The relationship between oxidative stress, smoking and the clinical severity of psoriasis

Total oxidant capacity, total antioxidant capacity, ischemic modified albumin, microRNA levels, and their relationship with psoriasis area and severity index

Aims To examine the differences in the levels of microRNA, ischemic modified albumin (IMA), total oxidant capacity (TOC), and total antioxidant capacity (TAC) of persons with and without psoriasis and, in the case group, the relationship between these parameters and psoriasis area and severity index (PASI). Methods Blood samples were collected from patients and healthy participants to examine levels of these parameters. Results The mean serum TOC level was higher in the case group. The mean serum TAC and IMA levels were significantly lower in the case group (P <0.001). It was observed that the mean serum miR-203 and miR-146a levels were increased in psoriasis patients. It was determined that there was only a significant positive weak correlation between miR-203 and PASI (r = 0.232, P = 0.027). Limitations The small sample size, not controlling serum albumin and not evaluating the effects of the treatment agents used by the patients on oxidative and inflammatory processes. Conclusion In the case group changes in the mean serum TOC and TAC levels provide evidence that oxidative stress may play a critical role in disease pathogenesis. The increase in the mean serum miR-203 and miR-146a levels suggest the possibility of therapies targeting these microRNAs as a new option.

Protein adducts with lipid peroxidation products in patients with psoriasis

Psoriasis, one of the most frequent immune-mediated skin diseases, is manifested by numerous psoriatic lessons on the skin caused by excessive proliferation and keratinization of epidermal cells. These disorders of keratinocyte metabolism are caused by a pathological interaction with the cells of the immune system, including lymphocytes, which in psoriasis are also responsible for systemic inflammation. This is accompanied by oxidative stress, which promotes the formation of lipid peroxidation products, including reactive aldehydes and isoprostanes, which are additional pro-inflammatory signaling molecules. Therefore, the presented review is focused on highlighting changes that occur during psoriasis development at the level of lipid peroxidation products, including 4-hydroxynonenal, 4-oxononenal, malondialdehyde, and acrolein, and their influence on protein structures. Furthermore, we will examine inducing agents of cellular functioning, as well as intercellular signaling. These lipid peroxidation products can form adducts with a variety of proteins with different functions in the body, including proteins within skin cells and cells of the immune system. This is especially true in autoimmune diseases such as psoriasis. For example, these changes concern proteins involved in maintaining redox homeostasis or pro-inflammatory signaling. Therefore, the formation of such adducts should attract attention, especially during the design of preventive cosmetics or anti-psoriasis therapies.

Psoriasis hastalarında sigara içme durumu ile yaşam kalitesi arasındaki ilişkide hastalık şiddetinin aracı etkisi

Purpose: The aim of this study was to examine the relationship between smoking and quality of life and to investigate the mediating role of disease severity on this relationship in psoriasis patients. Materials and Methods: In the study, 268 psoriasis patients were reached by the convenience sampling method. In the study, patients' quality of life was measured with “dermatology quality of life index (DLQI)” and disease severity was measured with “psoriasis area and severity index (PASI)”. The effect of the independent variable (smoking) on the dependent variable (quality of life), both directly and indirectly through the mediating variable (disease severity), was examined by process analysis. Results: Smoking status shows statistically significant differences according to gender, age, marital status, occupation, and income groups. 17.02% of women and 44.09% of men smoke. 19.74% of single and 33.85% of married smoke. 20% of unemployed and 39.13% of employees smoke. 17.76% of low-income, 50.91% of middle-income, and 40.98% of high-income people smoke. This cross-sectional study revealed that smoking in psoriasis has no direct effect on the quality of life, but that smoking has a full indirect effect on the quality of life through disease severity. Conclusion: In the study, it was found that smoking negatively affects the quality of life through both disease severity. Accordingly, it is recommended that patients be informed about the effect of smoking on their diseases.

Paraoxonase and arylesterase activity of serum PON-1 enzyme in psoriatic patients: a systematic review and meta-analysis

Human serum paraoxonase-1 (PON-1) is a critical antioxidant defense system against lipid oxidation. Decreased PON-1 activity has been associated with systemic oxidative stress in several disease states. We conducted a systematic review and meta-analysis of plasma/serum concentrations of PON-1 paraoxonase and arylesterase activity in psoriasis, a chronic immune-mediated and inflammatory skin disease. The electronic databases PubMed, Web of Science, and Scopus were searched from inception to November 2021. In total, 14 studies in 691 psoriatic patients and 724 healthy controls were included in the meta-analysis. Serum paraoxonase activity was significantly lower in psoriatic patients (SMD = - 2.30, 95% CI - 3.17 to - 1.42; p < 0.001); however, no significant between-group differences were observed in serum arylesterase activity (SMD = - 0.34, 95% CI - 0.11 to 0.80; p = 0.14). The pooled SMD values were not substantially altered in sensitivity analysis. There was no publication bias. In conclusion, our meta-analysis has shown that serum paraoxonase, but not arylesterase, activity is significantly lower in psoriasis, suggesting an impaired antioxidant defense in these patients.

The Involvement of Oxidative Stress in Psoriasis: A Systematic Review

Psoriasis is a chronic, immune-mediated inflammatory dermatosis characterized by the appearance of erythematous plaques, covered by white scales, occasionally pruritogenic, and distributed mainly on the extensor areas. Oxidative stress is defined as an imbalance or a transient or chronic increase in the levels of free oxygen/nitrogen radicals, either as a result of the exaggerated elevation in their production or the decrease in their ability to be eliminated by antioxidant systems. Although the pathogenesis of psoriasis remains far from elucidated, there are studies that delineate an involvement of oxidative stress in this skin disorder. Thus, a systematic search was computed in PubMed/Medline, Web of Science and SCOPUS and, in total, 1293 potentially eligible articles exploring this research question were detected. Following the removal of duplicates and the exclusion of irrelevant manuscripts based on the screening of their titles and abstracts (n = 995), 298 original articles were selected for full-text review. Finally, after we applied the exclusion and inclusion criteria, 79 original articles were included in this systematic review. Overall, the data analyzed in this systematic review point out that oxidative stress markers are elevated in psoriasis and share an association with the duration and severity of the disease. The concentrations of these biomarkers are impacted on by anti-psoriasis therapy. In addition, the crosstalk between psoriasis and oxidative stress is influenced by several polymorphisms that arise in genes encoding markers or enzymes related to the redox balance. Although the involvement of oxidative stress in psoriasis remains undisputable, future research is needed to explore the utility of assessing circulating serum, plasma, urinary and/or skin biomarkers of oxidative stress and of studying polymorphisms in genes regulating the redox balance, as well as how can these findings be translated into the management of psoriasis, as well in understanding its pathogenesis and evolution.

Impact of smoking on psoriasis risk and treatment efficacy: a meta-analysis

Objective

Psoriasis is an immune-mediated chronic inflammatory disease with skin and joint manifestations. Smoking is considered an unfavorable lifestyle factor for psoriasis. We aimed to explore the association between smoking, disease risk, and treatment efficacy in relation to psoriasis.

Methods

We searched the Cochrane Library, Embase, and PubMed databases for studies examining the relationship between smoking and psoriasis, up to 12 April 2020. We then conducted a meta-analysis using a fixed-effects model to obtain odds ratios (ORs) with 95% confidence intervals (CIs).

Results

Ever, current, and former smokers all had higher risks of developing psoriasis than non-smokers (pooled ORs (95% CIs): 1.60 (1.51–1.69), 1.63 (1.48–1.80), and 1.36 (1.13–1.64), respectively). Ever smokers were less likely to show disease improvement at 6 months following treatment with biologic agents than non-smokers (pooled OR (95% CI): 0.80 (0.67–0.95)).

Conclusions

Smoking increases psoriasis risk and negatively impacts the benefits of biologic agents. However, the number of reports is limited and more studies are needed to confirm the effects of smoking and smoking cessation on therapeutic response in patients with psoriasis. Education to encourage a healthy lifestyle remains a valuable approach in clinical practice.

The role of xenobiotics in triggering psoriasis

Psoriasis is a common inflammatory skin disease affecting approximately 2% of the world population. A complex interplay of genetic predisposition and risk factors contributes to the risk of its onset. Several xenobiotics have been implicated in the pathogenesis of psoriasis. Drugs are among the most investigated trigger factors; strong association with disease induction or exacerbation has been reported for β-blockers, lithium, NSAIDs and ACE inhibitors, all of which are commonly used in the management of various comorbidities in psoriasis patients. Furthermore, inhibitors of TNF have a well-documented potential for triggering new-onset psoriasis when used for other indications (e.g. Crohn's disease or rheumatoid arthritis), while post-marketing data have revealed the same association for ustekinumab. Several other drugs have been connected with psoriasis, but the evidence is less compelling. Smoking and alcohol have been reported to increase the risk for occurrence of psoriasis, but can also affect unfavorably the course of the disease and its response to treatment. Furthermore, exposure to secondhand smoke, especially in childhood, also mediates the risk. Emerging data now suggest that air pollution also has a detrimental effect on skin disease, including psoriasis, but this association needs further investigation. Understanding of the toxic effect of xenobiotics on the initiation and clinical course of psoriasis can contribute to its better control, as it can help with the avoidance of triggering factors and, in some cases, influence the success of pharmacological treatment. It, therefore, has an important place in the comprehensive management of psoriasis.

The effect of smoking on the psoriasis: Is it related to nail involvement?

Psoriasis is a chronic inflammatory skin disease that negatively affects the quality of life with remissions and relapses. Smoking, which is known to accelerate the development of comorbidities that can accompany psoriasis such as atherosclerotic heart disease, metabolic syndrome, is also an independent risk factor for psoriasis. In our study, we aimed to investigate the relationship between smoking and psoriasis. The study included a total of 476 participants with 276 psoriasis patients and 200 healthy volunteers. One hundred and thirty-nine (69.5%) cases in the psoriasis group and 61 (30.5%) cases in the control group were smoking. Patients with psoriasis had more cigarette smoking than the control group (P < .001). Smoking was present in 100 cases (61%) of 164 cases with nail psoriasis and psoriatic nail was significantly more frequently observed in patients with psoriasis when smoking was present (P < .001). It was observed that systemic treatment requirements were higher in smoking psoriasis patients (P = .04). It is known that cigarette use increases in patients with psoriasis compared to the normal population, and cigarette use also increases the psoriasis area severity index (PASI). In our study, a significant relationship was found between smoking and psoriasis nail involvement first in the literature. Furthermore, the need for systemic treatment was higher in smokers.

Association between vitiligo and smoking: A nationwide population-based study in Korea

No study has examined the associations between vitiligo and smoking. The purpose of this study was to investigate the incidence of vitiligo according to smoking status. We used clinical data from individuals aged over 20 years who received a health examination in the National Insurance Program between 2009 and 2012 (n = 23,503,807). We excluded individuals with pre-existing vitiligo who had ever been diagnosed with vitiligo before the index year (n = 35,710) or who were diagnosed with vitiligo within a year of the index year (n = 46,476). Newly diagnosed vitiligo was identified using claims data from baseline to date of diagnosis or December 31, 2016 (n = 22,811). The development of vitiligo was compared according to self-reported smoking status by a health examination survey. The hazard ratio of vitiligo in current smokers was 0.69 (95% confidence interval; 0.65-0.72) with a reference of never-smokers after adjustment for age, sex, regular exercise, drinking status, body mass index, diabetes mellitus, hypertension, dyslipidemia, history of stroke, and history of ischemic heart diseases. The decreased risk of vitiligo in current smokers persisted after subgroup analysis of sex and age groups. The results suggested there are suppressive effects of smoking on the development of vitiligo. Further studies are needed to evaluate the mechanism of smoking on the development of vitiligo.

Evaluation of serum lipid, lipoprotein, and apolipoprotein levels in psoriatic patients: a systematic review and meta-analysis of case-control studies

Introduction

Psoriasis is a T cell-mediated inflammatory skin disease in which fatty acids may be a link between psoriasis and its comorbidity.

Aim

The present meta-analysis aimed to evaluate lipid, lipoprotein, and apolipoprotein levels in the psoriatic patients compared with the control subjects.

Material and methods

Four databases, including Web of Science, Scopus, PubMed, and Cochrane Library were searched until July 2017. All records analysed were case-control studies. The quality of the questionnaires was evaluated using the Newcastle-Ottawa Scale (NOS). A random-effects meta-analysis was done by Rev Man 5.3 using mean difference (MD) and 95% confidence intervals (CIs).

Results

Out of 580 studies identified in four databases, 49 studies were included and analysed in this meta-analysis. The results showed that MD of total cholesterol, triglyceride, LDL, VLDL, HDL, Lp(a), Apo A1, and Apo B levels in the patients compared with the controls were (MD = 13.74 mg/dl; 95% CI: 7.72-19.75; p< 0.00001), (MD = 26.04 mg/dl; 95% CI: 20.77-31.31; p< 0.00001), (MD = 11.41 mg/dl; 95% CI: 6.26-16.57; p< 0.0001), (MD = 4.82 mg/dl; 95% CI: 3.63-6.00; p< 0.00001), (MD = -2.78 mg/dl; 95% CI: -4.53 - -1.03; p< 0.002), (MD = 8.51 mg/dl; 95% CI: 4.86-12.17; p< 0.0001), (MD = -6.60 mg/dl; 95% CI: -13.96 - 0.75; p< 0.08), and (MD = 9.70 mg/dl; 95% CI: 3.02-16.39; p< 0.004), respectively.

Conclusions

This meta-analysis identified abnormality of serum lipid, lipoprotein, and apolipoproteinprofiles in psoriatic patients compared with the controls as well as possibly a greater risk of atherosclerosis and cardiovascular (CV) accidents in the patients.

Investigation of oxidant and antioxidant levels in patients with psoriasis

Background/aim

Psoriasis is an immune-mediated chronic inflammatory skin disease that is seen in 1%–3% of the population. It is characterized by symmetrical papulosquamous lesions on the scalp, knees, elbows, sacral region, and extensor surfaces of the extremities. Psoriasis affects both sexes equally. It is thought that reactive oxygen species have an important role in inflammatory skin diseases, especially in psoriasis. There are few studies investigating serum oxidant-antioxidant levels in psoriasis. In this study, we aimed to investigate serum oxidant and antioxidant levels in psoriasis and their effects on its pathogenesis.

Materials and methods

Included in this study were 50 patients with psoriasis who had not been treated with any systemic medication and 45 healthy volunteers (control group). The total oxidant status (TOS), total antioxidant status (TAS), malondialdehyde (MDA), and 8-hydroxy 2’-deoxyguanosine (8H2D) were studied via venous blood sampling. The parameters were measured spectrophotometrically. The study was approved by the Local Ethics Committee of the Atatürk University Faculty of Medicine.

Results

The mean ages of the patients and control group were 32.48 (±14.45) and 35.64 (±17.40) years, respectively. Of the patients, 23 were male and 27 were female. Of the healthy volunteers, 20 were male and 25 were female. The mean disease duration was 8.77 (±6.90) years. The mean Psoriasis Area and Severity Index (PASI) score was 11.41 (±9.62). The mean TOS levels of the patient and control groups were 63.12 (±33.23) and 4.50 (±9.74), respectively. This difference was statistically significant (P = 0.00). The mean TAS levels of the patient and control groups were 3.15 (±0.70) and 3.16 (±0.44), respectively, without any statistically significant difference. The mean MDA levels in the patient and control groups were 14.84 (±6.66) and 12.77 (±4.87), respectively, without any statistically significant difference. The mean 8H2D levels of the patient and control groups were 16,781.2 (±5918.95) and 15,276.13 (±6084.95), respectively. This difference was also not statistically significant. There was no correlation between PASI scores and the above-mentioned parameters.

Conclusion

In the present study, the TOS levels showed a significant statistical difference between the psoriasis and control groups. This finding supports the effect of the oxidant system in the pathogenesis of psoriasis. This was the first study to investigate MDA, TOS, TAS, and 8H2D levels together in patients with psoriasis. More studies are needed to clearly understand the relationship between psoriasis and the oxidant-antioxidant system.

How lifestyle factors and their associated pathogenetic mechanisms impact psoriasis

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.

Proanthocyanidins: novel treatment for psoriasis that reduces oxidative stress and modulates Th17 and Treg cells

Psoriasis is a common, chronic, inflammatory skin disease that affects 2%-4% of the global population. Recent studies have shown that increased oxidative stress (OS) and T-cell abnormalities are central to the pathogenesis of this disease. The resulting reactive oxygen species (ROS) induces proliferation and differentiation of Th17/Th1/Th22 cells and inhibits the anti-inflammatory activities of regulatory T lymphocytes (Treg). Subsequent secretions of inflammatory cytokines, such as interleukin (IL)-17, IL-22, tumor necrosis factor alpha (TNF-α), and interferon-gamma (IFN-γ), and vascular endothelial growth factor (VEGF), stimulate keratinocyte proliferation and angiogenesis. Proanthocyanidins are a class of flavonoids from plants and fruits, and have various antioxidant, anti-inflammatory, and anti-angiogenic properties. Numerous reports have demonstrated therapeutic effects of proanthocyanidins for various diseases. Among clinical activities, proanthocyanidins suppress cell proliferation, prevent OS, and regulate Th17/Treg cells. Because the pathogenesis of psoriasis involves OS and T cells dysregulation, we reviewed the effects of proanthocyanidins on OS, Th17 and Treg cell activities, and keratinocyte proliferation and angiogenesis. Data from multiple previous studies warrant consideration of proanthocyanidins as a promising strategy for the treatment of psoriasis.

Relationship between environmental factors, age of onset and familial history in Japanese patients with psoriasis

Psoriasis is a chronic inflammatory disease that often involves the skin and joints. Psoriasis develops at any age and the distribution of age of onset of psoriasis is bimodal in Japan. Also, male predominance is distinct in Japanese psoriatic patients. To clarify the relationship between sex difference and habitual/environmental status, age and incidence of familial psoriasis, we analyzed data from the Fukuoka University Psoriasis Registry. A total of 1120 Japanese patients (751 men, 369 women) were analyzed. The male/female ratio was 2.03:1. Smoking and drinking habit, known as risk factors of psoriasis, were significantly more prevalent in men. Age-specific psoriasis-onset rate standardized by population showed bimodal distribution in both men and women; the younger peak was in their 30s for men and 10s in women; the second peak was in the 50s for both sexes. A familial history of psoriasis was seen in 6.3% of patients overall; however, female patients showed a significantly higher rate (8.7%) compared with men (5.1%, P = 0.024). When stratified by age of onset, the frequency of familial history was much higher among women with onset at less than 30 years (15.4%), compared with 30 years or more (5.3%, P = 0.0026). Our data suggest that genetic factors have a stronger influence in young women who experience fewer environmental factors such as smoking and drinking. This is the first study to show that there is a difference in the incidence of familial psoriasis depending on age of onset of psoriasis in Japan.

The Pathophysiological Mechanisms and the Quest for Biomarkers in Psoriasis, a Stress-Related Skin Disease

Psoriasis is a physically, emotionally, and socially invalidating multifactorial disorder, with a significant impact on the patients' quality of life. Stress is one of the leading triggers for psoriasis and has been associated with disease onset and subsequent flare-ups, while the flare-ups by themselves often lead to psychological discomfort. The treatment of psoriasis is individualized, depending on the patients' measurable severity of illness, as well as the impact the skin condition has on patients' quality of life, as assessed by standardized questionnaires. The clinical scales used nowadays for measuring the severity of psoriasis are characterized by low reproducibility and high variability between examiners. Hence, there is a real need to identify objectively measurable biomarkers to standardize the assessment of the severity of psoriasis. We aim to review the pathophysiological mechanisms involved in psoriasis, focusing on the most critical advances in psoriasis biomarker discovery, pointing out those biomarkers which have also been studied in other stress-related conditions, thus emphasizing the relationship between psoriasis and stress.

Dynamic thiol/disulfide homeostasis and effects of smoking on homeostasis parameters in patients with psoriasis

PURPOSE

Recently, increased reactive oxygen species (ROS), reduced antioxidant capacity, and oxidative stress have been suggested in the pathogenesis of psoriasis. The aim of this study to evaluate the thiol/disulfide homeostasis in patients with psoriasis.

MATERIALS AND METHODS

Ninety patients with psoriasis who did not receive any systemic treatment in the last six  months were included in the study. Seventy-six age and gender-matched healthy volunteers served as control group. Thiol/disulfide homeostasis was measured in venous blood samples obtained from patient and control groups.

RESULTS

Native thiol and total thiol levels were significantly higher in patients than in control group. When thiol/disulfide hemostasis parameters and clinical and demographic characteristics were compared, a negative correlation was detected between native thiol and total thiol with age. The levels of total thiols had also negative correlation with PASI and duration of the disease. When we divided the patients into smokers and non-smokers, native thiol and total thiol levels were significantly higher in smokers than in controls, whereas native thiol and total thiol levels were comparable in non-smoker patients and controls.

CONCLUSIONS

Thiol/disulfide balance shifted towards thiol in psoriasis patients and this may be responsible for increased keratinocyte proliferation in the pathogenesis of psoriasis.

Plasma total antioxidant capacity and peroxidation biomarkers in psoriasis

Systemic biomarkers of oxidative stress can be relevant for assessment of psoriasis severity, for prediction of the outcome of therapy and of the development of comorbidities. In this review we aimed to evaluate the relationship between plasma total antioxidant capacity (TAC) and peroxidation biomarkers, as well as their association with dyslipidemia and systemic inflammation in psoriasis. The review of 59 case–control comparisons (from 41 studies) and 17 interventions (from 13 studies) suggests that peroxidation markers are more sensitive than TAC in the evaluation of oxidative stress in psoriasis. Although few studies investigated the effect of treatment on oxidative stress, it seems that biological drugs could be the better choice in the treatment of psoriasis. However, considering the limitations of TAC and plasma peroxidation markers, this review suggests that new methods should be developed in order to evaluate systemic oxidative stress in psoriasis.

Psoriasis, non-alcoholic fatty liver disease, and cardiovascular disease: Three different diseases on a unique background

Psoriasis is a chronic inflammatory immune-mediated skin disease, frequently associated with systemic comorbidities. According to recent data, patients with psoriasis show a greater prevalence of metabolic syndrome, which confers a higher cardiovascular risk. The link between these pathological conditions appears to be a chronic low-grade inflammatory status. The aim of this review is to focus on the multiple epidemiological and physio-pathogenetic aspects linking non-alcoholic fatty liver disease, psoriasis, and cardiovascular disease.

Integrating lifestyle-focused approaches into psoriasis care: improving patient outcomes?

Psoriasis is one of the most well described cutaneous disorders, with a large body of literature devoted to describing its pathogenesis and treatment. In recent years, attention has turned toward the mechanisms by which lifestyle can impact psoriatic disease, and how lifestyle interventions may help to alleviate cutaneous, rheumatological, and comorbid disease in the setting of psoriasis. The following review explores our current understanding of the interaction between lifestyle factors and psoriasis and describes outcomes of interventions meant to target these factors.

A case series of the effects of a novel composition of a traditional natural preparation for the treatment of psoriasis

The objective of this study was to assess the effectiveness of a specific composition of a traditional herbal preparation (DurrDerma) in adult patients with moderate to severe skin psoriasis. The preparation is a newly developed topical combination containing plant-based extracts traditionally used in skin disease as black cumin, olive oil, tea tree oil, cocoa butter completed by vitamin A and vitamin B12. We documented the effectiveness of the preparation in a first case series. A total of 12 patients (8 males and 4 females, 21–86 y) with manifest and treatment-resistant psoriasis were included and treated for 12 weeks. All patients were assigned to twice-daily treatment with the DurrDerma preparation. Treatment success as determined by the Psoriasis Area and Severity Index (PASI) score, the body surface area, and the dermatology life index was achieved (PASI reduction of >75%) in 10 of the 12 treated patients (83%). The remaining two patients showed a PASI reduction of ≤50%. In 5 of the patients PASI reduction was achieved <12 weeks (between week 3–11). The beneficial effect in responder patients might be explained by a synergistic anti-oxidative and anti inflammatory activity of all components present in DurrDerma. We conclude that the new preparation using a traditional approach seems to be a promising complementary treatment for psoriasis.

Smoking-induced expression of the GPR15 gene indicates its potential role in chronic inflammatory pathologies

Despite the described clear epigenetic effects of smoking, the effect of smoking on genome-wide gene expression in the blood is obscure. We therefore studied the smoking-induced changes in the gene-expression profile of the peripheral blood. RNA was extracted from the whole blood of 48 individuals with a detailed smoking history (24 never-smokers, 16 smokers, and 8 ex-smokers). Gene-expression profiles were evaluated with RNA sequencing, and results were analyzed separately in 24 men and 24 women. In the male smokers, 13 genes were statistically significantly (false-discovery rate <0.1) differentially expressed; in female smokers, 5 genes. Although most of the differentially expressed genes were different between the male and female smokers, the G-protein-coupled receptor 15 gene (GPR15) was differentially expressed in both male and female smokers compared with never-smokers. Analysis of GPR15 methylation identified significantly greater hypomethylation in smokers compared with that in never-smokers. GPR15 is the chemoattractant receptor that regulates T-cell migration and immunity. Up-regulation of GPR15 could explain to some extent the health hazards of smoking with regard to chronic inflammatory diseases.

Methylene blue attenuates renal ischemia-reperfusion injury in rats

BACKGROUND AND PURPOSE

In our study, we investigated the effects of methylene blue (MB) on histopathological changes in renal ischemia/reperfusion (I/R) injury rat model.

MATERIAL AND METHODS

Twenty-one Sprague-Dawley male rats were divided equally into three groups. Group 1 (control) was administered intraperitoneal saline solution. In Groups 2 (untreated group) and 3 (MB treatment), the renal arteries were clamped, and ischemia (for 1 hour) and then reperfusion (for 4 hours) were applied. Thirty minutes before ischemia, the untreated group received physiological saline, whereas the treatment group was administered 30 mg/kg MB through an intraperitoneal route. Blood samples were drawn, and renal specimens were harvested 5.5 hours after physiologic saline injection in the control and immediately after the reperfusion period in the other groups. The levels of tissue superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), total oxidant status (TOS), total antioxidant status (TAS), plasma urea, creatinine and ischemia modified albumin (IMA) were measured. Moreover, the histopathological damage score of the renal tissue was determined.

RESULTS

MB significantly alleviated the severity of histopathological damage by increasing the levels of tissue SOD and TAS and decreasing TOS concentrations in the renal I/R model (p<0.05).

CONCLUSION

Administration of MB in renal I/R damage may play a protective role.

Psoriasis and smoking: a systematic review and meta-analysis

Psoriasis is an inflammatory skin disease associated with increased cardiovascular comorbidity. Smoking is associated with an increased risk of cardiovascular disease, and prior studies have suggested that patients with psoriasis are more likely to be active smokers. Smoking may also be a risk factor in the development of psoriasis. We conducted a systematic review and meta-analysis to assess the prevalence of smoking among patients with psoriasis, and we reviewed the contribution of smoking to the incidence of psoriasis. A total of 25 prevalence and three incidence studies were identified. The meta-analysis of prevalence studies included a total of 146 934 patients with psoriasis and 529 111 patients without psoriasis. Random effects meta-analysis found an association between psoriasis and current smoking [pooled odds ratio (OR) 1·78, 95% confidence interval (CI) 1·52-2·06], as well as between psoriasis and former smoking (pooled OR 1·62, 95% CI 1·33-1·99). Meta-regression analysis did not reveal any sources of study heterogeneity, but a funnel plot suggested possible publication bias. A subset of studies also examined the association between moderate-to-severe psoriasis and smoking, with a pooled OR of 1·72 (95% CI 1·33-2·22) for prevalent smoking. The three incidence studies found an association between smoking and incidence of psoriasis, with a possible dose-effect of smoking intensity and duration on psoriasis incidence. These findings suggest that smoking is an independent risk factor for the development of psoriasis, and that patients with established psoriasis continue to smoke more than patients without psoriasis.

Association between tobacco smoking and response to tumour necrosis factor α inhibitor treatment in psoriatic arthritis: results from the DANBIO registry

OBJECTIVES

To investigate the association between tobacco smoking and disease activity, treatment adherence and treatment responses among patients with psoriatic arthritis (PsA) initiating the first tumour necrosis factor α inhibitor therapy (TNFi) in routine care.

METHODS

Observational cohort study based on the Danish nationwide DANBIO registry. Kaplan-Meier plots, logistic and Cox regression analyses by smoking status (current/previous/never smoker) were calculated for treatment adherence, ACR20/50/70-responses and EULAR-good-response. Additional stratified analyses were performed according to gender and TNFi-subtype (adalimumab/etanercept/infliximab).

RESULTS

Among 1388 PsA patients included in the study, 1148 (83%) had known smoking status (33% current, 41% never and 26% previous smokers). Median follow-up time was 1.22 years (IQR 0.44-2.96). At baseline, current smokers had lower Body Mass Index (27 kg/m(2) (23-30)/28 kg/m(2) (24-31)) (median (IQR)), shorter disease duration (3 years (1-8)/5 years (2-10)), lower swollen joint count (2 (0-5)/3 (1-6)), higher visual-analogue-scale (VAS) patient global (72 mm (54-87)/68 mm (50-80)), VAS fatigue (72 mm (51-86)/63 mm (40-77)) and Health Assessment Questionnaire (HAQ) score (1.1 (0.7 to 1.5)/1.0 (0.5 to 1.5)) than never smokers (all p<0.05). Current smokers had shorter treatment adherence than never smokers (1.56 years (0.97 to 2.15)/2.43 years (1.88 to 2.97), (median (95% CI)), log rank p=0.02) and poorer 6 months' EULAR-good-response rates (23%/34%), ACR20 (24%/33%) and ACR50 response rates (17%/24%) (all p<0.05), most pronounced in men. In current smokers, the treatment adherence was poorer for infliximab (HR) 1.62, 95% CI 1.06 to 2.48) and etanercept (HR 1.74, 1.14 to 2.66) compared to never smokers, but not for adalimumab (HR 0.80, 0.52 to 1.23).

CONCLUSION

In PsA, smokers had worse baseline patient-reported outcomes, shorter treatment adherence and poorer response to TNFi's compared to non-smokers. This was most pronounced in men and in patients treated with infliximab or etanercept.

Evaluation of systemic oxidant/antioxidant status and paraoxonase 1 enzyme activities in psoriatic patients treated by narrow band ultraviolet B phototherapy

OBJECTIVES

Ultraviolet B is a potent oxidative stress (OS) inducer in the skin; however, there are no data about the systemic oxidative effect of narrow band ultraviolet B (NB-UVB) phototherapy. In this study, we aimed to investigate the change in the OS status of psoriatic patients who were treated by NB-UVB phototherapy and to determine the relationships between OS, psoriasis severity, and systemic inflammatory condition.

METHODS

Twenty-four psoriatic patients were treated with a total of 30 sessions of NB-UVB irradiation. Psoriasis area and severity index (PASI), serum levels of high sensitive C-reactive protein (hsCRP), total antioxidant status (TAS), total oxidant status (TOS), the oxidative stress index (OSI), serum paraoxonase (PON), and arylesterase (ARE) activities before and after NB-UVB therapy were determined.

RESULTS

PASI scores significantly decreased after NB-UVB therapy (P = 0.001). The pre- and post-treatment hsCRP and TAS levels were similar (P = 0.253 and 0.301, respectively). TOS and OSI values significantly increased after phototherapy (both P < 0.001). PON and ARE activities did not change after treatment (both P > 0.05). There was no correlation between PASI and hsCRP, TAS, TOS, OSI, PON, and ARE values (P > 0.05).

CONCLUSION

A systemic OS may emerge in psoriatic patients treated by NB-UVB phototherapy.

Smoking as a permissive factor of periodontal disease in psoriasis

BACKGROUND

Population-based studies have identified smoking as a pathogenetic factor in chronic periodontitis. At the same time, chronic periodontal disease has also been found to occur more often in persons suffering from psoriasis than in controls with no psoriasis. It is known that smoking aggravates both periodontal disease and psoriasis, but so far it has not been investigated how smoking influences the occurrence and severity of periodontal disease in psoriasis.

METHODS

A hospital-based study was conducted to investigate this question. The study population consisted of 82 psoriasis patients and 89 controls. All patients received a full-mouth periodontal examination, and a published classification based on bleeding on probing, clinical attachment level and probing depth was utilized for staging. Both patients and controls were divided into smoker and non-smoker groups, and the resulting groups were compared in terms of periodontal status. Beyond the descriptive statistics, odds ratios were computed.

RESULTS

Psoriasis in itself increased the likelihood of severe periodontal disease to 4.373 (OR, as compared to non-smoker controls, p<0.05), while smoking increased it to 24.278 (OR, as compared to non-smoker controls, p<0.001) in the studied population. In other words, the risk of severe periodontal disease in psoriasis turned out to be six times higher in smokers than in non-smokers.

CONCLUSIONS

The results of this study corroborate those of other studies regarding the link between psoriasis and periodontal disease, but they also seem to reveal a powerful detrimental effect of smoking on the periodontal health of psoriasis patients, whereby the authors propose that smoking may have a permissive effect on the development of severe periodontal disease in psoriasis.

Effect of the systemic use of methotrexate on the oxidative stress and paraoxonase enzyme in psoriasis patients

Previous studies have indicated that oxidative stress contributes in the efficacy and toxicity of methotrexate (MTX) treatment. The present study aims to investigate the systemic MTX treatments impact on the total oxidant and antioxidant status of the patients with psoriasis. A total of 26 psoriasis patients were included in the study. Serum total oxidant status (TOS), total antioxidant status (TAS), and serum paraoxonase enzyme (PON) levels were measurement of all patients, and Oxidative Stress Index (OSI) were calculated before and after 8 weeks of MTX therapy. Psoriasis Area Severity Index scores of the patients decreased significantly after MTX treatment. While the serum concentrations of total cholesterol, low density lipoprotein, and high density lipoprotein decreased significantly, the serum ALT levels of the patients increased significantly after MTX treatment. There was no statistically significant alteration in serum levels of PON, TAS, TOS, and OSI after the MTX therapy. The oxidative stress emerging with 8-week MTX treatment is not significantly increased in the patients. In parallel with the decreasing inflammation by MTX treatment in patients with psoriasis, a decrease in oxidative stress (OS) is also expected. However, the expected reduction in OS might have been precluded by MTX-induced OS, which resulted in no significant difference between pre- and post-treatment values of OS parameters in our study. There is a possibility that the 8-week results may change with longer treatment durations and higher cumulative doses.