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Scutari M, Kerob D, Salah S. Inferring skin-brain-skin connections from infodemiology data using dynamic Bayesian networks. Sci Rep 2024; 14:10266. [PMID: 38704447 PMCID: PMC11069591 DOI: 10.1038/s41598-024-60937-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/29/2024] [Indexed: 05/06/2024] Open
Abstract
The relationship between skin diseases and mental illnesses has been extensively studied using cross-sectional epidemiological data. Typically, such data can only measure association (rather than causation) and include only a subset of the diseases we may be interested in. In this paper, we complement the evidence from such analyses by learning an overarching causal network model over twelve health conditions from the Google Search Trends Symptoms public data set. We learned the causal network model using a dynamic Bayesian network, which can represent both cyclic and acyclic causal relationships, is easy to interpret and accounts for the spatio-temporal trends in the data in a probabilistically rigorous way. The causal network confirms a large number of cyclic relationships between the selected health conditions and the interplay between skin and mental diseases. For acne, we observe a cyclic relationship with anxiety and attention deficit hyperactivity disorder (ADHD) and an indirect relationship with depression through sleep disorders. For dermatitis, we observe directed links to anxiety, depression and sleep disorders and a cyclic relationship with ADHD. We also observe a link between dermatitis and ADHD and a cyclic relationship between acne and ADHD. Furthermore, the network includes several direct connections between sleep disorders and other health conditions, highlighting the impact of the former on the overall health and well-being of the patient. The average R 2 for a condition given the values of all conditions in the previous week is 0.67: in particular, 0.42 for acne, 0.85 for asthma, 0.58 for ADHD, 0.87 for burn, 0.76 for erectile dysfunction, 0.88 for scars, 0.57 for alcohol disorders, 0.57 for anxiety, 0.53 for depression, 0.74 for dermatitis, 0.60 for sleep disorders and 0.66 for obesity. Mapping disease interplay, indirect relationships, and the key role of mediators, such as sleep disorders, will allow healthcare professionals to address disease management holistically and more effectively. Even if we consider all skin and mental diseases jointly, each disease subnetwork is unique, allowing for more targeted interventions.
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Affiliation(s)
- Marco Scutari
- Istituto Dalle Molle di Studi sull'Intelligenza Artificiale (IDSIA), Lugano, Switzerland.
| | - Delphine Kerob
- La Roche-Posay Dermatological Laboratories, Levallois-Perret, France
- Department of Dermatology, AP-HP Saint-Louis Hospital, Paris, France
| | - Samir Salah
- La Roche-Posay Dermatological Laboratories, Levallois-Perret, France
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2
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Chaudhary R, Prasad A, Agarwal V, Rehman M, Kumar A, Kaushik AS, Srivastava S, Srivastava S, Mishra V. Chronic stress predisposes to the aggravation of inflammation in autoimmune diseases with focus on rheumatoid arthritis and psoriasis. Int Immunopharmacol 2023; 125:111046. [PMID: 37879231 DOI: 10.1016/j.intimp.2023.111046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/27/2023] [Accepted: 10/08/2023] [Indexed: 10/27/2023]
Abstract
The global incidence of autoimmune diseases is on the rise, and many healthcare professionals believe that chronic stress plays a prominent role in both the aggravation and remission of these conditions. It is believed that prolonged exposure to stress is associated with neuroimmune axis malfunction, which eventually dysregulates multiple immunological factors as well as deregulates autoimmune responses that play a central role in various autoimmune diseases, including rheumatoid arthritis and psoriasis. Herein, we performed validation of an 8-week long rat model of chronic unpredictable stress (CUS) which consisted of exposing groups of rats to random stressors daily for 8 weeks. Additionally, we developed a novel rat model combining 8-week long random stressor-induced CUS with CIA-triggered arthritis and IMQ-triggered psoriasis and have successfully used both these models to assess the role of chronic stress in the aggravation of arthritis and psoriasis, respectively. Notably, the 8-week CUS protocol extensively aggravated and prolonged both arthritis and psoriasis condition in the rat model by upregulating the release of different pro-inflammatory cytokines, dysregulation of immune cell responses and oxidative stress system, which were all related to severe inflammation. Further, CUS aggravated macroscopic features and the increase in destruction of joint tissue and epidermal thickness induced by CIA and IMQ, respectively, in rats. In conclusion, this study suggests that exposure to an 8-week long CUS paradigm aggravates the distinctive characteristics of rheumatoid arthritis and psoriasis in rats via amplifying the inflammatory circuits and immune cell responses linked to these autoimmune diseases.
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Affiliation(s)
- Rishabh Chaudhary
- Department of Pharmaceutical Sciences, Babasaheb Bhimrao Ambedkar University, Vidya Vihar, Raebareli Road, Lucknow 226025, U.P., India
| | - Ajay Prasad
- Department of Pharmaceutical Sciences, Babasaheb Bhimrao Ambedkar University, Vidya Vihar, Raebareli Road, Lucknow 226025, U.P., India
| | - Vipul Agarwal
- Department of Pharmaceutical Sciences, Babasaheb Bhimrao Ambedkar University, Vidya Vihar, Raebareli Road, Lucknow 226025, U.P., India
| | - Mujeeba Rehman
- Department of Pharmaceutical Sciences, Babasaheb Bhimrao Ambedkar University, Vidya Vihar, Raebareli Road, Lucknow 226025, U.P., India
| | - Anand Kumar
- Department of Pharmaceutical Sciences, Babasaheb Bhimrao Ambedkar University, Vidya Vihar, Raebareli Road, Lucknow 226025, U.P., India
| | - Arjun Singh Kaushik
- Department of Pharmaceutical Sciences, Babasaheb Bhimrao Ambedkar University, Vidya Vihar, Raebareli Road, Lucknow 226025, U.P., India
| | - Siddhi Srivastava
- Department of Pharmaceutical Sciences, Babasaheb Bhimrao Ambedkar University, Vidya Vihar, Raebareli Road, Lucknow 226025, U.P., India
| | - Sukriti Srivastava
- Department of Pharmaceutical Sciences, Babasaheb Bhimrao Ambedkar University, Vidya Vihar, Raebareli Road, Lucknow 226025, U.P., India
| | - Vikas Mishra
- Department of Pharmaceutical Sciences, Babasaheb Bhimrao Ambedkar University, Vidya Vihar, Raebareli Road, Lucknow 226025, U.P., India.
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3
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Starr I, Seiffert-Sinha K, Sinha AA, Gokcumen O. Evolutionary context of psoriatic immune skin response. Evol Med Public Health 2022; 9:474-486. [PMID: 35154781 PMCID: PMC8830311 DOI: 10.1093/emph/eoab042] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 11/22/2021] [Indexed: 12/18/2022] Open
Abstract
The skin is vital for protecting the body and perceiving external stimuli in the environment. Ability to adapt between environments is in part based on skin phenotypic plasticity, indicating evolved homeostasis between skin and environment. This homeostasis reflects the greater relationship between the body and the environment, and disruptions in this balance may lead to accumulation of susceptibility factors for autoimmune conditions like psoriasis. In this study, we examined the relationship between rapid, lineage-specific evolution of human skin and formation of psoriatic skin responses at the transcriptome level. We collected skin tissue biopsies from individuals with psoriasis and compared gene expression in psoriatic plaques to non-plaque psoriatic skin. We then compared these data with non-psoriatic skin transcriptome data from multiple primate species. We found 67 genes showing human-specific skin expression that are also differentially regulated in psoriatic skin; these genes are significantly enriched for skin barrier function, immunity and neuronal development. We identified six gene clusters with differential expression in the context of human evolution and psoriasis, suggesting underlying regulatory mechanisms in these loci. Human and psoriasis-specific enrichment of neuroimmune genes shows the importance of the ongoing evolved homeostatic relationship between skin and external environment. These results have implications for both evolutionary medicine and public health, using transcriptomic data to acknowledge the importance of an individual’s surroundings on their overall health. The skin is important for protecting the body from the environment and perceiving external stimuli, creating an evolved balance between skin and the environment. We compare skin gene expression in humans with psoriasis to humans and non-human primates without psoriasis to better understand human-specific evolutionary changes in the skin. Our results suggest important evolutionary links between skin perception, human-specific skin development and immune response.
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Affiliation(s)
- Izzy Starr
- Department of Biological Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Kristina Seiffert-Sinha
- Department of Dermatology, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Animesh A Sinha
- Department of Dermatology, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Omer Gokcumen
- Department of Biological Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
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4
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Singh S, Sharma N, Behl T, Sarkar BC, Saha HR, Garg K, Singh SK, Arora S, Amran MS, Abdellatif AAH, Bilgrami AL, Ashraf GM, Rahman MS. Promising Strategies of Colloidal Drug Delivery-Based Approaches in Psoriasis Management. Pharmaceutics 2021; 13:pharmaceutics13111978. [PMID: 34834393 PMCID: PMC8623849 DOI: 10.3390/pharmaceutics13111978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/28/2021] [Accepted: 11/09/2021] [Indexed: 12/13/2022] Open
Abstract
Psoriasis is a chronic inflammatory autoimmune disorder that moderately affects social and interpersonal relationships. Conventional treatments for psoriasis have certain problems, such as poor drug penetration through the skin, hyper-pigmentation, and a burning sensation on normal and diseased skin. Colloidal drug delivery systems overcome the pitfalls of conventional approaches for psoriasis therapeutics and have improved patient safety parameters, compliance, and superior effectiveness. They also entail reduced toxicity. This comprehensive review’s topics include the pathogenesis of psoriasis, causes and types of psoriasis, conventional treatment alternatives for psoriasis, the need for colloidal drug delivery systems, and recent studies in colloidal drug delivery systems for the treatment of psoriasis. This review briefly describes colloidal drug delivery approaches, such as emulsion systems—i.e., multiple emulsion, microemulsion, and nano-emulsion; vesicular systems—i.e., liposomes, ethosomes, noisomes, and transferosomes; and particulate systems—i.e., solid lipid nanoparticles, solid lipid microparticles, nano-structured lipid carriers, dendrimers, nanocrystals, polymeric nanoparticles, and gold nanoparticles. The review was compiled through an extensive search of the literature through the PubMed, Google Scholar, and ScienceDirect databases. A survey of literature revealed seven formulations based upon emulsion systems, six vesicular drug delivery systems, and fourteen particulate systems reported for antipsoriatic drugs. Based on the literature studies of colloidal approaches for psoriasis management carried out in recent years, it has been concluded that colloidal pharmaceutical formulations could be investigated broadly and have a broad scope for effective management of many skin disorders in the coming decades.
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Affiliation(s)
- Sukhbir Singh
- Department of Pharmacology, Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, Punjab, India; (S.S.); (N.S.); (K.G.); (S.K.S.); (S.A.)
| | - Neelam Sharma
- Department of Pharmacology, Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, Punjab, India; (S.S.); (N.S.); (K.G.); (S.K.S.); (S.A.)
| | - Tapan Behl
- Department of Pharmacology, Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, Punjab, India; (S.S.); (N.S.); (K.G.); (S.K.S.); (S.A.)
- Correspondence: (T.B.); (M.S.R.); Tel.: +88-017-2006-1803 (M.S.R.)
| | - Bidhan Chandra Sarkar
- Department of Biochemistry, Primeasia University, 12- Kemal Ataturk Avenue, HBR Tower Banani C/A, Dhaka 1213, Bangladesh; (B.C.S.); (H.R.S.)
| | - Hasi Rani Saha
- Department of Biochemistry, Primeasia University, 12- Kemal Ataturk Avenue, HBR Tower Banani C/A, Dhaka 1213, Bangladesh; (B.C.S.); (H.R.S.)
| | - Kanika Garg
- Department of Pharmacology, Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, Punjab, India; (S.S.); (N.S.); (K.G.); (S.K.S.); (S.A.)
| | - Supriya Kamari Singh
- Department of Pharmacology, Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, Punjab, India; (S.S.); (N.S.); (K.G.); (S.K.S.); (S.A.)
| | - Sandeep Arora
- Department of Pharmacology, Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, Punjab, India; (S.S.); (N.S.); (K.G.); (S.K.S.); (S.A.)
| | - Md. Shah Amran
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Dhaka, Shahbag, Dhaka 1000, Bangladesh;
| | - Ahmed A. H. Abdellatif
- Department of Pharmaceutics, College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia;
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Al-Azhar University, Assiut 71524, Egypt
| | - Anwar L. Bilgrami
- Deanship of Scientific Research, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Department of Entomology, Rutgers University, New Brunswick, NJ 08901, USA
| | - Ghulam Md Ashraf
- Pre-Clinical Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Md. Sohanur Rahman
- Department of Biochemistry and Molecular Biology, Trust University, Barishal, Ruiya, Nobogram Road, Barishal 8200, Bangladesh
- Correspondence: (T.B.); (M.S.R.); Tel.: +88-017-2006-1803 (M.S.R.)
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5
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Mrowietz U, Dieckmann T, Gerdes S, Szymczak S, von Spreckelsen R, Körber A. ActiPso: definition of activity types for psoriatic disease: A novel marker for an advanced disease classification. J Eur Acad Dermatol Venereol 2021; 35:2027-2033. [PMID: 34076926 DOI: 10.1111/jdv.17434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/29/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Assessment of psoriasis is exclusively done measuring severity using somatic scores such as the psoriasis area and severity index or patient-reported outcomes such as the dermatology life quality index. There is no established tool to measure a patient's individual psoriasis activity over time. OBJECTIVES Development of a new tool to classify psoriasis activity types. METHODS Open patient interviews were performed and adapted in several steps and by using different groups of patients. Wording of the tool's axis and description how to use it was optimized with the input of patients. The final ActiPso tool was used in a prospective study in psoriasis patients. RESULTS Four activity types could be identified describing psoriasis intensity (e.g. severity, itch, pain) over one typical year and an event/trigger type describing flares. In the study in 586 psoriasis patients of the 536 patients eligible for analysis 40.9% self-classified as type 1 ('stable'), 22.6% as type 2 ('unstable'), 30.6% as type 3 ('winter type') and 6.0% as type 4 ('summer type'), respectively. Flares of psoriasis as identified by the event/trigger type were reported in 36.1% of patients with activity type 1, 67.8% with type 2, 73.8% of type 3 and 59.4% of type 4, respectively. CONCLUSIONS Interviewed patients were able to describe their course of psoriatic disease and to name potential triggering factors. By doing so, activity types of psoriasis were defined for the first time and the importance of events/triggers for flares described and integrated into ActiPso types as a basis for advanced patient-centric management. A limitation of ActiPso is that in regions with no seasonal variations types 3 and 4 may not apply.
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Affiliation(s)
- U Mrowietz
- Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - T Dieckmann
- Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - S Gerdes
- Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - S Szymczak
- Institute of Medical Informatics and Statistics, Kiel University and University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - R von Spreckelsen
- Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A Körber
- Dermatology Practice RÜ 143, Essen, Germany
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6
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Gieler U, Gieler T, Peters EMJ, Linder D. Haut und Psychosomatik – Psychodermatologie heute. J Dtsch Dermatol Ges 2020; 18:1280-1300. [PMID: 33251743 DOI: 10.1111/ddg.14328_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Uwe Gieler
- Universitäts-Hautklinik, Universitätsklinikum Gießen
| | - Tanja Gieler
- Kinder- und Jugendpsychosomatik, Universitäts-Kinderklinik, Universitätsklinikum Gießen
| | - Eva Milena Johanne Peters
- Psychoneuroimmunologie Labor, Klinik für Psychosomatik und Psychotherapie, Universitätsklinikum Gießen, Gießen in Kooperation mit der Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin - Charité, Berlin
| | - Dennis Linder
- Universitäts-Hautklinik, Universität Padua, Italien, Institut für Medizinische Psychologie und Psychotherapie, Medizinische Universität Graz, Österreich
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7
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Gieler U, Gieler T, Peters EMJ, Linder D. Skin and Psychosomatics - Psychodermatology today. J Dtsch Dermatol Ges 2020; 18:1280-1298. [PMID: 33251751 PMCID: PMC7756276 DOI: 10.1111/ddg.14328] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/21/2020] [Indexed: 02/06/2023]
Abstract
Modern psychodermatology relies on the bio-psycho-social disease model in psychosomatics, according to which biological, psychological and social factors (on various levels, from molecules to the biosphere) play a major role in the disease pathogenesis through complex, non-linear interactions over the entire disease course. It is nowadays experimentally proven that "emotions get into the skin". Recent research shows close anatomical, physiological and functional connections between skin and nervous system, already known to be ontogenetically related. These connections are reflected in many skin diseases where psychological and somatic etiological factors are closely intertwined. A holistic approach by the physician should do justice to this interdependence; biological, psychological and social factors should be adequately taken into account when taking anamnesis, making a diagnosis and choosing a therapy. The "visibility" of the skin organ bestows dermatology a special position among the various other clinical subjects, and renders a holistic, psychosomatic approach to the patient that is particularly important. The life course belongs also to modern psychodermatological approaches. Based on the modern psychodermatology concept, other corresponding sub-areas such as psychogastroenterology, psychocardiology etc. have emerged. After the theoretical part of this article, some selected skin diseases are discussed in more detail from the psychosomatic point of view.
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Affiliation(s)
- Uwe Gieler
- Department of DermatologyUniversity Hospital Gießen
| | - Tanja Gieler
- Psychosomatic Medicine for Children and AdolescentsDepartment of PediatricsUniversity Hospital Gießen
| | - Eva Milena Johanne Peters
- Laboratory for PsychoneuroimmunologyDepartment of Psychosomatic Medicine and PsychotherapyUniversity Hospital Gießen in cooperation with the Department of Psychosomatic Medicine and PsychotherapyUniversity Hospital – CharitéBerlin
| | - Dennis Linder
- Department of DermatologyUniversity of PaduaItalyInstitute for Medical Psychology and PsychotherapyMedical University GrazAustria
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8
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Gibson R, Williams P, Hancock J. An introduction to the assessment and management of psychodermatological disorders. BJPSYCH ADVANCES 2020. [DOI: 10.1192/bja.2020.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYPsychodermatology is an emerging field at the interface between psychiatry, psychology and dermatology. There is a strong bidirectional relationship between a number of dermatological disorders and psychiatric disorders. This article provides an overview of psychiatric disorders with dermatological symptoms, and dermatological disorders with secondary psychophysiological consequences. The principles of management and our insights into establishing a psychodermatology service in the UK are discussed.
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9
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Wang Y, Li P, Zhang L, Fu J, Di T, Li N, Meng Y, Guo J, Zhao J. Stress aggravates and prolongs imiquimod-induced psoriasis-like epidermal hyperplasis and IL-1β/IL-23p40 production. J Leukoc Biol 2020; 108:267-281. [PMID: 32421901 DOI: 10.1002/jlb.3ma0320-363rr] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 03/06/2020] [Accepted: 03/15/2020] [Indexed: 12/11/2022] Open
Abstract
Psoriasis is a common, chronic multifactorial inflammatory skin disease with both genetic and environmental components. A number of studies have suggested that psoriasis episodes are often preceded by stressful life events. Nevertheless, the underline mechanisms of stress in psoriasis remain unexplored. To address this question, we established an emotional stress mouse model induced by empty bottle stimulation, and applied imiquimod (IMQ), a ligand of TLR7/8 and effective potent immune activator, on the dorsal skin to induce psoriasis-like lesions. We found that empty bottles induced emotional stress exaggerated and prolonged psoriasiform dermatitis, which appeared as more prominent epidermal hyperplasia in the emotional stress mice compared with the control mice. Higher mRNA expression of Il-1β, Il-17a, and Il-22, as well as higher secretion of IL-1β, IL-12p40, IL-17, and IL-22 were observed in the skin lesion of emotional stress mice. The emotional stress condition and IMQ treatment synergistically led to higher expression levels of neurotransmitters and their receptors in the skin, especially substance P (SP), we also found that SP could stimulate DCs to secrete more IL-23p40 in vitro. In addition, NK-1R antagonist partially abrogated enhanced epidermal thickness and the level of neurotransmitters in emotional stress mice. Taken together, these results indicate that stress exacerbates and prolongs psoriasiform dermatitis in mice by up-regulating IL-1β and IL-23p40, which were related to local DCs stimulated by abnormal SP.
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Affiliation(s)
- Yan Wang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing Key Laboratory of Clinic and Basic Research with Traditional Chinese Medicine on Psoriasis, Dongcheng, Beijing, P. R. China
| | - Ping Li
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing Key Laboratory of Clinic and Basic Research with Traditional Chinese Medicine on Psoriasis, Dongcheng, Beijing, P. R. China
| | - Lu Zhang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing Key Laboratory of Clinic and Basic Research with Traditional Chinese Medicine on Psoriasis, Dongcheng, Beijing, P. R. China
| | - Jing Fu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing Key Laboratory of Clinic and Basic Research with Traditional Chinese Medicine on Psoriasis, Dongcheng, Beijing, P. R. China
| | - Tingting Di
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing Key Laboratory of Clinic and Basic Research with Traditional Chinese Medicine on Psoriasis, Dongcheng, Beijing, P. R. China
| | - Ningfei Li
- Beijing University of Chinese Medicine, Chaoyang, Beijing, China
| | - Yujiao Meng
- Beijing University of Chinese Medicine, Chaoyang, Beijing, China
| | - Jianning Guo
- Beijing University of Chinese Medicine, Chaoyang, Beijing, China
| | - Jingxia Zhao
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing Key Laboratory of Clinic and Basic Research with Traditional Chinese Medicine on Psoriasis, Dongcheng, Beijing, P. R. China
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10
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Ayasse MT, Buddenkotte J, Alam M, Steinhoff M. Role of neuroimmune circuits and pruritus in psoriasis. Exp Dermatol 2020; 29:414-426. [PMID: 31954075 DOI: 10.1111/exd.14071] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 12/09/2019] [Accepted: 12/31/2019] [Indexed: 12/19/2022]
Abstract
Psoriasis is a chronic inflammatory skin disease presenting with an array of clinical phenotypes, often associated with pruritus. Environmental and psychological stressors can exacerbate psoriasis symptoms and provoke flares. Recent studies suggest a dysfunctional hypothalamic-pituitary-adrenal (HPA) axis in some patients with psoriasis that can result in immune dysregulation. The immune system, in turn, can communicate with the nervous system to induce, maintain or aggravate psoriasis. In the skin, peripheral sensory as well as autonomic nerves control release of inflammatory mediators from dendritic cells, mast cells, T cells or keratinocytes, thereby modulating inflammatory responses and, in case of sensory nerves, pruritus. In response to the environment or stress, cytokines, chemokines, proteases, and neuropeptides fluctuate in psoriasis and influence immune responses as well as nerve activity. Furthermore, immune cells communicate with sensory nerves which control release of cytokines, such as IL-23, that are ultimately involved in psoriasis pathogenesis. Nerves also communicate with keratinocytes to induce epidermal proliferation. Notably, in contrast to recent years the debilitating problem of pruritus in psoriasis has been increasingly appreciated. Thus, investigating neuroimmune communication in psoriasis will not only expand our knowledge about the impact of sensory nerves in inflammation and pruritus and give new insights into the impact of environmental factors activating neuroimmune circuits or of stress in psoriasis, but may also lead to novel therapies. This review summarizes the relevant literature on the role of neuroimmune circuits, stress and how the central HPA axis and its peripheral equivalent in the skin, impact psoriasis.
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Affiliation(s)
- Marissa T Ayasse
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Jörg Buddenkotte
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.,Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | - Majid Alam
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | - Martin Steinhoff
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, Doha, Qatar.,Medical School, Qatar University, Doha, Qatar.,School of Medicine, Weill Cornell University, New York, NY, USA
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11
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Yang H, Zheng J. Influence of stress on the development of psoriasis. Clin Exp Dermatol 2019; 45:284-288. [PMID: 31592542 DOI: 10.1111/ced.14105] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2019] [Indexed: 01/18/2023]
Affiliation(s)
- H. Yang
- Department of Dermatology Rui Jin Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200025 China
| | - J. Zheng
- Department of Dermatology Rui Jin Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200025 China
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12
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Madden SK, Flanagan KL, Jones G. How lifestyle factors and their associated pathogenetic mechanisms impact psoriasis. Clin Nutr 2019; 39:1026-1040. [PMID: 31155371 DOI: 10.1016/j.clnu.2019.05.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 04/11/2019] [Accepted: 05/06/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUNDS AND AIMS Psoriasis is a skin disorder affecting approximately 2-3% of the global population. While research has revealed a strong genetic component, there are few studies exploring the extent to which lifestyle factors influence psoriasis pathogenesis. The aim of this review was to describe the role of lifestyle factors as both a potential cause and treatment for psoriasis. The review also examines the underlying mechanisms through which these lifestyle factors may operate. METHODS This narrative review aims to incorporate current knowledge relating to both lifestyle and pathogenetic factors that contribute to and alleviate psoriasis presentation. Studies reporting the effect of an inflammatory diet and potential dietary benefits are reported, as well as insights into the effects of stress, smoking and alcohol, insulin resistance and exercise. RESULTS Poor nutrition and low Omega 3 fatty acid intake, likely combined with fat malabsorption caused by gut dysbiosis and systemic inflammation, are associated with psoriasis. The data strongly suggest that improvements to disease severity can be made through dietary and lifestyle interventions and increased physical activity. Less conclusive, although worthy of mention, is the beneficial effect of bile acid supplementation. CONCLUSIONS Lifestyle interventions are a promising treatment for psoriasis and its associated co-morbidities. However, gaps and inadequacies exist within the literature, e.g. methodology, absence of a unified scoring system, lack of controlled clinical data and lack of studies without simultaneous usage of biologics or alternative therapies. Future directions should focus on high quality cohort studies and clinical trials.
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Affiliation(s)
- Seonad K Madden
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Australia.
| | - Katie L Flanagan
- School of Medicine, College of Health and Medicine, University of Tasmania, Australia; School of Health & Biomedical Science, Royal Melbourne Institute of Technology, Australia; Infectious Diseases Service, Launceston General Hospital, Australia; Dept. of Immunology and Pathology, Monash University, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Australia
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Cho KA, Kim HJ, Kim YH, Park M, Woo SY. Dexamethasone Promotes Keratinocyte Proliferation by Triggering Keratinocyte Growth Factor in Mast Cells. Int Arch Allergy Immunol 2019; 179:53-61. [PMID: 30909282 DOI: 10.1159/000494624] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 10/16/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The skin is a dynamic body organ that can be activated by both central and local hypothalamic-pituitary-adrenal axis systems. This phenomenon might be the crucial explanation why stress can cause relapse of chronic inflammatory skin diseases, such as psoriasis. Here, we determined the effects of mast cells on keratinocyte proliferation under stress hormone stimulation. METHODS We subcutaneously injected dexamethasone on the shaved back of mice and evaluated histological changes and keratinocyte growth factor (KGF) expression on dermal mast cells. Further, human mast cell line (HMC-1) and keratinocyte cell line (HaCaT) cells were treated with dexamethasone in vitro to observe the extent of proliferation and the expression of KGF. Finally, the supernatants of HMC-1 cells treated with dexamethasone were used for the culture of HaCaT cells to investigate the effect on proliferation. RESULTS We observed epidermal thickening in dexamethasone-injected mice, accompanied by an increase in the number of KGF-expressing dermal mast cells. Similar to mouse dermal mast cells, KGF was highly expressed in the human mast cell line HMC-1 following stimulation with dexamethasone. Further, dexamethasone-treated mast cells promoted keratinocyte proliferation in vitro. However, the effects of mast cells on keratinocytes were significantly diminished in the presence of anti-KGF-blocking antibodies. CONCLUSION Taken together, our results show that a stressful environment may disturb skin barrier homeostasis through mast cell-derived KGF expression.
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Affiliation(s)
- Kyung-Ah Cho
- Department of Microbiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Hye Ji Kim
- Department of Microbiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Yu-Hee Kim
- Department of Microbiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Minhwa Park
- Department of Microbiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - So-Youn Woo
- Department of Microbiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea,
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Pro-inflammatory Cytokines, Biomarkers, Genetics and the Immune System: A Mechanistic Approach of Depression and Psoriasis. ACTA ACUST UNITED AC 2018; 47:177-186. [DOI: 10.1016/j.rcp.2017.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 10/14/2016] [Accepted: 03/27/2017] [Indexed: 11/18/2022]
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Tohid H, Aleem D, Jackson C. Major Depression and Psoriasis: A Psychodermatological Phenomenon. Skin Pharmacol Physiol 2016; 29:220-30. [DOI: 10.1159/000448122] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/29/2016] [Indexed: 11/19/2022]
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Breuer K, Göldner F, Jäger B, Werfel T, Schmid-Ott G. Chronic stress experience and burnout syndrome have appreciable influence on health-related quality of life in patients with psoriasis. J Eur Acad Dermatol Venereol 2015; 29:1898-904. [DOI: 10.1111/jdv.12999] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 01/07/2015] [Indexed: 11/30/2022]
Affiliation(s)
- K. Breuer
- Department of Allergology and Occupational Dermatology; Dermatologikum Hamburg; Hamburg Germany
| | - F.M. Göldner
- Department of Internal Medicine VI/Psychosomatic Medicine and Psychotherapy; University Hospital Tübingen; Tübingen Germany
| | - B. Jäger
- Department of Psychosomatic Medicine and Psychotherapy; Hannover Medical School; Hannover Germany
| | - T. Werfel
- Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - G. Schmid-Ott
- Institute for Innovative Rehabilitation, Hospital Management and Distress Medicine (IREHA); Lielje Group; Löhne Germany
- Department of Psychosomatic Medicine; Berolina Clinic; Löhne Germany
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Hunter HJA, Griffiths CEM, Kleyn CE. Does psychosocial stress play a role in the exacerbation of psoriasis? Br J Dermatol 2014; 169:965-74. [PMID: 23796214 DOI: 10.1111/bjd.12478] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2013] [Indexed: 01/19/2023]
Abstract
It is widely accepted that psychosocial stress can result from the daily strains of living with a diagnosis of psoriasis. There is now an evolving body of work to suggest that psychosocial stress may also play a role in the exacerbation of psoriasis. We discuss the historical evidence supporting a temporal relationship between psychosocial stress and the exacerbation of psoriasis. The underlying pathophysiological mechanisms by which this occurs are largely unknown, but current evidence points towards a role for nerve-related factors, namely their interaction with mast cells and the potentiation of neurogenic inflammation in this regard. It is also likely that the physiological stress response in patients with psoriasis differs from that in healthy individuals, as evidenced by alterations in the hypothalamic-pituitary-adrenal axis and sympathetic-adrenal-medullary system function. Psychological stress results in a redistribution of leucocytes with increased trafficking of inflammatory cells into the skin, which may exacerbate psoriasis. Langerhans cells play a role in the stress response of normal skin; their function in the stress response of patients with psoriasis is open to speculation. We discuss the influence of stress reactivity in patients with psoriasis and the impact of stress reduction strategies in the management of psoriasis. Finally, we suggest potentially fruitful areas for future research.
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Affiliation(s)
- H J A Hunter
- Dermatological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, M6 8HD, U.K
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Milčić D, Janković S, Vesić S, Milinković M, Janković J. Assessment of quality of life in patients with psoriasis: a study from Serbia. Int J Dermatol 2014; 54:523-8. [PMID: 24738764 DOI: 10.1111/ijd.12391] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Psoriasis has a substantial impact on patients' quality of life. OBJECTIVES The aims of this study were to assess the impact of the clinical severity of psoriasis on patients' quality of life and to determine the effects of psoriasis-related stress on patients' everyday life. METHODS The cross-sectional study was conducted at the Institute of Dermatovenereology, Clinical Center of Serbia, Belgrade. The study included 201 patients (124 men and 77 women), aged 18-70 with a diagnosis of psoriasis, hospitalized or treated as outpatients during 2009. For the assessment of patients' quality of life, the psoriasis disability index (PDI) was used. The stress related to psoriasis was measured with the psoriasis life stress inventory (PLSI) and disease severity with the psoriasis area and severity index (PASI). RESULTS We found moderate correlation between PLSI and all PDI subscales and overall score (correlation coefficients ranged from 0.334 to 0.521). The correlation between PASI and PDI subscales was weak, while we failed to find any significant correlation between PASI and the PLSI. The results of multiple regression analysis indicated that stress, more severe disease, and lower educational level are significant determining factors of a poorer quality of life in patients with psoriasis. CONCLUSION Our results support the importance of assessing the quality of life in psoriasis and effects of stress in patients' adjustment to their condition and may have important implications for a psychological stress management approach in the clinical management of psoriasis.
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Affiliation(s)
- Danijela Milčić
- Institute of Dermatovenereology, Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Stohl LL, Zang JB, Ding W, Manni M, Zhou XK, Granstein RD. Norepinephrine and adenosine-5'-triphosphate synergize in inducing IL-6 production by human dermal microvascular endothelial cells. Cytokine 2013; 64:605-12. [PMID: 24026137 PMCID: PMC3835662 DOI: 10.1016/j.cyto.2013.08.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 08/05/2013] [Indexed: 12/11/2022]
Abstract
Endothelial cells (ECs) play important roles in cutaneous inflammation, in part, by release of inflammatory chemokines/cytokines. Because dermal blood vessels are innervated by sympathetic nerves, the sympathetic neurotransmitter norepinephrine (NE) and the co-transmitter adenosine-5'-triphosphate (ATP) may regulate expression of EC inflammatory factors. We focused on IL-6 regulation because it has many inflammatory and immune functions, including participation in Th17 cell differentiation. Strikingly, NE and ATP synergistically induced release of IL-6 by a human dermal microvascular endothelial cell line (HMEC-1). Adrenergic antagonist and agonist studies indicated that the effect of NE on induced IL-6 release is primarily mediated by β2-adrenergic receptors (ARs). By real-time PCR IL-6 mRNA was also synergistically induced in HMEC-1 cells. This synergistic effect of NE and ATP was reproduced in primary human dermal endothelial cells (pHDMECs) and is also primarily mediated by β2-ARs. Under conditions of stress, activation of the symphathetic nervous system may lead to release of ATP and NE by sympathetic nerves surrounding dermal blood vessels with induction of IL-6 production by ECs. IL-6 may then participate in immune and inflammatory processes including generation of Th17 cells. Production of IL-6 in this manner might explain stress-induced exacerbation of psoriasis, and perhaps, other skin disorders involving Th17-type immunity.
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Affiliation(s)
- Lori L. Stohl
- Department of Dermatology, Weill Cornell Medical College, 1305 York Avenue, 9 Floor, New York, New York, 10021, United States
| | - Julie B. Zang
- Department of Dermatology, Weill Cornell Medical College, 1305 York Avenue, 9 Floor, New York, New York, 10021, United States
| | - Wanhong Ding
- Department of Dermatology, Weill Cornell Medical College, 1305 York Avenue, 9 Floor, New York, New York, 10021, United States
| | - Michela Manni
- Department of Dermatology, Weill Cornell Medical College, 1305 York Avenue, 9 Floor, New York, New York, 10021, United States
| | - Xi K. Zhou
- Department of Public Health, Weill Cornell Medical College, 402 E. 67 Street, New York, New York, 10065, United States
| | - Richard D. Granstein
- Department of Dermatology, Weill Cornell Medical College, 1305 York Avenue, 9 Floor, New York, New York, 10021, United States
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21
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D'Erme AM, Zanieri F, Campolmi E, Santosuosso U, Betti S, Agnoletti AF, Cossidente A, Lotti T. Therapeutic implications of adding the psychotropic drug escitalopram in the treatment of patients suffering from moderate-severe psoriasis and psychiatric comorbidity: a retrospective study. J Eur Acad Dermatol Venereol 2012; 28:246-9. [PMID: 22963277 DOI: 10.1111/j.1468-3083.2012.04690.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND It is known that stress and/or psychiatric diseases can play an important role in determining psoriasis, including the well-known negative somato-psychiatric rebound that comes with the disease. METHODS Samples of 38 subjects suffering from both moderate-severe psoriasis treated with anti-TNFα, and depressive and/or anxious mood disorders were studied. Part of them were additionally treated with escitalopram, whereas the other group only consulted to a dermatological and psychiatric follow-up. The aim of this study was to determine if an improvement in the dermatological manifestation as well as an improvement in the anxious-depressive disorder can be observed. RESULTS The study revealed that patients treated with escitalopram had a reduction of psycho-diagnostic test scores that measure depression and anxiety levels as well as the values of pruritus. CONCLUSION Our study suggests that psychological interventions and antidepressant medications may improve perceived symptom severity, quality of life and major compliance to the treatment in selected patients (suffering from psoriasis and mood disturbance), without a clinician necessarily being able to see an impact on psoriasis severity.
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Affiliation(s)
- A M D'Erme
- Division of Dermatology, Department of Critical Care Medicine and Surgery, University of Florence, FlorenceAnatomy Department, University of Florence, FlorenceDISSAL, Section of Dermatology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, GenoaChair of Dermatology and Venereology, Guglielmo Marconi University, Rome, Italy
| | - F Zanieri
- Division of Dermatology, Department of Critical Care Medicine and Surgery, University of Florence, FlorenceAnatomy Department, University of Florence, FlorenceDISSAL, Section of Dermatology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, GenoaChair of Dermatology and Venereology, Guglielmo Marconi University, Rome, Italy
| | - E Campolmi
- Division of Dermatology, Department of Critical Care Medicine and Surgery, University of Florence, FlorenceAnatomy Department, University of Florence, FlorenceDISSAL, Section of Dermatology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, GenoaChair of Dermatology and Venereology, Guglielmo Marconi University, Rome, Italy
| | - U Santosuosso
- Division of Dermatology, Department of Critical Care Medicine and Surgery, University of Florence, FlorenceAnatomy Department, University of Florence, FlorenceDISSAL, Section of Dermatology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, GenoaChair of Dermatology and Venereology, Guglielmo Marconi University, Rome, Italy
| | - S Betti
- Division of Dermatology, Department of Critical Care Medicine and Surgery, University of Florence, FlorenceAnatomy Department, University of Florence, FlorenceDISSAL, Section of Dermatology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, GenoaChair of Dermatology and Venereology, Guglielmo Marconi University, Rome, Italy
| | - A F Agnoletti
- Division of Dermatology, Department of Critical Care Medicine and Surgery, University of Florence, FlorenceAnatomy Department, University of Florence, FlorenceDISSAL, Section of Dermatology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, GenoaChair of Dermatology and Venereology, Guglielmo Marconi University, Rome, Italy
| | - A Cossidente
- Division of Dermatology, Department of Critical Care Medicine and Surgery, University of Florence, FlorenceAnatomy Department, University of Florence, FlorenceDISSAL, Section of Dermatology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, GenoaChair of Dermatology and Venereology, Guglielmo Marconi University, Rome, Italy
| | - T Lotti
- Division of Dermatology, Department of Critical Care Medicine and Surgery, University of Florence, FlorenceAnatomy Department, University of Florence, FlorenceDISSAL, Section of Dermatology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, GenoaChair of Dermatology and Venereology, Guglielmo Marconi University, Rome, Italy
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Psychological Stress and the Cutaneous Immune Response: Roles of the HPA Axis and the Sympathetic Nervous System in Atopic Dermatitis and Psoriasis. Dermatol Res Pract 2012; 2012:403908. [PMID: 22969795 PMCID: PMC3437281 DOI: 10.1155/2012/403908] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 07/30/2012] [Accepted: 08/01/2012] [Indexed: 01/17/2023] Open
Abstract
Psychological stress, an evolutionary adaptation to the fight-or-flight response, triggers a number of physiological responses that can be deleterious under some circumstances. Stress signals activate the hypothalamus-pituitary-adrenal (HPA) axis and the sympathetic nervous system. Elements derived from those systems (e.g., cortisol, catecholamines and neuropeptides) can impact the immune system and possible disease states. Skin provides a first line of defense against many environmental insults. A number of investigations have indicated that the skin is especially sensitive to psychological stress, and experimental evidence shows that the cutaneous innate and adaptive immune systems are affected by stressors. For example, psychological stress has been shown to reduce recovery time of the stratum corneum barrier after its removal (innate immunity) and alters antigen presentation by epidermal Langerhans cells (adaptive immunity). Moreover, psychological stress may trigger or exacerbate immune mediated dermatological disorders. Understanding how the activity of the psyche-nervous -immune system axis impinges on skin diseases may facilitate coordinated treatment strategies between dermatologists and psychiatrists. Herein, we will review the roles of the HPA axis and the sympathetic nervous system on the cutaneous immune response. We will selectively highlight how the interplay between psychological stress and the immune system affects atopic dermatitis and psoriasis.
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Jensen GS, Patel D, Benson KF. A novel extract from bovine colostrum whey supports innate immune functions. II. Rapid changes in cellular immune function in humans. Prev Med 2012; 54 Suppl:S124-9. [PMID: 22285946 DOI: 10.1016/j.ypmed.2012.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 01/04/2012] [Accepted: 01/04/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate acute effects of bovine colostrum low-molecular weight fraction (CLMWF) on selected aspects of innate immune function in healthy human subjects. METHODOLOGY A placebo-controlled, double-blinded, randomized cross-over trial involving 12 healthy subjects, age 22-72, was conducted at NIS Labs during the year 2010. Placebo or 150 mg CLMWF was given orally. Blood was drawn immediately before and at 1 and 2h after consumption. RESULTS A single dose of CLMWF, when compared to placebo, resulted in rapid increase in phagocytic activity of monocytes at 1h (P<0.12) and polymorphonuclear cells at 1h (P<0.08) and 2h (P<0.03) after consumption. Observations included increased numbers of CD3(+) T cells (P<0.05), and a transient reduction in circulating CD3(-)CD56(+) natural killer (NK) cells at 1h (P<0.04), returning to normal levels at 2h after consumption (P<0.96). The relative increase of NK cells from 1 to 2h after consumption was not associated with an increase in CD69 or CD25 activation markers, suggesting that new NK cells were mobilized into circulation. CONCLUSION The increased phagocytic activity and rapid transient changes in NK cell numbers suggest that upon consumption, interaction of CLMWF with immune cells in the gut mucosa triggers immediate events with systemic consequences.
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De Mozzi P, Johnston G, Alexandroff A. Psoriasis: an evidence-based update. Report of the 9th Evidenced Based Update Meeting, 12 May 2011, Loughborough, U.K. Br J Dermatol 2012; 166:252-60. [DOI: 10.1111/j.1365-2133.2011.10767.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
Psoriasis is a chronic, relapsing, cutaneous condition with 1-2% prevalence in the general population. There are many factors involved in the induction and/or exacerbation of psoriasis of which stress is a well-known trigger factor in the appearance or exacerbation of psoriasis. Stress reaction in patients with psoriasis is probably mediated by the hypothalamic-pituitary-adrenal relationship with immunologic effects. Stress response involves increased levels of neuroendocrine hormones and autonomic neurotransmitters. Psychological stress or an abnormal response to stressors has been found to modify the evolution of skin disorders such as psoriasis. It can also have substantial psychological, and psychosocial impact on a patient's quality of life. Treatment regimens include stress-reduction strategies, such as biofeedback, meditation, yoga, and self-help approaches. This review focuses the relationship between psoriasis and stress, especially relating to psychosocial, psychological, and emotional stress aspects.
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Affiliation(s)
- Kabbur H Basavaraj
- Department of Dermatology, Venereology and Leprosy, JSS Medical College, JSS University, Mysore-570015, Karnataka, India.
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Coates LC, Jonckheere CL, Molin S, Mease PJ, Ritchlin CT. Summary of the International Federation of Psoriasis Associations (IFPA) meeting: a report from the GRAPPA 2009 annual meeting. J Rheumatol 2011; 38:530-9. [PMID: 21362781 DOI: 10.3899/jrheum.101115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The International Federation of Psoriasis Associations (IFPA) organized the second World Psoriasis and Psoriatic Arthritis Conference in Stockholm, Sweden, in June 2009. The 2009 collaborative multidisciplinary meeting attracted nearly 1000 clinicians and investigators from dermatology, rheumatology, basic science, and industry, as well as patients and leaders of patient organizations, from 68 countries. The major theme of the meeting was "Psoriasis - Skin and Beyond," and the primary aim was to highlight the significant effects of psoriasis and related comorbidities on patient function and quality of life. The annual meeting of GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) was held concurrently, and several GRAPPA members attended both meetings. Key presentations at IFPA that GRAPPA members believed were highlights of that meeting are summarized here.
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Affiliation(s)
- Laura C Coates
- University of Leeds, Chapel Allerton Hospital, Leeds LS7 4SA, UK.
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