Sexy again: the renaissance of neutrophils in psoriasis

Notwithstanding their prominent presence in psoriatic skin, the functional role of neutrophilic granulocytes still remains somewhat enigmatic. Sparked by exciting scientific discoveries regarding neutrophil functions within the last years, the interest in these short-lived cells of the innate immune system has been boosted recently. While it had been known for some time that neutrophils produce and respond to a number of inflammatory mediators, recent research has linked neutrophils with the pathogenic functions of IL-17, possibly in conjunction with the formation of NETs (neutrophil extracellular traps). Antipsoriatic therapies exert their effects, at least in part, through interference with neutrophils. Neutrophils also appear to connect psoriasis with comorbid diseases. However, directly tampering with neutrophil functions is not trivial as evinced by the failure of therapeutic approaches targeting redundantly regulated cellular communication networks. It has also become apparent that neutrophils link important pathogenic functions of the innate and the adaptive immune system and that they are intricately involved in regulatory networks underlying the pathophysiology of psoriasis. In order to advocate intensified research into the role of this interesting cell population, we here highlight some features of neutrophils and put them into perspective with our current view of the pathophysiology of psoriasis.

Diagnosis and underdiagnosis of comorbidities in psoriasis patients - need for a multidisciplinary approach

BACKGROUND:

Psoriasis is an immune-mediated disease that manifests predominantly in the skin, although systemic involvement may also occur. Although associated comorbidities have long been recognized and despite several studies indicating psoriasis as an independent risk factor for cardiovascular events, little has been done in general medical practice regardind screening. In the United States, less than 50% of clinicians are aware of these recommendations.

OBJECTIVE:

To identify the prevalence of these comorbidities in 296 patients followed up at a university dermatology clinic.

METHODS:

Systematically investigated comorbidity frequencies were compared with general practitioners' registry frequencies. Clinical features correlated with comorbidities were also investigated.

RESULTS:

High prevalences of systematically investigated comorbidities such as hypertension (30%) and dyslipidemia (26.5%) were documented. Conversely, data from general practitioners' records showed that 33% of dyslipidemia cases were undiagnosed and indicated possible underdiagnosis of some comorbidities. Furthermore, an association was found between: the number of comorbidities and psoriasis duration, age and high body mass index an association was found between the number of comorbidities and psoriasis duration, age, high body mass index, waist circumference or waist-to-hip ratio. (p<0.05).

CONCLUSION:

Disease duration, age and high body mass index, waist circumference or waist-to-hip ratio are possible criteria for choosing which patients should be screened for comorbidities. Underdiagnosis of comorbidities by general practitioners highlights the need for a multidisciplinary approach in psoriasis management.

The Relationship of Obesity With the Severity of Psoriasis: A Systematic Review

BACKGROUND

Psoriasis is a chronic inflammatory disease associated with obesity. The increased production of adipocytokines in central adiposity contributes to the systemic inflammation of obesity and perhaps to psoriasis.

OBJECTIVE

The objective of this systematic review is to determine the association of obesity with psoriasis severity.

METHODS

We searched PubMed, EMBASE, and Cochrane Database for English-language papers involving human subjects for all years. We extracted data on age, sex, body mass index (BMI), proportion obese, and psoriasis severity index score (PASI).

RESULTS

We identified 254 articles in our search and included 9. The sample size was 134 823 psoriasis patients. Seven of the 9 studies found a statistically significant association of increased psoriasis severity with higher BMI.

CONCLUSION

Increased severity of psoriasis appears to be associated with increased BMI. Most studies were cross-sectional or case-control, making it difficult to determine temporality. Dermatologists should consider recording BMI for psoriasis patients and offering them lifestyle counseling.

Particular features of lipid metabolism in psoriasis patients with concomitant metabolic syndrome

Goal. To assess particular features of lipid metabolism in psoriasis patients with concomitant metabolic syndrome (MS). Materials and methods. Total cholesterol, triglycerides (TG) and high density lipoprotein cholesterol (HDL cholesterol) were determined in the blood serum of psoriasis patients by the enzymatic method using a spectrophotometer at the wavelength of 500 nm. The level of low-density lipoprotein cholesterol (LDL cholesterol) was determined by the calculation method using W. Friedewald’s formula (1972). The cholesterol atherogenicity ratio (CAR) was calculated by the formula: CAR = (Total cholesterol - HDL cholesterol) / HDL cholesterol Results. Patients suffering from psoriasis vulgaris are distinguished by lipid metabolism abnormalities characterized by the development of atherogenic dyslipidemia, increase in the total cholesterol, TG and LDL cholesterol in blood, reduction in the HDL cholesterol level and increased CAR. Patients with concomitant metabolic disorders have more obvious changes.