%,对照组总有效率为50.00%,两组总有效率相比差异有统计学意义(P0.05);治疗后试验组与对照组相比,PASI评分、DLQI评分明显降低,差异具有统计学意义(P0.05);治疗后试验组在红斑、浸润改善方面优于对照组,差异具有统计学意义(P0.05)。两组患者均无明显不良反应。结论活血解毒汤对寻常性银屑病血瘀证安全有效。     

白细胞介素36α对小鼠银屑病样皮损及趋化因子CCL20的影响

目的 探讨白细胞介素(IL)36α对小鼠银屑病样皮损及CC趋化因子配体20(CCL20)的影响.方法 30只BALB/c雌性小鼠分为3组:凡士林空白对照组(对照组)、咪喹莫特模型组(模型组)以及IL-36α实验组(实验组).用小鼠银屑病皮损面积和疾病严重程度评分(PASI)观察银屑病样小鼠皮损动态变化.光镜下观察皮损组织形态学变化,并测量表皮层厚度.用实时荧光定量PCR、Western印迹检测对照组与模型组小鼠皮损中IL-36α表达情况,用实时荧光定量PCR、Western印迹法、免疫组化方法检测小鼠皮损中CCL20的含量变化.结果 模型组皮损中IL-36α mRNA表达水平明显高于对照组(△Ct值分别为0.0195±0.0059、0.0012±0.0004,两组比较,P＜0.05);模型组皮损中IL-36α蛋白表达水平明显高于对照组(分别为3.922±0.248、0.690±0.025,两组比较,P＜0.05).对照组、实验组CCL20 mRNA表达(△Ct值)分别为0.378±0.075、2.152±0.793,与模型组(0.999±0.178)比较,差异有统计学意义(P＜0.05);对照组、实验组CCL20蛋白表达结果分别为0.025±0.009、0.397±0.033,与模型组(0.145±0.030)比较,差异有统计学意义(P＜0.05).免疫组化结果表明,实验组皮损中CCL20的含量较模型组显著增加,差异有统计学意义(Z=2.294,P＜0.05).结论 IL-36α可通过促进CCL20表达,加重银屑病样小鼠皮损病变.